Acute migraine: an overview

Authors

  • Sandhya Manorenj Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20250952

Keywords:

Migraine, Primary headache disorder, Treatment of acute attack

Abstract

Migraine is a primary headache disorder that affects people of all ages. It is the second most common type of headache disorder after tension headache. Migraine headache usually begins in adolescence, peak in the third decade of life, and becomes less frequent and less severe in later decades. Migraine affects women three times more often than men. Migraine can be very debilitating and can significantly impair an individual's ability to perform daily activities. Creating a clinical review on acute migraine and its management, using a pragmatic approach based on recent advances. The author reviewed the available literature on migraine and identified relevant articles through a literature search in the PubMed database to create this review. Migraine diagnosis is based on clinical examination and medical history, and imaging is usually not required. There are two main types of pharmacological treatment for migraine: abortive treatment to stop acute attacks and prophylactic treatment or preventive medication to reduce the frequency and severity of attacks. The treatment of migraine is constantly improving with new target-specific treatments, neuromodulation devices, and non-oral formulations of established medicines. This comprehensive review focuses on recent guidelines, newer approved drugs, and emerging therapies for managing acute migraine.

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References

Ashina M. Migraine. N Engl J Med. 2020;383(19):1866-76. DOI: https://doi.org/10.1056/NEJMra1915327

Steiner TJ, Stovner LJ, Jensen R, Uluduz D, Katsarava Z. Migraine remains second among the world's causes of disability, and first among young women: findings from GBD2019. J Headache Pain. 2020;21:137. DOI: https://doi.org/10.1186/s10194-020-01208-0

Charles JA, Rapoport AM. The American Headache Society's Position Statement on Integrating New Migraine Treatments into Clinical Practice - Comments. Headache. 2019;59(4):629. DOI: https://doi.org/10.1111/head.13496

Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American Headache Society evidence assessment of migraine pharmacotherapies. Headache. 2015;55(1):3-20. DOI: https://doi.org/10.1111/head.12499

Ailani J, Burch RC, RobbinsMS, Board of Directors of the American Headache Society. The American Headache Society consensus statement: update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-39. DOI: https://doi.org/10.1111/head.14153

Diener HC, Tassorelli C, Dodick DW, Silberstein SD, Lipton RB, Ashina M, et al; International Headache Society Clinical Trials Committee. Guidelines of the International Headache Society for controlled trials of preventive treatment of migraine attacks in episodic migraine in adults. Cephalalgia. 2020;40(10):1026-44. DOI: https://doi.org/10.1177/0333102420941839

Tassorelli C, Diener HC, Silberstein SD, Dodick DW, Goadsby PJ, Jensen RH, et al. Guidelines of the International Headache Society for clinical trials with neuromodulation devices for the treatment of migraine. Cephalalgia. 2021;41(11-12):1135-51. DOI: https://doi.org/10.1177/03331024211010413

Abu-Arafeh I, Hershey AD, Diener HC, Tassorelli C. Guidelines Update: Guidelines of the International Headache Society for controlled trials of preventive treatment of migraine in children and adolescents, 1st edition - An experience-based update. Cephalalgia. 2023;43(5):3331024231178239. DOI: https://doi.org/10.1177/03331024231178239

Diener HC, Förderreuther S, Gaul C, Giese F, Hamann T, Holle-Lee D, et al. Prevention of migraine with monoclonal antibodies against CGRP or the CGRP receptor: Addition to the S1 guideline: Therapy of migraine attacks and prevention of migraine. Recommendations of the Germany Society of Neurology and the German Migraine and Headache Society. Neurol Res Pract. 2020;2:11. DOI: https://doi.org/10.1186/s42466-020-00057-1

Alsaadi T, Kayed DM, Al-Madani A, Hassan AM, Krieger D, Riachi N, et al. Acute Treatment of Migraine: Expert Consensus Statements from the United Arab Emirates (UAE). Neurol Ther. 2024;13(2):257-81. DOI: https://doi.org/10.1007/s40120-023-00576-4

Chatterjee JH, Blume HK. Triptans in the Acute Migraine Management of Children and Adolescents: An Update. Curr Pain Headache Rep. 2024;28(7):641-9. DOI: https://doi.org/10.1007/s11916-024-01213-x

