Abstract

PHARMACOTHERAPY OF MIGRAINE

*Parmeshwar Subhash Ghadge, Dr. Sadhana Shahi, Parmeshwar Babasaheb Matlabe, Ashwini Devidas Waghmode

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Abstract

Migraine is defined as recurrent attack of headaches that are commonly unilateral and accompanied by gastrointestinal and visual disorder. Migraine is more prevalent in females than males. It is primarily a complex neurovascular disorder involving vasodilation of intracranial, extracerebral blood vessels and simultaneous stimulation of surrounding trigeminal sensory nervous pain pathway that results in headache. The activation of trigeminovascular system causes release of various vasodilators, especially CGRP that induces pain response and at the same time, decrease level of neurotransmitter serotonin have been observed in migraine patients. The calcitonin gene-related peptide (CGRP), a neuropeptide play an integral role in the pathophysiology of migraine. This paper discusses the hypothesized role of CGRP in migraine and reviews the mechanism of this neuropeptide in migraine pathophysiology. The increase CGRP synthesis and release might be mediated by activation of mitogen-activated protein kinase pathway. Blocking synthesis of cyclooxygenase by NSAIDs decrease the synthesis of prostaglandin or blocking synthesis of CGRP, which are involved in the pathophysiology of migraine headache. The migraine specific drugs such as triptans, monoclonal antibodies, NSAIDs and new class of drug most commonly used therapies for the migraine attack. serotonin receptors have been found on the trigeminal nerve and cranial vessels and their agonists especially triptans prove effective in migraine treatment. Currently CGRP receptor antagonists, triptans are used for antimigraine therapeutics.

Keywords: Chronic migraine, Diagnosis, management of migraine Triptans, NSAIDs, Onabotulinum toxin A.