Activation of the trigeminovascular system involving calcitonin-gene related peptide (CGRP) release plays a key role in migraine. Small molecule CGRP receptor antagonists known as gepants can treat migraines, and monoclonal antibodies can also target CGRP and its receptors. Studies have shown them to be less effective than triptans.

University of Michigan - Ann Arbor

* Non-steroidal anti-inflammatory drugs
* Triptans
* CGRP receptor antagonists
* Ergotamines

Treatments for migraine

de Vries, T., Villalón, C. M., & MaassenVanDenBrink, A. (2020). Pharmacological treatment of migraine: CGRP and 5-HT beyond the triptans. Pharmacology & therapeutics, 211, 107528. https://doi.org/10.1016/j.pharmthera.2020.107528

Pharmacological treatment of migraine: CGRP and 5-HT beyond the triptans

Non-steroidal anti-inflammatory drugs (NSAIDs) are a first-in-line treatment for migraine. They inhibit neurogenic inflammation and central sensitization. Examples: aspirin, ibuprofen, diclofenac, naproxen.

NSAIDs as migraine treatment

A first-in-line treatment for migraine. Although they are less effective than NSAIDs, they do not cause antiplatelet effects or gastric irritation. Acetaminophen can be used in combination with aspirin and caffeine to treat headache.

Acetaminophen as migraine treatment

Triptans are used to treat moderate to severe migraine and are agonists for serotonin receptors.

Triptans as migraine treatment

An older treatment for migraines. Although it has similar effectiveness as triptans, it has less receptor specificity and can result in nausea and leg cramps or tingling extremities due to its vasoconstrictive effects.

Ergotamines as migraine treatment

CGRP receptor antagonists as migraine treatment

Sleep is known to consistently relieve migraines. It reduces sensory transmission and responsiveness to painful stimuli. Migraines generally increases non-REM sleep, which indicates that the brain needs more sleep during migraine episodes. Neuropeptides known as orexins, which are involved in wakefulness, also play roles in pain sensation and thus could be targeted in migraine treatments.

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