Steiner TJ, Stovner LJ. Global epidemiology of migraine and its implications for public health and health policy. Nat Rev Neurol. 2023;19(2):109-17. DOI: https://doi.org/10.1038/s41582-022-00763-1

Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev. 2017;97:553-622. DOI: https://doi.org/10.1152/physrev.00034.2015

Piccininni M, Brinks R, Rohmann JL, Kurth T. Estimation of migraine prevalence considering active and inactive states across different age groups. J Headache Pain. 2023;24(1):83. DOI: https://doi.org/10.1186/s10194-023-01624-y

Olesen J. Headache Classification Committee of the International Headache Society (IHS) the international classification of headache disorders, abstracts. Cephalalgia. 2018;38(1):1-211. DOI: https://doi.org/10.1177/0333102417738202

Bigal ME, Serrano D, Reed M, Lipton RB. Chronic migraine in the population: burden, diagnosis, and satisfaction with treatment. Neurology. 2008;71(8):559-66. DOI: https://doi.org/10.1212/01.wnl.0000323925.29520.e7

Lee W, Cho SJ, Hwang H, Lee M, Kim EH, Kim KM, et al. Crystal-clear days and unclear days in migraine: A population-based study. Headache. 2022;62(7):818-27. DOI: https://doi.org/10.1111/head.14359

Olson AK, Hansen KA. Menstrual Migraines: Diagnosis, Evidence, and Treatment. S D Med. 2021;74(12):570-5.

Kamourieh S, Rozen T, Anderson JM. Status migrainosus. Handb Clin Neurol. 2024;199:413-39. DOI: https://doi.org/10.1016/B978-0-12-823357-3.00017-3

Ornello R, Andreou AP, De Matteis E, Jürgens TP, Minen MT, Sacco S. Resistant and refractory migraine: clinical presentation, pathophysiology, and management. EBioMedicine. 2024;99:104943. DOI: https://doi.org/10.1016/j.ebiom.2023.104943

Kouremenos E, Arvaniti C, Constantinidis TS, Giannouli E, Fakas N, Kalamatas T, et al; Hellenic Headache Society. Consensus of the Hellenic Headache Society on the diagnosis and treatment of migraine. J Headache Pain. 2019;20(1):113. DOI: https://doi.org/10.1186/s10194-019-1060-6

Stewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology. 2001;56(6):S20-8. DOI: https://doi.org/10.1212/WNL.56.suppl_1.S20

Blumenfeld AM, Varon SF, Wilcox TK, Buse DC, Kawata AK, Manack A, et al. Disability, HRQoL and resource use among chronic and episodic migraineurs: results from the International Burden of Migraine Study (IBMS). Cephalalgia. 2011;31(3):301-15. DOI: https://doi.org/10.1177/0333102410381145

Dodick DW. Migraine. Lancet. 2018;391:1315-30. DOI: https://doi.org/10.1016/S0140-6736(18)30478-1

Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, et al. Vestibular migraine: diagnostic criteria. J Vestib Res. 2012;22(4):167-72. DOI: https://doi.org/10.3233/VES-2012-0453

Grangeon L, Lange KS, Waliszewska-Prosół M, Onan D, Marschollek K, Wiels W, et al; European Headache Federation School of Advanced Studies (EHF-SAS). Genetics of migraine: where are we now? J Headache Pain. 2023;24(1):12. DOI: https://doi.org/10.1186/s10194-023-01547-8

Tan RY, Markus HS. CADASIL: Migraine, Encephalopathy, Stroke and Their Inter-Relationships. PLoS One. 2016;11(6):e0157613. DOI: https://doi.org/10.1371/journal.pone.0157613

Brennan KC, Bates EA, Shapiro RE, Zyuzin J, Hallows WC, Huang Y, et al. Casein kinase iδ mutations in familial migraine and advanced sleep phase. Sci Transl Med. 2013;5(183):1-11. DOI: https://doi.org/10.1126/scitranslmed.3005784

Williams LB, Javed A, Sabri A, Morgan DJ, Huff CD, Grigg JR, et al. ALPK1 missense pathogenic variant in five families leads to ROSAH syndrome, an ocular multisystem autosomal dominant disorder. Genet Med Off J Am Coll Med Genet. 2019;21:2103-15. DOI: https://doi.org/10.1038/s41436-019-0476-3

