Migraine pathology:

Migraines involves the trigeminal nerve distribution to intra-cranial arteries. The trigeminal nerves release peptide neurotransmitters especially calcitonin gene-related peptide (CGRP), which is a strong vasodilator. Extravasation of plasma and plasma proteins into the perivascular space causes mechanical stretching and in turn activities the pain nerves in the dura.

Treatment:

Triptans eg Sumatriptan– They are selective agonists for 5-HT1D and 5-HT1B, this causes vasoconstriction and prevents the vasodilatory effects of the migraine as well as the pain associated with it, they also modulate neurotransmitter release thus reducing the amount of CGRP.

Ergot alkaloids eg Ergotamine – Partial agonist at 5-HT and at alpha adrenoreceptors especially in vessels thus preventing the vasodilation associated with migraines

Anti-inflammatory analgesics eg Aspirin- Control the pain associated with a migraine

Calcium channel blockers eg Verapamil- effective in the prophylaxis of migraine

Beta blockers eg Propranolol – effective in the prophylaxis of migraine