Scientific Approach to Migraine

Migraine is a common episodic headache disorder; prevalence of migraine in most western countries is 10-12%. The mechanism of migraine pain development is not fully understood. The theory of neurogenic inflammation proposes that the main event is the inflammation in the vessel wall which leads to leakage of nociceptive substances, causing thickening of the vessel wall and dilatation of vascular smooth muscles. The release of vasoactive neuropeptides causes depolarization of trigeminal perivascular axons, thus causing pain. Triptans are recommended for acute migraine attacks; studies have shown that their use increases productivity at work and improves the quality of life. Preventive therapy is recommended in migraine patients with frequent, severe, long-lasting attacks, in cases where acute therapy is not efficient, if there is a contraindication to the drug, failure or unbearable side-effects from acute treatments, overuse of acute medications or in special cases such as hemiplegic migraine. Beta-blockers and tricyclic antidepressants were often used as first line therapy for migraine prevention. Other p reventive drugs include pizotifen, flunarizine, and anticonvulsives. Migraine is often associated with a number of commorbid diseases: allergies, hypotension, epilepsy, fatigue sy, gastritis, iritabile colon disease, vertigo; therefore, preventive and acute therapy should be tailored individually.