Scientists try to study the phases of a migraine so that they can ultimately develop specific treatments for them. In addition to the brain structures we’ve reviewed in the video, there are certain neurotransmitters that are involved in transmitting pain signals in the migraine pathway. Calcitonin gene related peptide, or CGRP, deserves special attention. We know that CGRP levels are increased in patients with chronic migraine, that infusion of CGRP can induce headaches in migraineurs, and that drugs targeting CGRP and its receptor are effective migraine therapies. Despite knowing how important it is in migraines, exactly when and where it is released remains elusive. Once released, however, CGRP induces inflammation and dilates blood vessels.

With knowledge of the migraine phases, we can start to explain why some therapies work by their actions on this pathway. Dopamine blocking drugs could potentially work in the prodromal phase, where its release is governed by the hypothalamus. Drugs designed to block CGRP and the CGRP receptors can be effective in treating and preventing migraines. Other medications reduce stop pain by blocking CGRP release. Regular onabotulinim toxin injections, used in the cosmetic industry for skin wrinkles, can also effectively prevent migraines by blocking CGRP release from nerve endings. Devices periodically applied to the head and neck, such as single pulse transcranial magnetic stimulation or non-invasive vagal nerve stimulation may treat migraines by blocking the changes in charge (cortical spreading depolarization) spreading over the cerebral cortex, for example. These as well as non-pharmacologic strategies such as avoidance of migraine triggers and exercise can help manage migraine attacks.

Every migraineur is unique and not all treatments are safe or suitable for everyone. Treatment options should always be reviewed with a qualified physician prior to starting them.

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