The last few decades have witnessed a major progress in migraine treatment
based on novel clinical findings as well as advanced pathophysiological understanding
of the disease. Studies focusing on the activation of trigeminovascular system during
migraine attacks complemented by identification of several genes related to migraine
susceptibility have elaborated the role of dural neurogenic inflammation, nociceptive
sensitization mechanisms and cortical spreading depression in migraine
pathophysiology. Triptans and CGRP antagonists have emerged as novel migrainespecific
agents for acute attack treatment although clinical use of CGRP antagonists is
hampered by their side effects. Several unrelated classes of drugs ranging from betablockers
to antiepileptics have been identified to be effective for migraine prophylaxis.
A wide variety of novel targets including CGRP, glutamate receptors, nitric oxide
synthase are in drug development pipeline for both acute as well as prophylactic
treatment. Availability of a wide range of experimental and human models of migraine
is promising in facilitating this progress. This chapter will focus on the current and
future therapeutic agents for acute and prophylactic migraine treatment and their
mechanisms of action.
Keywords: Antiepileptics, CGRP antagonists, Drug treatment, Headache,
Migraine, Neurogenic inflammation, NSAIDs, Spreading depression,
Trigeminovascular system, Triptans.
