Researchers reviewed developments in migraine therapy, including how the illness is classified and how diet and clinical interventions have advanced to significantly lower the frequency, pain, and severity of attacks, in a recent paper that was published in the journal Medicina. They draw attention to developments in the study of calcitonin gene-related peptides (CGRP) and the function of CGRP antagonists in the management of the illness. They also shed light on the function of low-glycemic and ketogenic diets in the treatment of disease. According to their research, CGRP receptor antagonists can significantly raise the number of migraine-free days that patients experience each month when taken in conjunction with dietary and exercise changes.

The Essential Guide to Migraine

A collection of long-term neurological disorders collectively referred to as "migraines" are marked by recurrent episodes of moderate to severe throbbing and pulsating pain on one side of the head. Frequently, it is accompanied by light and sound sensitivity as well as nausea. Although some reports have included children, adolescents are the ones most commonly affected. The risk of migraines is lower in those over 50.

Women are more likely than men to suffer from migraines; 12–14% of the sex suffers from it compared to 6-8% of men. In addition, compared to men, women typically experience longer attacks and more noticeable symptoms. When combined with its direct symptoms, which typically include blurred vision, loss of motor control, and difficulty speaking, the condition is ranked by the World Health Organization (WHO) as the seventh most disabling disease worldwide, or third if women alone are included.

As of yet, there are no known treatments for the illness;

 instead, clinical measures are mainly focused on controlling the occurrence and intensity of the illness. Five macro-groups have been identified by recent research that has also examined the factors (triggers) causing the disease: 1. Hormonal factors (particularly in women), 2. Dietary factors, 3. Environmental triggers, 4. Psychological factors (stress), and 5. Others. By comprehending how these variables interact and creating interventions specific to each patient, quality of life losses that patients currently endure could be significantly minimized.

Classification and diagnosis of migraines

The International Headache Society (IHS) first classified migraines in 1988, which marked a significant advance in the treatment of the condition by enabling the use of common terminology in scientific and medical research for the first time. Since its release in 2018, the most recent edition, "International Classification of Headache Disorders (ICHD-3rd edition beta version, called ICHD-3)," has been included in the World Health Organization's International Classification of Diseases (ICD-11).

More than 300 distinct types of headaches are recognized by conventional migraine classification, which divides them into 14 hierarchical groups with each group having a higher diagnostic accuracy than the one before it. The four groups are used to diagnose primary headaches, which typically have a genetic origin. When diagnosing migraines that develop as comorbidities in other diseases, groups 5 through 12 are utilized. Lastly, secondary headaches caused by non-genetic causes like head trauma, psychiatric disorders, hormonal imbalances, and substance abuse are classified into groups 13 and 14.

Remarkably, despite decades of research in the field, migraine diagnosis is still limited to screening for symptoms of the illness due to the lack of clinical diagnostic tests.

Treatment strategies for migraines

Historically, the goal of clinical migraine interventions, which include medication, has been to treat migraine-related pathologies in order to decrease the frequency of attacks. As a result, groups 5 through 12 of the previously mentioned classification have received the majority of attention. For instance, when migraines are a side effect of underlying cardiac conditions, beta-blockers are used to treat the heart issues under the theory that improved cardiovascular health would eventually lead to better outcomes for migraine sufferers.

Interventions aimed at controlling attacks after they happen are handled case-by-case according to the intensity of the attack; moderate attacks are managed with analgesics (ibuprofen), while the most severe ones require the use of antiemetic and triptan combinations along with intravenous fluids to replace those lost due to vomiting. Interestingly, none of the commonly prescribed drugs were created to treat migraines, which accounts for their poor effectiveness (the best-case scenario is a 50% decrease in the frequency and intensity of attacks).

The role of the calcitonin gene-related peptide (CGRP) receptor in migraine pathology has been identified by recent research, which is encouraging. The G-protein-coupled receptor (GPCR) family (B) that includes CGRP is primarily expressed in trigeminal neural ganglions. The identification of these receptors and the clarification of their connection to migraines have facilitated the swift creation of CGRP antagonists and, more recently, anti-CGRP monoclonal antibodies. These are innovative medications that are typically injected subcutaneously and block CGRP receptors, significantly enhancing the prognosis for migraine sufferers.

The first CGRP antagonist created expressly to treat migraines was olcegepant, but because of its large volume, it needed to be administered intravenously on a regular basis. As an oral substitute for Olcegepant, telcagepant was later created. Unfortunately, these medications had the well-known side effect of giving patients milder headaches that resembled migraines, just like all other CGRP antagonists that came after. On the other hand, advances in the field of monoclonal antibody research have led to the creation of anti-CGRP monoclonal antibodies, which have proven to be more effective than CGRP antagonists in treating patients while also being safe and free of side effects, even when used for extended periods of time.

Is diet a factor?

There is a strong correlation between food and different types of migraines, according to research; certain foods and diets increase the risk of migraines, while others help to prevent or treat them. Coffee is a perfect illustration of the "everything in moderation" rule; while overindulging in it can trigger migraines, moderation is one of the most well-known natural ways to prevent attacks.

Foods high in fiber, complex carbohydrates, and minerals—particularly calcium and magnesium—have shown promise in the treatment of the ailment and pain managment. Recent studies have also demonstrated the effectiveness of cannabis (Cannabis sativa) and ginger (Zingiber officinale) as natural, side-effect-free substitutes for anti-migraine medications.

While each patient has different trigger foods, dairy products, chocolate, eggs, meat, wheat, nuts, and certain fruits and vegetables (such as tomatoes, onions, corn, bananas, and apples) are the most frequently mentioned culprits. But the worst and most common triggers are alcohol-based drinks, particularly red wine. On the other hand, adult migraines can be controlled with increased calcium and magnesium intake and sodium abstinence (< 2400 mg/day), according to research by the Dietary Approaches to Stop Hypertension (DASH). Building on these findings, clinical trials have shown that diets high in plant-based foods and healthy fats, like the Mediterranean diet, can significantly reduce the frequency and duration of attacks by way of their association with the gut microbiome.

The low-carb, high-fat ketogenic diet was first created in the 1920s to treat childhood epilepsy, but it has since been discovered to be remarkably effective against a variety of other illnesses, including migraine.

In some clinically tested patients, the ketogenic diet has remarkably led to the complete cessation of migraines, demonstrating its usefulness as a safe behavioral modification against the illness. Regretfully, the exact mechanism by which this dietary pattern modifies migraine pathology remains unknown.

In conclusion

An overview of both traditional and contemporary developments in anti-migraine research is provided in this review. It looks at how the illness is categorized, treatment options for controlling the long-term ailment, and how food can either cause or prevent migraines. The study emphasizes the advantages of safe and effective therapies that can enhance patients' quality of life and, in certain situations, completely eliminate migraines, such as anti-CGRP monoclonal antibodies and diets like the Mediterranean and ketogenic diets.