An update on migraine pathophysiology and mechanism-based pharmacotherapeutics for migraine.

The pathophysiologic mechanisms of migraine are complex but appear to primarily involve the trigeminovascular system. Within this system, a number of factors may contribute to the generation and perpetuation of pathophysiologic changes leading to migraine. Current migraine medications exert their therapeutic benefit via actions at various points relating to these pathophysiologic changes. However, no single agent currently exists that targets all the hypothesized anatomical and cellular mechanisms of the migraine process. A future strategy for achieving optimal therapeutic effect and improving clinical outcomes in migraine involves rational targeting of the multiple mechanisms involved in its pathophysiology; conceptually, this may require concomitant use of multiple pharmacotherapeutic agents.