TY - JOUR
T1 - A critical review of the neurovascular nature of migraine and the main mechanisms of action of prophylactic antimigraine medications
AU - Marichal-Cancino, Bruno A.
AU - González-Hernández, Abimael
AU - Guerrero-Alba, Raquel
AU - Medina-Santillán, Roberto
AU - Villalón, Carlos M.
N1 - Funding Information:
This work was financially supported by: the ?Fondo Sectorial de Investigaci?n para la Educaci?n? (CONACyT, Grant No. A1-S-23631 to AGH); the SEP-Cinvestav Research Support Fund (Grant No. 50 to CMV) and the ?Direcci?n General de Investigaci?n y Posgrado? (UAA, Grant No. PIFF21-1 to BAMC). Figure 1 was drawn using biorender.com with license paid by the Autonomous University of Aguascalientes to BAMC.
Publisher Copyright:
© 2021 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2021
Y1 - 2021
N2 - Introduction: Migraine involves neurovascular, functional, and anatomical alterations. Migraineurs experience an intense unilateral and pulsatile headache frequently accompanied with vomiting, nausea, photophobia, etc. Although there is no ideal preventive medication, frequency in migraine days may be partially decreased by some prophylactics, including antihypertensives, antidepressants, antiepileptics, and CGRPergic inhibitors. However, the mechanisms of action involved in antimigraine prophylaxis remain elusive. Areas covered: This review recaps some of the main neurovascular phenomena related to migraine and currently available preventive medications. Moreover, it discusses the major mechanisms of action of the recommended prophylactic medications. Expert opinion: In the last three years, migraine prophylaxis has evolved from nonspecific to specific antimigraine treatments. Overall, nonspecific treatments mainly involve neural actions, whereas specific pharmacotherapy (represented by CGRP receptor antagonists and CGRPergic monoclonal antibodies) is predominantly mediated by neurovascular mechanisms that may include, among others: (i) reduction in the cortical spreading depression (CSD)–associated events; (ii) inhibition of pain sensitization; (iii) blockade of neurogenic inflammation; and/or (iv) increase in cranial vascular tone. Accordingly, the novel antimigraine prophylaxis promises to be more effective, devoid of significant adverse effects (unlike nonspecific treatments), and more beneficial for the quality of life of migraineurs.
AB - Introduction: Migraine involves neurovascular, functional, and anatomical alterations. Migraineurs experience an intense unilateral and pulsatile headache frequently accompanied with vomiting, nausea, photophobia, etc. Although there is no ideal preventive medication, frequency in migraine days may be partially decreased by some prophylactics, including antihypertensives, antidepressants, antiepileptics, and CGRPergic inhibitors. However, the mechanisms of action involved in antimigraine prophylaxis remain elusive. Areas covered: This review recaps some of the main neurovascular phenomena related to migraine and currently available preventive medications. Moreover, it discusses the major mechanisms of action of the recommended prophylactic medications. Expert opinion: In the last three years, migraine prophylaxis has evolved from nonspecific to specific antimigraine treatments. Overall, nonspecific treatments mainly involve neural actions, whereas specific pharmacotherapy (represented by CGRP receptor antagonists and CGRPergic monoclonal antibodies) is predominantly mediated by neurovascular mechanisms that may include, among others: (i) reduction in the cortical spreading depression (CSD)–associated events; (ii) inhibition of pain sensitization; (iii) blockade of neurogenic inflammation; and/or (iv) increase in cranial vascular tone. Accordingly, the novel antimigraine prophylaxis promises to be more effective, devoid of significant adverse effects (unlike nonspecific treatments), and more beneficial for the quality of life of migraineurs.
KW - Antimigraine prophylaxis
KW - migraine
KW - neurovascular axis
KW - propranolol
UR - http://www.scopus.com/inward/record.url?scp=85114508385&partnerID=8YFLogxK
U2 - 10.1080/14737175.2021.1968835
DO - 10.1080/14737175.2021.1968835
M3 - Artículo de revisión
C2 - 34388955
AN - SCOPUS:85114508385
SN - 1473-7175
VL - 21
SP - 1035
EP - 1050
JO - Expert Review of Neurotherapeutics
JF - Expert Review of Neurotherapeutics
IS - 9
ER -