Abstract
Initially the new classification of primary headaches is mentioned. The next part of the article is dedicated to migraine.
Systematic review summarizes the clinical manifestations and the existing knowledge about the pathophysiology and treatment of this disorder. In the pathophysiology of migraine the activation of trigeminovascular system and the release of calcitonin gene-related peptide (CGRP), substance P and neurokinin A plays the most important role.
These mediators lead to the sterile perivascular neurogenic inflammation in meninges. The attention is targeted especially to the CGRP, which seems to be the key mediator in the pathophysiology of migraine.
The acute treatment of migraine attacks consists in the use of simple analgesics, non-steroidal anti-inflammatory drugs, ergotamines and triptans. Patients with frequent or long lasting attacks require the prophylactic treatment.
So far beta-blockers, antiepileptic drugs, calcium channel blockers and antidepressants are used. Injections of onabotulinumtoxin A reduce the frequency of attacks in chronic migraine.
The most promising new approach in the prophylactic treatment are monoclonal antibodies able to block either CGRP or its receptor.