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Migraine.
Nat Rev Dis Primers. 2022 01 13; 8(1):2.NR

Abstract

Migraine is a common, chronic, disorder that is typically characterized by recurrent disabling attacks of headache and accompanying symptoms, including aura. The aetiology is multifactorial with rare monogenic variants. Depression, epilepsy, stroke and myocardial infarction are comorbid diseases. Spreading depolarization probably causes aura and possibly also triggers trigeminal sensory activation, the underlying mechanism for the headache. Despite earlier beliefs, vasodilation is only a secondary phenomenon and vasoconstriction is not essential for antimigraine efficacy. Management includes analgesics or NSAIDs for mild attacks, and, for moderate or severe attacks, triptans or 5HT1B/1D receptor agonists. Because of cardiovascular safety concerns, unreliable efficacy and tolerability issues, use of ergots to abort attacks has nearly vanished in most countries. CGRP receptor antagonists (gepants) and lasmiditan, a selective 5HT1F receptor agonist, have emerged as effective acute treatments. Intramuscular onabotulinumtoxinA may be helpful in chronic migraine (migraine on ≥15 days per month) and monoclonal antibodies targeting CGRP or its receptor, as well as two gepants, have proven effective and well tolerated for the preventive treatment of migraine. Several neuromodulation modalities have been approved for acute and/or preventive migraine treatment. The emergence of new treatment targets and therapies illustrates the bright future for migraine management.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Ferrari MD
Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands. M.D.Ferrari@lumc.nl.
Goadsby PJ
Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. Department of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Boston, MA, USA. NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK.
Burstein R
Department of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.
Kurth T
Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Ayata C
Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA. Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Charles A
Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Ashina M
Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
van den Maagdenberg AMJM
Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands. Department of Human Genetics, Leiden University Medical Centre, Leiden, Netherlands.
Dodick DW
Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA.

MeSH

AnalgesicsAntibodies, MonoclonalCalcitonin Gene-Related Peptide Receptor AntagonistsHumansMigraine DisordersTryptamines

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

35027572

Citation

Ferrari, Michel D., et al. "Migraine." Nature Reviews. Disease Primers, vol. 8, no. 1, 2022, p. 2.
Ferrari MD, Goadsby PJ, Burstein R, et al. Migraine. Nat Rev Dis Primers. 2022;8(1):2.
Ferrari, M. D., Goadsby, P. J., Burstein, R., Kurth, T., Ayata, C., Charles, A., Ashina, M., van den Maagdenberg, A. M. J. M., & Dodick, D. W. (2022). Migraine. Nature Reviews. Disease Primers, 8(1), 2. https://doi.org/10.1038/s41572-021-00328-4
Ferrari MD, et al. Migraine. Nat Rev Dis Primers. 2022 01 13;8(1):2. PubMed PMID: 35027572.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Migraine. AU - Ferrari,Michel D, AU - Goadsby,Peter J, AU - Burstein,Rami, AU - Kurth,Tobias, AU - Ayata,Cenk, AU - Charles,Andrew, AU - Ashina,Messoud, AU - van den Maagdenberg,Arn M J M, AU - Dodick,David W, Y1 - 2022/01/13/ PY - 2021/11/26/accepted PY - 2022/1/14/entrez PY - 2022/1/15/pubmed PY - 2022/3/18/medline SP - 2 EP - 2 JF - Nature reviews. Disease primers JO - Nat Rev Dis Primers VL - 8 IS - 1 N2 - Migraine is a common, chronic, disorder that is typically characterized by recurrent disabling attacks of headache and accompanying symptoms, including aura. The aetiology is multifactorial with rare monogenic variants. Depression, epilepsy, stroke and myocardial infarction are comorbid diseases. Spreading depolarization probably causes aura and possibly also triggers trigeminal sensory activation, the underlying mechanism for the headache. Despite earlier beliefs, vasodilation is only a secondary phenomenon and vasoconstriction is not essential for antimigraine efficacy. Management includes analgesics or NSAIDs for mild attacks, and, for moderate or severe attacks, triptans or 5HT1B/1D receptor agonists. Because of cardiovascular safety concerns, unreliable efficacy and tolerability issues, use of ergots to abort attacks has nearly vanished in most countries. CGRP receptor antagonists (gepants) and lasmiditan, a selective 5HT1F receptor agonist, have emerged as effective acute treatments. Intramuscular onabotulinumtoxinA may be helpful in chronic migraine (migraine on ≥15 days per month) and monoclonal antibodies targeting CGRP or its receptor, as well as two gepants, have proven effective and well tolerated for the preventive treatment of migraine. Several neuromodulation modalities have been approved for acute and/or preventive migraine treatment. The emergence of new treatment targets and therapies illustrates the bright future for migraine management. SN - 2056-676X UR - https://www.unboundmedicine.com/medline/citation/35027572/Migraine_ DB - PRIME DP - Unbound Medicine ER -