The Pathology of Migraines:

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

Treatment:

Triptans eg Rizatriptan– Selective agonists for 5-HT1D and 5-HT1B. Causes
vasoconstriction and prevents the vasodilatory effects and pain associated with migraines.

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

Anti-inflammatory analgesics eg Aspirin- Controls migraine pains.

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

Beta blockers eg Timolol–Used in the prophylaxis of migraine.