How do the Currently Used Prophylactic Agents Work in Migraine?

Abstract

Since migraine attacks are often frequent they require management with agents that reduce their number. Such agents, although often effective, are mechanistically ill-understood, They have been suggested to work through four main mechanisms, 5HT2 antagonism, modulation of plasma protein extravasation, modulation of central aminergic control mechanisms and membrane stabilizing effects through actions at voltage-sensitive channels. The evidence for these mechanisms, except plasma protein extravasation (see Cutrer, this supplement) is examined in the light of current thoughts concerning the pathophysiology of migraine. The understanding of the action of preventative drugs is at a relatively immature stage. Recent developments in pharmacology and studies of the pathophysiology of migraine have provided a substrate around which concepts can be developed. The actions and indeed the locus of action of the preventatives is crucial since these drugs are likely to point to the basic defect which underlies the process responsible for a migraine attack. Understanding this process can only facilitate patient management both in terms of explaining the disease and its implications and in controlling its clinical manifestations.