• Deborah I. Friedman
  • Shamin MasrourEmail author


Migraine is the most common cause of recurrent headaches encountered in clinical practice and the most prevalent neurological condition worldwide (World Health Organization. Atlas of headache disorders and resources in the world. Geneva: World Health Organization, 2011). It affects approximately 18% of women and 7% of men and children, touches one in four families, and is more common than diabetes and asthma combined (Lipton et al. Neurology 77:1905–1905, 2011; Hauser et al. Centers for disease control and prevention, US census bureau, and the Arthritis foundation, 1993). Migraine is consistently in the top ten of the World Health Organization’s most disabling disorders worldwide and is the second only to back pain as the leading cause of missed work days in the United States (World Health Organization. Atlas of headache disorders and resources in the world. Geneva: World Health Organization, 2011).

While pain management specialists focus on treating the pain of migraine, migraine is more than a headache; it is even possible to have migraine with little to no pain. Herein, we discuss the diagnosis and treatment of migraine in an era of new and emerging therapies based on the pathophysiology of the disorder.


Migraine Primary headache Migraine prophylaxis Migraine abortive therapy 


  1. 1.
    World Health Organization. Atlas of Headache Disorders and Resources in the World 2011. Geneva: World Health Organization. p. 2011.Google Scholar
  2. 2.
    Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2011;77(21):1905.CrossRefGoogle Scholar
  3. 3.
  4. 4.
    Guidetti V, Faedda N. From 0° to 18°: how headache changes over time. Neurol Sci. 2017;38(S1):103–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Gelfand AA. Episodic syndromes of childhood associated with migraine. Curr Opin Neurol. 2018;31:1.PubMedCrossRefGoogle Scholar
  6. 6.
    Lagman-Bartolome AM, Lay C. Pediatric migraine variants: a review of epidemiology, diagnosis, treatment, and outcome. Curr Neurol Neurosci Rep. 2015;15(6)Google Scholar
  7. 7.
    Evans RW, Marcus D, Furman JM. Motion sickness and migraine. Headache. 2007;47(4):607–10.PubMedCrossRefGoogle Scholar
  8. 8.
    Pavlovic JM, Stewart WF, Bruce CA, et al. Burden of migraine related to menses: results from the AMPP study. J Headache Pain. 2015;16:24.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Stewart WF, Lipton RB, Chee E, Sawyer J, Silberstein SD. Menstrual cycle and headache in a population sample of migraineurs. Neurology. 2000;55:1517–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Goadsby P, Goldberg J, Silberstein S. Migraine in pregnancy. Obstet Anesth Dig. 2009;29(1):45.CrossRefGoogle Scholar
  11. 11.
    Devlen J. Anxiety and depression in migraine. J R Soc Med. 1994;87(6):338–41.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Lake AE, Rains JC, Penzien DB, Lipchik GL. Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance. Headache. 2005;45(5):493–506.PubMedCrossRefGoogle Scholar
  13. 13.
    Wang S-J. Comorbidities of migraine. Front Neurol. 2010;4:1–9.Google Scholar
  14. 14.
    Lau C-I, Lin C-C, Chen H-J, Wang H-C, Chen W-H, Liang J-A. Increased risk of essential tremor in migraine: a population-based retrospective cohort study. PLoS One. 2017;12(3):e0173586.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Uneri A. Migraine and benign paroxysmal positional vertigo: an outcome study of 476 patients. Ear Nose Throat J. 2005;83(12):814–5.CrossRefGoogle Scholar
  16. 16.
    Gormley P, Kurki MI, Hiekkala ME, et al. Common variant burden contributes significantly to the familial aggregation of migraine in 1,589 families. Neuron. 2018;98(4):743–53.Google Scholar
  17. 17.
    Dodick DW. Migraine. Lancet. 2018;391(10127):1315–30.PubMedCrossRefGoogle Scholar
  18. 18.
    Maniyar FH, Sprenger T, Monteith T, Schankin C, Goadsby PJ. Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks. Brain. 2014;137:232–41.PubMedCrossRefGoogle Scholar
  19. 19.
    Hadjikhani N, Sanchez Del Rio M, Wu O, Schwartz D, Bakker D, Fischl B, et al. Mechanisms of migraine aura revealed by functional MRI in human visual cortex. Proc Natl Acad Sci U S A. 2001;98(8):4687–92.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Afridi SK, Griffin NJ, Kaube H, et al. A positron emission tomographic study in spontaneous migraine. Arch Neurol. 2005;62:1270–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of migraine: a disorder of sensory processing. Physol Rev. 2017;97:553–622.Google Scholar
  22. 22.
    Barbanti P, Fofi L, Aurilia C, Egeo G, Caprio M. Ketogenic diet in migraine: rationale, findings and perspectives. Neurol Sci. 2017;38(S1):111–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Friedman DI, Dye TDV. Migraine and the environment. Headache. 2009;49(6):941–52.PubMedCrossRefGoogle Scholar
  24. 24.
    Becker W. Weather and migraine: can so many patients be wrong? Cephalalgia. 2010;31(4):387–90.PubMedCrossRefGoogle Scholar
  25. 25.
    Bravo TP, Schwedt T. Poor acute treatment may lead to chronic migraine. Neurology Times March 4, 2015.Google Scholar
  26. 26.
    Pryse-Phillips WE, Dodick DW, Edmeads JG, Gawel MJ, Nelson RF, Purdy RA, Robinson G, Stirling D, Worthington I. Guidelines for the nonpharmacologic management of migraine in clinical practice. Canadian Headache Society. Can Med Assoc J. 1998;159(1):147–54.Google Scholar
  27. 27.
    Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American Headache Society evidence assessment of migraine pharmacotherapies. Headache. 2015;55(1):3–20.PubMedCrossRefGoogle Scholar
  28. 28.
    Grimsrud KW, Singh RBH. Emerging treatments in episodic migraine. Curr Pain Headache Rep. 2018;22(9):61.PubMedCrossRefGoogle Scholar
  29. 29.
    Reuter U, Mcclure C, Liebler E, Pozo-Rosich P. Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials. J Neurol Neurosurg Psychiatry. 2019;90(7):796–804.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Kuca B, Silberstein SD, Wietecha L, Berg PH, Dozier G, Lipton RB. Lasmiditan is an effective acute treatment for migraine. Neurology. 2018;91(24)PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Aurora SK, Kori SH, Barrodale P, Mcdonald SA, Haseley D. Gastric stasis in migraine: more than just a paroxysmal abnormality during a migraine attack. CME. Headache. 2006;46(1):57–63.PubMedCrossRefGoogle Scholar
  32. 32.
    Dodick DW. Triptan nonresponder studies: implications for clinical practice. Headache. 2005;45:156–62.PubMedCrossRefGoogle Scholar
  33. 33.
    Kristoffersen ES, Lundqvist C. Medication-overuse headache: epidemiology, diagnosis and treatment. Ther Adv Drug Safety. 2014;5(2):87–99.CrossRefGoogle Scholar
  34. 34.
    International Headache Society. The international classification of headache disorders, 3rd edn. Cephalalgia. 2018;38:1–211.Google Scholar
  35. 35.
    Westergaard ML, Hansen EH, Glümer C, Jensen RH. Prescription pain medications and chronic headache in Denmark: implications for preventing medication overuse. Eur J Clin Pharmacol. 2015;71(7):851–60.PubMedCrossRefGoogle Scholar
  36. 36.
    De Felice M, Ossipov MH, Wang R, et al. Triptan-induced latent sensitization: a possible basis for medication overuse headache. Ann Neurol. 2010;67:325–37.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Silberstein SD, Holland S, Freitag F, et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the quality standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1337–45.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Estemalik E, Tepper S. Preventive treatment in migraine and the new US guidelines. Neuropsychiatr Dis Treat. 2013;9:709.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Maasumi K, Tepper SJ, Kriegler JS. Menstrual migraine and treatment options: review. Headache. 2016;57(2):194–208.PubMedCrossRefGoogle Scholar
  40. 40.
    Dodick DW, Turkel CC, Degryse RE, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50(6):921–36.PubMedCrossRefGoogle Scholar
  41. 41.
    Simpson DM, Hallett M, Ashman EJ, et al. Practice guideline update summary: botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2016;86(19):1818–26.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Holland S, Silberstein S, Freitag F, Dodick D, Argoff C, Ashman E. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: [RETIRED]. Neurology. 2012;78(17):1346–53.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Allen SM, Mookadam F, Cha SS, Freeman JA, Starling AJ, Mookadam M. Greater occipital nerve block for acute treatment of migraine headache: a large retrospective cohort study. J Am Board Fam Med. 2018;31(2):211–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Yanuck J, Shah S, Jen M, Dayal R. Occipital nerve blocks in the emergency department for initial medication-refractory acute occipital migraines. Clin Pract Cases Emerg Med. 2019;3(1):6–10.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Inan LE, Inan N, Karadaş Ö, et al. Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study. Acta Neurologica Scandinavica. 2015;132(4):270–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Cady R, Saper J, Dexter K, Manley HR. A double-blind, placebo-controlled study of repetitive transnasal sphenopalatine ganglion blockade with Tx360®as acute treatment for chronic migraine. Headache. 2014;55(1):101–16.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Binfalah M, Alghawi E, Shosha E, Alhilly A, Bakhiet M. Sphenopalatine ganglion block for the treatment of acute migraine headache. Pain Res Treat. 2018;2018:1–6.CrossRefGoogle Scholar
  48. 48.
    Mellick LB, Mcilrath ST, Mellick GA. Treatment of headaches in the ED with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 417 patients. Headache. 2006;46(9):1441–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Hipskind J. Paraspinous cervical nerve block for primary headache. Emerg Med. 2017;49(04):162–5.CrossRefGoogle Scholar
  50. 50.
    Mekhail NA, Estemalik E, Azer G, Davis K, Tepper SJ. Safety and efficacy of occipital nerves stimulation for the treatment of chronic migraines: randomized, double-blind, controlled single-center experience. Pain Pract. 2016;17(5):669–77.PubMedCrossRefGoogle Scholar
  51. 51.
    Dodick DW, Silberstein SD, Reed KL, et al. Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: long-term results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia. 2014;35(4):344–58.PubMedCrossRefGoogle Scholar
  52. 52.
    Openey C, Alo K. Peripheral neurostimulation for the treatment of chronic, disabling transformed migraine. Headache. 2003;43:369–75.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Neurology and Neurotherapeutics, Department of OphthalmologyUT Southwestern Medical CenterDallasUSA
  2. 2.Department of Neurology and NeurotherapeuticsUT Southwestern Medical CenterDallasUSA

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