Gawde Prathamesh, Shah Harsh, Patel Harsh, Bharathi Koppineedi S, Patel Neil, Sethi Yashendra, Kaka Nirja
Medicine and Surgery, Lokmanya Tilak Municipal Medical College, Mumbai, IND.
Medicine and Surgery, Pandit Deendayal Upadhyay Medical College, Rajkot, IND.
Cureus. 2023 Feb 2;15(2):e34553. doi: 10.7759/cureus.34553. eCollection 2023 Feb.
Migraine affects about one billion people worldwide yearly and is one of the most common neurologic illnesses, with a high prevalence and morbidity, particularly among young adults and females. Migraine is associated with many comorbidities, including stress, sleep difficulties, and suicidal ideation. Migraine, despite its widespread occurrence, is underdiagnosed and undertreated. Because of the complicated and primarily unknown mechanisms of migraine formation, several social and biological risk factors, such as hormone imbalances, genetic and epigenetic impacts, and cardiovascular, neurological, and autoimmune illnesses, have been proposed. Through the mid-20th century diversion of the now-defunct vascular theory, the pathophysiology of migraine has developed from a historical study of the "humours" to a distinct entity as a neurological disorder. The range of therapeutic targets has broadened significantly, increasing the number of specialized clinical trials. Understanding the biology of migraine through careful research has resulted in the identification of major therapeutic classes: (i) triptans, serotonin 5-HT1B/1D receptor agonists, (ii) gepants, calcitonin gene-related peptide (CGRP) receptor antagonists, (iii) ditans, 5-HT1F receptor agonists, (iv) CGRP monoclonal antibodies, and (v) glurants, mGlu5 modulators, with further targets being explored. This review provides a comprehensive overview of the most recent literature on epidemiology and risk factors and exposes knowledge gaps.
偏头痛每年影响全球约10亿人，是最常见的神经系统疾病之一，具有高患病率和发病率，尤其在年轻人和女性中。偏头痛与许多合并症相关，包括压力、睡眠困难和自杀意念。尽管偏头痛普遍存在，但诊断不足且治疗不充分。由于偏头痛形成的机制复杂且主要未知，已提出了几种社会和生物学风险因素，如激素失衡、遗传和表观遗传影响以及心血管、神经和自身免疫性疾病。通过20世纪中叶现已过时的血管理论的转变，偏头痛的病理生理学已从对“体液”的历史研究发展成为一种独特的神经系统疾病实体。治疗靶点的范围显著扩大，专门的临床试验数量增加。通过仔细研究了解偏头痛的生物学特性，已确定了主要的治疗类别：（i）曲坦类药物，即5-羟色胺1B/1D受体激动剂；（ii） gepants类药物，即降钙素基因相关肽（CGRP）受体拮抗剂；（iii） ditans类药物，即5-羟色胺1F受体激动剂；（iv） CGRP单克隆抗体；以及（v） glurants类药物，即代谢型谷氨酸受体5（mGlu5）调节剂，还有更多靶点正在探索中。本综述全面概述了关于流行病学和风险因素的最新文献，并揭示了知识空白。
