Migraine treatment throughout the lifecycle

Abstract

The treatment of migraine headache is often suboptimal despite significant advances in our understanding of the pathophysiology and treatment of migraine. Children, adolescents, women and the elderly are particularly at risk of receiving inadequate or inappropriate therapy. In this review, the reader is brought up-to-date with changes to the International Headache Society diagnostic criteria for migraine. The pathophysiology of migraine is also reviewed, with a special emphasis on the evolving concept of central sensitization and cutaneous allodynia since this concept has led to a paradigm shift in the way migraines are managed. A review of the evidence supporting the benefits of early treatment before pain becomes moderate-to-severe is provided. Recommendations for acute and prophylactic treatments throughout the lifecycle are made in light of clinical practice guidelines and more recent evidence. Lastly, the current optimal treatment of migraine is provided and the potential role of calcitonin gene-related peptide antagonists in the future is discussed.

Keywords::

• amitriptyline
• central sensitization
• dihydroergotamine
• isometheptene
• menstrual migraine
• metoclopramide
• migraine
• neurogenic inflammation
• propranolol
• sumatriptan