U.O.C. Pediatrics -S. Giuseppe Moscati Hospital, 83100 Avellino, Italy.
Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", 70126 Bari, Italy.
Medicina (Kaunas). 2024 Jan 15;60(1):163. doi: 10.3390/medicina60010163.
The study of migraine is based on the complexity of the pathology, both at the pathophysiological and epidemiological levels. Although it affects more than a billion people worldwide, it is often underestimated and underreported by patients. Migraine must not be confused with a simple headache; it is a serious and disabling disease that causes considerable limitations in the daily life of afflicted people, including social, work, and emotional effects. Therefore, it causes a daily state of suffering and discomfort. It is important to point out that this pathology not only has a decisive impact on the quality of life of those who suffer from it but also on their families and, more generally, on society as a whole. The clinical picture of migraine is complex, with debilitating unilateral or bilateral head pain, and is often associated with characteristic symptoms such as nausea, vomiting, photophobia, and phonophobia. Hormonal, environmental, psychological, dietary, or other factors can trigger it. The present review focuses on the analysis of the physiopathological and pharmacological aspects of migraine, up to the correct dietary approach, with specific nutritional interventions aimed at modulating the symptoms. Based on the symptoms that the patient experiences, targeted and specific therapy is chosen to reduce the frequency and severity of migraine attacks. Specifically, the role of calcitonin gene-related peptide (CGRP) in the pathogenesis of migraine is analyzed, along with the drugs that effectively target the corresponding receptor. Particularly, CGRP receptor antagonists (gepants) are very effective drugs in the treatment of migraine, given their high diffusion in the brain. Moreover, following a ketogenic diet for only one or two months has been demonstrated to reduce migraine attacks. In this review, we highlight the diverse facets of migraine, from its physiopathological and pharmacological aspects to prevention and therapy.
偏头痛的研究基于病理学的复杂性,包括生理病理学和流行病学两个层面。尽管全球有超过 10 亿人受到偏头痛的影响,但患者往往对此低估和漏报。偏头痛不能与简单的头痛混淆;它是一种严重且致残的疾病,会给患者的日常生活带来相当大的限制,包括社交、工作和情感方面的影响。因此,它会导致患者每天都感到痛苦和不适。需要指出的是,这种疾病不仅对患者的生活质量具有决定性影响,还会对他们的家庭以及更广泛的社会产生影响。偏头痛的临床表现较为复杂,会出现单侧或双侧头痛,且常伴有恶心、呕吐、畏光和畏声等特征性症状。激素、环境、心理、饮食或其他因素都可能引发偏头痛。本综述重点分析了偏头痛的生理病理和药理学方面,以及正确的饮食方法,包括特定的营养干预措施,旨在调节症状。根据患者所经历的症状,选择有针对性和特异性的治疗方法,以减少偏头痛发作的频率和严重程度。具体而言,分析了降钙素基因相关肽(CGRP)在偏头痛发病机制中的作用,以及针对相应受体的有效药物。特别是 CGRP 受体拮抗剂( gepants)是治疗偏头痛非常有效的药物,因为它们在大脑中有很高的扩散性。此外,仅进行一到两个月的生酮饮食已被证明可以减少偏头痛发作。在本综述中,我们强调了偏头痛的多个方面,包括其生理病理和药理学方面,以及预防和治疗。