Haghdoost F, Togha M. Migraine management: Non-pharmacological points for patients and health care professionals. Open Med (Wars). 2022;17(1):1869-82. DOI: https://doi.org/10.1515/med-2022-0598

Waqas M, Ansari FUR, Nazir A, Hussain KSR, Sarfraz Z, Sarfraz A, et al. Zavegepant nasal spray for the acute treatment of migraine: A meta-analysis. Medicine (Baltimore). 2023;102(43):e35632. DOI: https://doi.org/10.1097/MD.0000000000035632

Tao X, Yan Z, Meng J, Wang W, Dai Q, Zhou Q, et al. The efficacy and safety of atogepant for the prophylactic treatment of migraine: evidence from randomized controlled trials. J Headache Pain. 2022;23(1):19. DOI: https://doi.org/10.1186/s10194-022-01391-2

Klein BC, Miceli R, Severt L, McAllister P, Mechtler L, McVige J, et al. Safety and tolerability results of atogepant for the preventive treatment of episodic migraine from a 40-week, open-label multicenter extension of the phase 3 ADVANCE trial. Cephalalgia. 2023;43(1):3331024221128250. DOI: https://doi.org/10.1177/03331024221128250

Yarnitsky D, Dodick DW, Grosberg BM, Burstein R, Ironi A, Harris D, et al. Remote Electrical Neuromodulation (REN) Relieves Acute Migraine: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Headache. 2019;59(8):1240-52. DOI: https://doi.org/10.1111/head.13551

Tiwari V, Agrawal S. Migraine and Neuromodulation: A Literature Review. Cureus. 2022;14(11):e31223. DOI: https://doi.org/10.7759/cureus.31223

Arca KN, Lambru G, Starling AJ. Neuromodulation in migraine. Handb Clin Neurol. 2024;199:179-200. DOI: https://doi.org/10.1016/B978-0-12-823357-3.00003-3

Daniel O, Tepper SJ, Deutsch L, Sharon R. External concurrent occipital and trigeminal neurostimulation relieves migraine headache: a prospective, randomized, double-blind, sham-controlled trial. Pain Ther. 2022;11(3):907-22. DOI: https://doi.org/10.1007/s40122-022-00394-w

Allen SM, Mookadam F, Cha SS, Freeman JA, Starling AJ, Mookadam M. Greater Occipital Nerve Block for Acute Treatment of Migraine Headache: A Large Retrospective Cohort Study. J Am Board Fam Med. 2018;31(2):211-8. DOI: https://doi.org/10.3122/jabfm.2018.02.170188

Phillips K, Koonalintip P, Wakerley BR. Migraine and Pregnancy. Life (Basel). 2024;14(10):1224. DOI: https://doi.org/10.3390/life14101224

Shen Y, Qi X, Wan T. The Treatment of Vestibular Migraine: A Narrative Review. Ann Indian Acad Neurol. 2020;23(5):602-7. DOI: https://doi.org/10.4103/aian.AIAN_591_19

Iannone LF, De Cesaris F, Geppetti P. Emerging Pharmacological Treatments for Migraine in the Pediatric Population. Life (Basel). 2022;12(4):536. DOI: https://doi.org/10.3390/life12040536

Turankar T, Sorte A, Wanjari MB, Chakole S, Sawale S. Relation and Treatment Approach of Migraine in Pregnancy and Breastfeeding. Cureus. 2023;15(3):e36828. DOI: https://doi.org/10.7759/cureus.36828

Di Stefano V, Rispoli MG, Pellegrino N, Graziosi A, Rotondo E, Napoli C, et al. Diagnostic and therapeutic aspects of hemiplegic migraine. J Neurol Neurosurg Psychiatr. 2020;91:764-71. DOI: https://doi.org/10.1136/jnnp-2020-322850

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Published

2025-03-28

How to Cite

Manorenj, S. (2025). Acute migraine: an overview : . International Journal Of Community Medicine And Public Health, 12(4), 1952–1964. https://doi.org/10.18203/2394-6040.ijcmph20250952

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Review Articles