Novel Treatment Approaches for the Management of Migraine Pain

Migraine is a chronic neurological illness with a complex aetiology that causes recurrent attacks of unilateral, frequently severe headaches that are typically throbbing in nature. These frequently begin in the central nervous system, making the individual more susceptible to external influences, which can culminate in a wave of CSD and sensory processing disorder. Existing treatment options include acute, preventive and non- pharmacological therapies. The primary medications that specifically treat migraine include ergot alkaloids (ergotamine, dihydroergotamine), β -adrenoceptor antagonists (propranolol), agonists (sumatriptan), or partial agonists (methysergide) at a particular subtype of 5-HT1-like receptors, calcium antagonists (flunarizine), and anti-inflammatory drugs (indomethacin). One of the disadvantages of current anti-migraine drugs is their ability to induce medication-overuse headache. Monoclonal antibodies targeted against calcitonin gene-related peptide (CGRP) is the foremost approach for migraine prophylaxis. Although it has gained recognition as a target for the treatment of migraines, the efficacy and applicability of CGRP modifiers call for the investigation of additional therapeutic targets for the reduction of pain. Recent prophylactic treatments include tonabersat, non–selective phosphodiesterase inhibitors, dual-orexin receptor antagonists, angiotensin–II receptor antagonists and anticonvulsant drugs. Individuals with obstinate chronic headache, several neuromodulatory treatment approaches like stimulation of the occipital nerve, sphenopalatine ganglion, vagal nerve, and transcutaneous supraorbital nerve are found to be effective. Non-pharmacological migraine prevention measures such as trigger control, cognitive behavioural therapy, biofeedback, relaxation treatment, and physical methods such as acupuncture, posture control, and physical therapy are discerned as effective strategies. In contrast to the excruciatingly sluggish development of new migraine medicines, a number of incredibly reassuring new therapeutic options are on the horizon. The identification of these novel therapeutic options for migraines is essential to address the limitations of current treatments, provide personalized care, minimize side effects, and ultimately enhance the overall standard of life of individuals living with migraines. This chapter discusses about the novel treatment strategies that are being investigated for the acute treatment and prevention of migraine.