Migraine in the era of precision medicine

Abstract

Migraine is a common neurovascular disorder in the neurologic clinics whose mechanisms have been explored for several years. The aura has been considered to be attributed to cortical spreading depression (CSD) and dysfunction of the trigeminovascular system is the key factor that has been considered in the pathogenesis of migraine pain. Moreover, three genes (CACNA1A, ATP1A2, and SCN1A) have come from studies performed in individuals with familial hemiplegic migraine (FHM), a monogenic form of migraine with aura. Therapies targeting on the neuropeptids and genes may be helpful in the precision medicine of migraineurs. 5-hydroxytryptamine (5-HT) receptor agonists and calcitonin gene-related peptide (CGRP) receptor antagonists have demonstrated efficacy in the acute specific treatment of migraine attacks. Therefore, ongoing and future efforts to find new vulnerabilities of migraine, unravel the complexity of drug therapy, and perform biomarker-driven clinical trials are necessary to improve outcomes for patients with migraine.

Association between Ménière’s disease and vestibular migraine

“…It is important to note that tension type headache among others is very often associated with vertigo (See Headache Classification Committee of the International Headache Society [54]). Also, when reviewing studies of vertigo and migraine, the most commonly associated migraine subtype was migraine without aura (80%), and only 12% had migraine with aura associated to vertigo [55]. Also, the duration of vertigo was less than 5 min (which is the shortest duration of migraine aura) in 25% of patients.…”

Association between PRDM16, MEF2D, TRPM8, LRP1 gene polymorphisms and migraine susceptibility in the She ethnic population in China

“…Migraine is a common chronic neurologic condition and neurovascular disease characterized by a unilateral headache lasting 4-72 hours that is accompanied by nausea, emesis, phonophobia, photophobia, visual disturbances and disability [1][2][3]. The lifetime incidence of migraine is 6.5% to 7.4% for males, and 18.2% to 21% for females, resulting in a male-to-female ratio of about 1:3 [4,5].…”

The Future of Migraine Prevention

“…Identification of biomarkers (genetic, molecular, imaging), will reshape diagnosis and treatment selection. Eventually, advances in technology, gene therapy and in other, seemingly unrelated, fields may reframe the landscape . While novel medications are an integral part of the future for migraine prevention, they are but one aspect of best practices and optimal care.…”