Modern strategies of targeted migraine therapy

Abstract

Migraine is a chronic common neurological disorder. It is an extremely disabling and significantly reduces the quality of life of patients. Developments of the field of fundamental research and functional neuroimaging studies have improved the understanding of the pathophysiology of migraine. New specific drugs and methods of treatment have appeared. They significantly reduced the severity of headache attacks and the course of the disease. Therefore the aim of this work is to analyze and summarize the information of modern professional literature of the pathophysiology and treatment of migraine. Data on the neurophysiological features of the brain in migraine, the emergence of drugs with other therapeutic targets, such as glutamate, amylin, adrenomedullin, orexins, and pituitary adenylate cyclase-activating polypeptide are presented. Recommendations are given for emergency treatment of a migraine attack, depending on the severity of the attack, the degree of maladaptation of the patient, concomitant symptoms, concomitant diseases and the patient's response to treatment. Prophylactic treatment can be divided into first-, second- and third-line drugs, but the choice of drugs and the order of their use depend on local practical recommendations and availability in individual regions and cost. Efficacy, safety of new drugs for specific migraine therapy are discussed such as molecules targeting calcitonin gene-related peptide (hepants and monoclonal antibodies) and serotonin 5-HT1F receptor agonists (ditans). Diagnosis and clinical management of migraine worldwide remain suboptimal. A large number of studies lead to a deeper understanding of the neurobiology of this disorder, the search for new treatment methods that are more adapted to the needs of patients and fundamentally change the approach to the disease. Keywords: calcitonin gene-related peptide, therapy, hepants, monoclonal antibodies, ditans.