Recent Advances in Drug Therapy of Migraine

Migraine is one of the foremost disabling diseases that preponderantly affects the feminine population. The clinical spectrum of migraine encompasses four stages- the prodrome, aura, the headache phase and also the postdrome. The management of migraine is directed at aborting and preventing the headache, the associated incapacitating symptoms (like photophobia, phonophobia, olfactive hypersensitivity, allodynia, nausea, vomiting, etc.) and also the symptoms of aura (like visual phenomena, sensory phenomena, language aura etc.). The pathophysiology of migraine includes the neuronal theory, the activation of the trigeminovascular system and cortical spreading depression. The present pharmacotherapy is directed against these mechanisms. The drug therapy of migraine includes abortive and prophylactic medications. Abortive medications presently in use embody nonspecific medication like NSAIDS and neuroleptics/ antiemetics, and specific medication like triptans, ergot alkaloids and CGRP (calcitonin gene related peptide) receptor antagonists. The newer medication under investigation include 5-HT 1F agonists, nNOS (neuronal nitric oxide synthase) synthase inhibitors, TRPV1 (transient receptor potential vanilloid) receptor modulators, drugs functioning on glutamatergic targets, propofol and benzopyran derivatives. Prophylactic medications are necessary only if the attacks are too frequent or severe. The drugs used are beta blockers, calcium channel blockers, anticonvulsants, antidepressants and onabotulinium toxin A. monoclonal antibodies against CGRP pathway, benzopyran derivatives, dual orexin receptor antagonists, nonspecific phosphodiesterase inhibitors and angiotensin receptor blockers are being investigated as potential new targets for migraine prevention. These treatments should be used suitably and judiciously to forestall complications and to enhance the standard of life in migraine patients.