Achievements of Recent Decades in the Diagnosis and Study of Migraine Pathogenesis

Significant advances have been made in recent decades in the study of migraine, which have changed our understanding of its neurobiology. Migraine is currently considered a neurovascular disorder, characterized by recurrent attacks consisting of consecutive phases of prodrome, aura, headache, and postdrome. Assessment of their clinical features has enabled us to classify the types of migraine—with aura, without aura, chronic, and its concomitant symptoms, to standardize the diagnostic algorithm and present them as criteria for headache classification. A leading role in attack onset is thought to be an imbalance in the interaction between central and peripheral nervous system structures involved in the transmission of pain and inflammation, and the vascular wall. The cause of these disturbances is thought to be primary neuronal dysfunction and related sensory processing disorders, spreading cortical depression, and decreased excitability threshold of the trigeminovascular system. Activation of the latter leads to the release of neuropeptides, development of aseptic inflammation in the vascular wall, pain and related non-pain symptoms. There is growing evidence that recently developed calcitonin gene-related peptide (CGRP) antagonists may lead the way in the treatment and prevention of migraines. A better understanding of the key molecules and mechanisms involved in various stages of migraine will help establish new therapeutic targets, ensuring qualitative improvements in the care for this common and disabling disease.