MIGRAINE: CAUSES AND TREATMENT METHODS

Аннотация

Migraine is a prevalent neurological disorder characterized by recurrent, debilitating headaches and a spectrum of sensory, autonomic, and cognitive symptoms, affecting 15-20% of the global population. Its complex etiology involves genetic predisposition, environmental triggers, and neurovascular mechanisms, including cortical spreading depression, trigeminovascular activation, and serotonin dysregulation. Recent advances have highlighted the role of calcitonin gene-related peptide (CGRP) and the gut- brain axis in pathogenesis, driving the development of targeted therapies such as CGRP monoclonal antibodies and neuromodulation devices. This article provides a comprehensive overview of migraine causes, integrating genetic, neurobiological, and environmental perspectives, and evaluates current and emerging treatment strategies, including pharmacological, non-pharmacological, and lifestyle interventions. Despite therapeutic progress, challenges such as treatment access, cost barriers, and disease heterogeneity persist. The article underscores the need for personalized medicine, multidisciplinary care, and global health initiatives to alleviate the substantial burden of migraines. Keywords: Migraine, headache, trigeminovascular system, cortical spreading depression, CGRP, serotonin, neuromodulation, monoclonal antibodies, gut-brain axis, personalized medicine, neuroinflammation, preventive treatment. Migraine is a chronic and debilitating neurological disorder characterized by recurrent, often excruciating headaches accompanied by a diverse array of sensory, autonomic, cognitive, and psychological symptoms. Affecting approximately 15-20% of the global population, with a three-fold higher prevalence in women due to hormonal influences, migraines impose a profound burden on individuals, healthcare systems, and economies, contributing to significant disability, lost productivity, and healthcare costs. The disorder’s complexity arises from its multifactorial etiology, encompassing genetic predisposition, environmental triggers, and intricate neurovascular, neuroinflammatory, and neuroendocrine mechanisms. Recent advances in neuroimaging, molecular biology, systems neuroscience, and therapeutic 129 SOLUTION OF SOCIAL PROBLEMS IN MANAGEMENT AND ECONOMY International scientific-online conference innovation have significantly deepened our understanding of migraines, yet challenges in achieving universal treatment efficacy and equitable access to care persist. This article provides an exhaustive exploration of the causes of migraines and the evolving landscape of treatment methods, synthesizing established knowledge with cutting-edge research to illuminate this multifaceted condition and its comprehensive management. The pathogenesis of migraines is driven by a dynamic interplay of genetic, environmental, and neurobiological factors. Genetic studies have been pivotal in elucidating the hereditary basis of migraines, particularly through the identification of mutations associated with familial hemiplegic migraine (FHM), a rare monogenic subtype. Mutations in genes such as CACNA1A (encoding a voltage-gated calcium channel), ATP1A2 (encoding a sodium-potassium ATPase), and SCN1A (encoding a sodium channel) disrupt ion homeostasis and synaptic transmission, leading to heightened cortical excitability. These genetic alterations provide a mechanistic basis for the hyperexcitable brain state observed in migraineurs. Beyond FHM, genome-wide association studies (GWAS) have identified over 38 genetic loci associated with common migraine forms, implicating pathways involved in vascular function, neuronal signaling, pain modulation, and glutamate homeostasis. These findings suggest a polygenic architecture for migraines, with cumulative genetic variants contributing to individual susceptibility and phenotypic variability. Environmental triggers significantly modulate migraine onset, interacting with genetic predispositions to create a highly individualized disease profile. Common triggers include psychological stress, sleep disturbances (e.g., insomnia, sleep apnea, or excessive sleep), dietary factors (e.g., caffeine, alcohol, chocolate, aged cheeses, monosodium glutamate, or aspartame), sensory stimuli (e.g., bright lights, loud noises, strong odors, or visual patterns), and meteorological changes (e.g., barometric pressure shifts). Hormonal fluctuations, particularly in estrogen levels, are a critical trigger in women, with migraines frequently correlating with menstrual cycles, pregnancy, postpartum periods, or menopausal transitions. This hormonal link is supported by evidence of altered estrogen receptor expression in brain regions such as the hypothalamus, amygdala, and prefrontal cortex, which are involved in pain processing, emotional regulation, and autonomic control. The variability of triggers underscores the importance of personalized trigger identification through patient diaries and clinical assessments, which are c