Migraine Management: A Pharmacological Review of Current and Emerging Therapies

Abstract

Migraine is a predominant and disabling neurovascular disorder branded by recurrent episodes of moderate to severe headache accompanied by nausea, photophobia, and phonophobia. Advances in the understanding of migraine pathophysiology—particularly the role of the trigeminovascular system and calcitonin gene-related peptide (CGRP)—have significantly transformed therapeutic strategies. This review provides a comprehensive overview of current and emerging pharmacological approaches for migraine management. Conventional acute treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs) and triptans, remain first-line therapies, while preventive options such as beta-blockers, antiepileptics, and antidepressants are widely used in clinical practice. However, limitations such as inadequate efficacy, adverse effects, and contraindications have driven the development of targeted therapies. Recently approved CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, and eptinezumab) and small-molecule CGRP receptor antagonists (gepants) offer improved specificity and tolerability. Additionally, serotonin (5-HT1F) receptor agonists (ditans) and neuromodulatory approaches represent promising alternatives, especially for patients with cardiovascular risks. Emerging research also highlights novel targets, including ion channels and neuroinflammatory pathways, as well as advancements in personalized medicine. Overall, the evolving pharmacological landscape provides more effective and safer treatment options, emphasizing the need for individualized therapy to optimize clinical outcomes in migraine patients.