The pathophysiology of migraine

Abstract:

A migraine is characterized by recurrent episodic attacks of headaches, usually accompanied by associated symptoms such as nausea, sensitivity to light, sound, and head movements. Since sensitization of trigeminal nociceptors and trigeminocervical complex neurons activation are preceded by the activity of certain brainstem nuclei and cortical spreading depression, the migraine is no longer considered a vascular, but a neurogenic disorder with secondary changes in brain perfusion. Recognition of the crucial role of CGRP and PACAP neuropeptides in the migraine pathophysiology have led to novel migraine therapies. Monoclonal antibodies against CGRP (eptinezumab, fremanezumab and galcanezumab) and CGRP receptor (erenumab) effectively prevent migraine attacks. Being more specific and having fewer adverse events, these medications represent considerable tharapeutic improvement.

Key words:
calcitonin gene-related peptide (CGRP); cortical spreading depression; migraine; nociceptors; sensitization; trigeminocervical complex