Clinical presentation and treatment of migraine.

The pathogenesis of migraine is not completely understood but may involve vasodilation of cerebral blood vessels and/or the release of vasoactive neuropeptides (ie, norepinephrine) from the perivascular axons in the dura mater after activation of the trigeminovascular system. Many environmental factors and physiologic influences may provoke a migraine or increase its severity. The typical migraine headache without aura is unilateral, pulsating, of moderate-to-severe intensity, and aggravated by physical activity. Migraine prevention is best achieved by avoidance of known migraine triggers or enhancers and by reducing the amount of lifestyle stressors. Pharmacotherapeutic options in the treatment of migraine are discussed herein.