Deimantė Sadauskaitė¹, Augustė Juknelytė ¹

¹ Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania

ABSTRACT

Migraine – a disorder characterized by recurrent headaches, which can last for 4-72 hours and affects one in nine adults. Migraine is classified into 6 subtypes: migraine without aura, migraine with aura, chronic migraine, complications of migraine, probable migraine and episodic syndromes that may be associated with migraine. The most common subtype is migraine without aura which tends to cause episodic recurrent headaches, photophobia, phonophobia, nausea, and vomiting. Typically, a migraine attack consists of 4 phases:  a prodrome phase, an aura phase, a pain phase and a postdrome phase that presents with numerous autonomic symptoms. An important role in the development of a migraine attack belongs to precipitants – factors that independently or in combinations can cause headaches to susceptible individuals. Precipitants for a migraine attack can be stress, fatigue, menstruation, auditory triggers, starvation or high caffeine intake. The frequency of migraine attacks and its impact on patients’ quality of life is individual and can differ from less than one attack per year to several attacks per month and it might result in a mild impairment in the activities of daily living as well as a complete disability while experiencing a migraine attack. The migraine treatment includes the management of migraine triggers, acute symptomatic treatment, and preventive treatment. The acute symptomatic treatment consists of the usage of nonsteroidal anti-inflammatory drugs, acetaminophen, triptans and antiemetic medications that might be given in different forms, depending on the clinical situation. The strategy of treatment of migraine attacks depends on the intensity of the headache, the usual speed of the progression of the headache, the presence of concomitant gastrointestinal symptoms, the degree of disability, the patient‘s response to the treatment used for the previous attacks, the anamnesis of recurrent attacks and the present contraindications for the use of specific drugs.  There is a relatively high number of medications used for the prevention of migraines, yet it is often limited by reported side effects, such as cognitive slowing, somnolence and weight gain, or by the insufficient effectiveness of the given medications. Because of this, a lot of attention is being focused on specific drugs, designed to bind to a calcitonin gene-related peptide (CGRP) or its receptor and to neutralize the effect of the excess CGRP in the trigeminal sensory fibers which are found during the presence of the migraine attacks. There is a new preventive migraine treatment in Lithuania – a biological therapy with erenumab directed against the CGPR receptor that is expected to significantly reduce the frequency of migraine headaches and to improve the qualify of life of the migraineurs.

Keywords: migraine, migraine triggers, pathophysiology, acute treatment, preventive treatment, erenumab