Management of Migraine: An Overview

Abstract

Migraine is a disabling type of headache due to a neurovascular disorder characterized by moderate to severe pain and specific associated features. Migraine has a high incidence and prevalence, affecting 20% of people at some point in their lives; women are more affected than men. There have been many pharmacologic options that have been used to treat acute migraine over the last years. Nevertheless, this article aims to point out the new drugs approved by the Food and Drug Administration (FDA), the calcitonin gene-related peptide (CGRP) inhibitor and review the traditional pharmacologic options and their combination available. There are two classes of CGRP inhibitors: small molecule CGRP receptor antagonists and anti-CGRP monoclonal antibodies. Their indications depend on the patient’s comorbidity, preference, and side effects. Due to their non-vasoconstrictive property, CGRP inhibitors can be considered a treatment option for patients with a contraindication of triptans and ergot alkaloids use. Another strategy to treat migraine attacks after they start is triptans. Therefore, this drug is considered an abortive therapy. However, triptans have many contraindications and drug interactions. Additionally, it should not be used for more than ten days per month to avoid the development of medication overuse headaches. Another classic group of drugs proven to be effective and safe for mild to moderate headache therapy is non-steroidal anti-inflammatory drugs (NSAIDs). Their easy access and lower cost are the most attractive advantages of this drug. Migraine treatment is not easy, and it might be necessary to use more than one drug. Combination drugs can be used as a first-line or second-line therapy, and they can also be helpful for refractory migraine treatment. Due to the different mechanisms of action, it can enhance the results of another drug or improve its effects. This treatment regimen can be used as the first or second line, depending on the context of the patient. Since migraine is a prevalent condition, all medical professionals must be up to date on migraine treatment methods because studies in this area are lacking.