Current perspectives on migraine: pathophysiological and therapeutic bases.
DOI:
https://doi.org/10.36557/2674-8169.2024v6n4p1989-1999Keywords:
migraine; pathogenesis; treatment; managementAbstract
Introduction: Migraine is a chronic neurological disorder characterized by recurrent episodes of pulsating headache, often unilateral, associated with symptoms such as nausea, vomiting, photophobia and phonophobia. Objective: To evaluate the pathophysiology and management of migraine. Methodology: This is a bibliographic review that included original articles and systematic reviews in English and Portuguese, which addressed the pathophysiological and therapeutic components of migraine, published between 2012 and 2024, selected from the PubMed, Scopus and SciELO databases. After careful selection, 21 articles were chosen to compose this bibliographic review. Results: Migraine is a neurological disorder characterized by distinct phases. In the premonitory phase, hypothalamic activation occurs, resulting in symptoms such as photophobia, fatigue and increased appetite. The aura phase is marked by cortical spreading depression, involving neuronal depolarization and a decrease in electrical activity. During the headache phase, there is activation of the trigeminovascular system, leading to the release of neurotransmitters such as CGRP, which amplify pain. Migraine management involves preventive therapy with medications such as propranolol, antidepressants, botulinum toxin and topiramate in addition to acute treatments such as triptans and DHE. Considerations: The pathophysiology is broad and involves multiple mechanisms. Treatment involves preventive and abortive therapy aimed at relieving symptoms during attacks. Effective migraine management requires a personalized approach, taking into account the severity of the attacks, the patient's comorbidities and the individual response to the different treatments available.
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References
Aguilar-Shea, A. L., Membrilla, M. J. A., & Diaz-de-Teran, J. (2021). Migraine review for general practice. Aten Primaria, 54(2), 102208. https://doi.org/10.1016/j.aprim.2021.102208
Benemei, S., De Cesaris, F., Fusi, C., Rossi, E., Lupi, C., & Geppetti, P. (2013). TRPA1 and other TRP channels in migraine. The Journal of Headache and Pain, 14(1), 71. https://doi.org/10.1186/1129-2377-14-71
Botox [prescribing information]. Madison, NJ: Allergan; 2018. Retrieved from www.allergan.com/assets/pdf/botox_pi.pdf Accessed April 01, 2024.
Burstein, R., Noseda, R., & Borsook, D. (2015). Migraine: Multiple processes, complex pathophysiology. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 35(17), 6619–6629. https://doi.org/10.1523/JNEUROSCI.0373-15.2015
Géraud, G., & Donnet, A. (2013). Migraine and hypothalamus. Rev Neurol (Paris), 169, 372–379. https://doi.org/10.1016/j.neurol.2013.03.005
Headache Classification Committee of the International Headache Society. (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38, 1-211.
Harriott, A. M., Takizawa, T., Chung, D. Y., & Chen, S. P. (2019). Spreading depression as a preclinical model of migraine. The Journal of Headache and Pain, 20(1), 45. https://doi.org/10.1186/s10194-019-1001-4
Herd, C. P., Tomlinson, C. L., Rick, C., Scotton, W. J., Edwards, J., Ives, N., Clarke, C. E., & Sinclair, A. (2018). Botulinum toxins for the prevention of migraine in adults. Cochrane Database of Systematic Reviews, 6(6), CD011616. https://doi.org/10.1002/14651858.CD011616.pub2
Karatas, H., Erdener, S. E., Gursoy-Ozdemir, Y., Lule, S., Eren-Koçak, E., Sen, Z. D., & Dalkara, T. (2013). Spreading depression triggers headache by activating neuronal Panx1 channels. Science, 339(6123), 1092–1095. https://doi.org/10.1126/science.1231897
Loder, E., Burch, R., & Rizzoli, P. (2012). The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache, 52(6), 930-945. https://doi.org/10.1111/j.1526-4610.2012.02185.x
Loder, E., & Rizzoli, P. (2018). Pharmacologic prevention of migraine: a narrative review of the state of the art in 2018. Headache, 58(suppl 3), 218-2. https://doi.org/10.1111/head.133765
Maniyar, F. H., Sprenger, T., Monteith, T., Schankin, C., & Goadsby, P. J. (2014). Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks. Brain, 137, 232–241. https://doi.org/10.1093/brain/awt320
Marmura, M. J., Silberstein, S. D., & Schwedt, T. J. (2015). The acute treatment of migraine in adults: the American Headache Society evidence assessment of migraine pharmacotherapies. Headache, 55(1), 3-20. https://doi.org/10.1111/head.12499
Noseda, R., Bernstein, C. A., Nir, R. R., Lee, A. J., Fulton, A. B., Bertisch, S. M., Hovaguimian, A., Cestari, D. M., Saavedra-Walker, R., Borsook, D., Doran, B. L., Buettner, C., & Burstein, R. (2016). Migraine photophobia originating in cone-driven retinal pathways. Brain: A Journal of Neurology, 139(7), 1971–1986. https://doi.org/10.1093/brain/aww119
Pringsheim, T., Davenport, W. J., Marmura, M. J., Schwedt, T. J., & Silberstein, S. (2016). How to apply the AHS evidence assessment of the acute treatment of migraine in adults to your patient with migraine. Headache, 56(7), 1194-1200. https://doi.org/10.1111/head.12870
Pulleda F, Shields K. (2018). Non-Pharmacological Approaches for Migraine. Neurotherapeutics, 15(2), 336-345. https://doi.org/10.1007/s13311-018-0623-6
Rizzoli, P. (2014). Preventive pharmacotherapy in migraine. Headache, 54(2), 364-369. https://doi.org/10.1111/head.12273
Vuralli, D., Ayata, C., & Bolay, H. (2018). Cognitive dysfunction and migraine. The Journal of Headache and Pain, 19, 109.
Wang, T., Chen, N., Zhan, W., Liu, J., Zhang, J., Liu, Q., Huang, H., He, L., Zhang, J., & Gong, Q. (2015). Altered effective connectivity of posterior thalamus in migraine with cutaneous allodynia: A resting-state fMRI study with Granger causality analysis. The Journal of Headache and Pain, 17, 17. https://doi.org/10.1186/s10194-016-0610-4
Woldeamanuel, Y. W., & Cowan, R. P. (2017). Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants. Journal of the Neurological Sciences, 372, 307-315.
Younis, S., Christensen, C. E., Toft, N. M., Søborg, T., Amin, F. M., Hougaard, A., & Ashina, M. (2019). Investigation of distinct molecular pathways in migraine induction using calcitonin gene-related peptide and sildenafil. Cephalalgia, 39(14), 1776–1788. https://doi.org/10.1177/0333102419882474
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Copyright (c) 2024 Nayara Fernanda Amorim Madeiros Ribeiro, Paulo Vytor Cardoso Nobre, Ana Carolina Matiotti Mendonça, Camille Motta Machado , Alexandre Salomão de Braz Oliveira, Gustavo Fonseca Medina Pereira , Pedro Henrique Padilha da Cunha, Clara Vitória Braz Lima de Oliveira, Alícia Malta Brandão Nunes, Maria Luísa Vieira Cuyabano Leite, Celiany Rocha Appelt, Katherine Pinaud Calheiros de Albuquerque Melo
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