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Pathophysiological basis of migraine prophylaxis.

Francesca Galletti1, Letizia Maria Cupini, Ilenia Corbelli

  • 1Clinica Neurologica, Università degli Studi di Perugia, Ospedale Santa Maria della Misericordia, 06132, Perugia, Italy.

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Summary

Migraine prevention involves various drugs targeting neuronal excitability and pain pathways. Conventional treatments include antidepressants, beta-blockers, and antiepileptics, with newer options showing promise.

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Area of Science:

  • Neuroscience
  • Pharmacology
  • Neurology

Background:

  • Migraine pathophysiology involves abnormal neuronal excitability and vascular events.
  • Current migraine prophylaxis utilizes drugs from various classes, often repurposed from other indications.
  • Understanding cellular and molecular mechanisms guides the selection of preventive treatments.

Purpose of the Study:

  • To review the pathophysiological basis for using antidepressants, beta-adrenergic blockers, calcium channel blockers, and antiepileptic drugs in migraine prevention.
  • To discuss established and emerging pharmacological strategies for migraine prophylaxis.
  • To highlight the goals of reducing migraine attack frequency, intensity, and associated disability.

Main Methods:

  • Review of existing literature on migraine pathophysiology and preventive treatments.
  • Discussion of drug mechanisms of action, including modulation of ionic channels and neurotransmitter systems.
  • Analysis of clinical findings for various drug classes, including conventional and novel agents.

Main Results:

  • Established preventive drugs include amitriptyline (antidepressant), propranolol (beta-blocker), topiramate, and valproic acid (antiepileptics).
  • Angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor blockers show promising results.
  • Other agents like atypical antipsychotics, nutritional supplements, and botulinum toxin have limited clinical findings.

Conclusions:

  • Migraine prevention aims to reduce attack frequency, intensity, and disability.
  • A range of pharmacological agents, targeting diverse pathophysiological mechanisms, are available for migraine prophylaxis.
  • Ongoing research continues to identify and validate new therapeutic strategies for migraine management.