Migraine: Epidemiology, Risk Factors, Pathophysiology, and Treatment

Migraine is a common, disabling brain disorder that affects about 1 billion people worldwide and disproportionately burdens women and working-age adults. Once viewed mainly as a vascular headache, migraine is now understood as a heterogeneous neurobiological syndrome arising from interactions among genetic susceptibility, hormonal influences, environmental exposures, and cortical, brainstem, trigeminovascular, and neuroinflammatory networks. Although calcitonin gene-related peptide (CGRP)-pathway therapies, gepants, and neuromodulation have transformed care, major gaps remain in disease stratification, prevention of chronification and management of special populations. Here, we review recent evidence on global and regional epidemiology, sex-specific and environmental risk factors, and the transition from episodic to chronic migraine. We then examine current mechanistic models, focusing on cortical spreading depolarization, trigeminovascular signaling, CGRP biology, neurogenic inflammation, glial activation, and brain network dysfunction. We also assess acute and preventive treatment strategies, including ditans, gepants, monoclonal antibodies, and onabotulinumtoxinA, and discuss persistent challenges in pediatric, geriatric, and pregnancy-associated migraine care. By integrating population, mechanistic and therapeutic perspectives, this review reframes migraine as a stratified brain network disorder rather than a uniform vascular pain syndrome. This synthesis highlights priorities for biomarker development, precision medicine, and more equitable implementation of effective migraine care.