Migraine, ten years of progress

Abstract

In the past ten years, migraine has really entered the field of science, with a number of major advances: The publication by the International Headache Society of the first classification of all varieties of headache and of guidelines for therapeutic trials in migraine. The achievement of the first large scale epidemiological and socioeconomical studies of migraine. New insights in pathophysiopathology with, firstly, the use of the activation of the trigemino-vascular system as a model for the migrainous headache, and secondly, two fundamental observations made with positron emission tomography during the attacks: A postero-anterior cortical spreading oligemia and a brain stem activation that could be a 'migrainous generator'. The discovery of a calcium channel gene and of at least 2 other genes in familial hemiplegic migraine. The development of a new pharmacological class of drugs, the triptans, 5 HT1B/1D agonists which act specifically on the headache phase of the attack. Despite theses advances, a lot has still to be done to understand what migraine really is and to improve the management of migraine sufferers.