Migraine and Current Pharmacologic Management

Abstract

In light of the multiple pharmacologic alternatives for migraine management, the adverse effects associated with different treatment regimens, and their varying efficacy, it is vital to undertake ongoing evaluations and seek a tailored therapeutic strategy. This case report describes two patients who presented with classic migraine headaches, with the first responding to both abortive and prophylactic migraine medications and the second, with status migrainosus-like presentation, responding to the newer antimigraine agents. We also examined current pharmacological therapeutic options and existing recommendations, analyzing their strengths and weaknesses. This case review exemplifies how treatment in the last 10 years and success in medications used for abortive and prophylactic therapy are evolving from the older agents to newer agents like the recently approved calcitonin gene receptor protein monoclonal antibody inhibitors.

Keywords: chronic migraine (cm); headache disorders; migraine; migraine disorder; resistant migraine.

Figure 1. Axial FLAIR MRI of the brain at the level of the basal ganglia and MRA image showing normal findings

FLAIR: fluid-attenuated inversion recovery; MRA: magnetic resonance angiography.

Figure 2. Axial non-contrast CT of the brain at the level of the basal ganglia and midline sagittal CT image showing normal finding

Figure 3. Illustration of headache and the interplay between the CGRP receptors and blocker

The image concept was adapted from [15,16]. (A) Headache in a patient before CGRP antibody. (B) Post-CGRP blocker and CGRP receptor blocker. Legal protection for original work. Both the artwork and the accompanying words were originally developed by us. CGRP: calcitonin gene-related peptide.