Abstract: Migraine is a complex neurological disorder characterized by recurrent episodes of moderate to severe headaches, often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. This article provides a comprehensive review of migraine, exploring its pathophysiology, clinical features, diagnostic approaches, management strategies, and recent innovations. By delving into the intricacies of migraine, ophthalmologists can improve their understanding and management of this debilitating condition.

Introduction: Migraine is one of the most prevalent neurological disorders worldwide, affecting millions of individuals across all age groups. Despite its high prevalence, migraine remains underdiagnosed and undertreated, highlighting the need for a better understanding of its complexities.

Pathophysiology: The pathophysiology of migraine involves intricate interplay between genetic, environmental, and neurovascular factors. Dysregulation of cortical and subcortical brain regions, trigeminovascular system activation, and cortical spreading depression contribute to the development of migraine attacks.

Clinical Manifestations: Migraine attacks typically present with unilateral throbbing headache accompanied by nausea, vomiting, photophobia, and phonophobia. Some patients may experience aura, characterized by transient neurological symptoms such as visual disturbances, sensory changes, or motor deficits.

Diagnostic Approaches: Diagnosis of migraine is primarily clinical, based on history and characteristic symptoms. Diagnostic criteria, such as those outlined by the International Classification of Headache Disorders, help differentiate migraine from other headache disorders. Neuroimaging studies may be warranted in atypical cases or when secondary causes are suspected.

Management Strategies: Management of migraine involves both acute treatment to alleviate symptoms during attacks and preventive measures to reduce the frequency and severity of episodes. Acute treatment options include analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, and antiemetics. Preventive therapies encompass lifestyle modifications, pharmacological agents, and neuromodulation techniques.

Emerging Therapies: Recent advancements in migraine management include the development of novel pharmacological agents targeting calcitonin gene-related peptide (CGRP) pathway, monoclonal antibodies against CGRP or its receptor, and neuromodulation devices such as transcranial magnetic stimulation (TMS) and non-invasive vagus nerve stimulation (nVNS).

Conclusion: Migraine poses significant challenges for patients and clinicians alike, necessitating a comprehensive approach to diagnosis and management. By staying informed about the latest research and therapeutic innovations, ophthalmologists can better support patients living with migraine.

For further reading and reference:

• American Migraine Foundation – Migraine Information and Resources: https://americanmigrainefoundation.org/
• Migraine Research Foundation – Understanding Migraine: https://migraineresearchfoundation.org/about-migraine/
• Neurology – Recent Advances in Migraine Research: https://n.neurology.org/