Migraine treatment update

Migraine is a highly disabling neurological disorder that affects more than 1 billion individuals worldwide. For decades, migraine has been thought to be a complex and indecipherable condition, poorly understood with regards to pathogenesis. Migraine is caused by the interaction of genetic and environmental factors on the functioning of multiple brain areas. Because of major progress in the understanding of its pathogenesis, novel mechanism-based drugs for preventing the debilitating attacks or for acutely treat them have recently emerged, thus enriching the armamentarium of treatments. In addition, neuromodulation and digital therapeutics are progressively gaining space in the migraine arena, which was entered in the last few years by monoclonal antibodies targeting CGRP, CGRP antagonists, 5HT1F agonists (ditans), peripheral nerve stimulation device and a more widespread and conscious use of electronic systems to identify and control attack triggers. Migraine management is presently undergoing a positive revolution where the paradigm is slowly, but progressively switching from the trial-and-error or comorbidity-driven approach to an informed clinical management built on the combination of evidence-based data and a panel of individual features: frequency and severity of attacks, previous treatment failures and patient's preferences. The availability of mechanism-specific drugs will hopefully facilitate the identification of biomarkers of response, which the scientific community is vigorously searching. Such an achievement will allow the final transition to the next level of migraine treatment, tailored therapies to individuals, thus granting the maximum effectiveness of treatments with the least possible amount of side effects.