What is a migraine and how does it manifest?
Migraine is not just a headache, but a complex neurological disease characterized by attacks of moderate to severe pain, often pulsating, accompanied by nausea, vomiting, and hypersensitivity to light and sound [1, 4]. This condition significantly impairs patients' quality of life on personal, family, and professional levels, and carries substantial social and economic consequences [4].
Migraine symptoms can be extremely debilitating, and every person with migraine needs treatment for acute attacks [1]. Patients with migraine often highlight pain relief or pain freedom as the primary priority when choosing therapy [7].
Modern methods for managing acute migraine attacks
Treatment of acute migraine attacks includes various approaches: from behavioral methods and non-specific medications to specific antimigraine agents and neuromodulation [1]. The physician's arsenal includes non-steroidal anti-inflammatory drugs (NSAIDs) and triptans, as well as newer classes of drugs such as ditans and gepants [4].
In recent years, new drugs with innovative mechanisms of action have been approved that target specific migraine pathways, providing more precise treatment with fewer side effects [1]. For some patients with vestibular migraine (a form of migraine manifested by dizziness), acute attacks can be alleviated with antiemetic drugs such as dimenhydrinate, meclizine, and metoclopramide [3].
Migraine Prevention: Strategies for Long-Term Control
For patients with frequent or severe migraine attacks, preventive treatment is recommended. This may include oral medications, botulinum toxin, and therapies that block the action of calcitonin gene-related peptide (CGRP) [4].
Oral preventive agents mentioned for vestibular migraine include metoprolol, amitriptyline, topiramate, valproic acid, or flunarizine [3]. Non-pharmacological methods, such as regular exercise, relaxation techniques, stress management, and biofeedback, can also be effective and can be combined with a pharmacological approach [3].
It is important to note that the efficacy of pharmacological migraine treatment in children and adolescents remains a subject of debate, and the safety profile of certain preventive medications in this vulnerable group raises concerns [8].
Neuromodulation and Genetic Aspects in Migraine Therapy
Neuromodulation is a modern trend in migraine treatment that uses devices to affect the nervous system. Over the past few years, the US Food and Drug Administration (FDA) has approved four neuromodulation devices for the treatment of acute migraine attacks [1]. Systematic reviews and meta-analyses of randomized controlled trials confirm the effectiveness of neurostimulation methods for both terminating acute attacks and preventing migraines [5].
In some cases, migraine may be linked to genetic factors. For example, a variant of the ATP1A2 gene (encoding the α2-subunit of Na+/K+-ATPase) is associated with various clinical phenotypes, including familial hemiplegic migraine type 2 (FHM2), epilepsy, and intellectual disability [2]. Early genetic testing can help determine the cause of the disease and select targeted treatment, as in the case of memantine, which reduced the frequency of migraines and seizures in a female patient with such a gene variant [2].
Migraine, Anxiety, and Panic States: Points of Intersection
Migraine, as a chronic neurological disease, frequently co-exists with other conditions, including anxiety disorders and depression [6]. Symptoms of anxiety and depression often manifest simultaneously, and studies point to a possible genetic predisposition to this combination [6]. Although panic attacks are not a direct consequence of migraines, the high level of anxiety and stress characteristic of people with migraines may contribute to the development or exacerbation of panic states.
It is important to note that there is significant therapeutic overlap between the treatment of anxiety and depression: many drugs effective for depression also help with symptoms of generalized anxiety disorder (GAD) [6]. Some of these drugs, such as amitriptyline or topiramate, are also used in migraine prevention [3, 4], which may explain their dual action in comorbid conditions. Stress management, relaxation techniques, and biofeedback recommended for the prevention of vestibular migraine can also be useful for reducing overall anxiety [3].
A Comprehensive Approach to Managing Migraine and Comorbid Conditions
Effective management of migraine and comorbid anxiety states requires a comprehensive approach. For many patients, a combination of various tools—from behavioral strategies and non-specific drugs to specific medications and neuromodulation—allows them to effectively cope with all types of attacks [1]. Explaining the nature of the disease and reassuring the patient are the first steps in therapy, as many do not require pharmacological treatment if attacks are infrequent and tolerable [3].
Understanding the connection between migraine, anxiety, and panic states enables physicians to develop more effective and personalized treatment strategies aimed not only at relieving pain but also at improving the patient's overall psycho-emotional state.
Sources
- [1] Acute Migraine Treatment. Continuum (Minneapolis, Minn.), 2021. https://pubmed.ncbi.nlm.nih.gov/34048394/
- [2] Prolonged coma and cerebral oedema in a patient with an ATP1A2 variant. Practical neurology, 2026. https://pubmed.ncbi.nlm.nih.gov/41290403/
- [3] Vestibular Migraine: Treatment and Prognosis. Seminars in neurology, 2020. https://pubmed.ncbi.nlm.nih.gov/31887753/
- [4] [Migraine treatment consensus document of the Spanish Society of Neurology (SEN), Spanish Society of Family and Community Medicine (SEMFYC), Society of Primary Care Medicine (SEMERGEN) and Spanish Association of Migraine and Headache (AEMICE) on migraine treatment]. Medicina clinica, 2024. https://pubmed.ncbi.nlm.nih.gov/38643025/
- [5] Neuromodulation techniques for acute and preventive migraine treatment: a systematic review and meta-analysis of randomized controlled trials. The journal of headache and pain, 2020. https://pubmed.ncbi.nlm.nih.gov/33302882/
- [6] Revisiting Treatment Options for Depressed Patients with Generalised Anxiety Disorder. Advances in therapy, 2021. https://pubmed.ncbi.nlm.nih.gov/34417993/
- [7] Priority acute and preventive migraine treatment benefits: Results of the Migraine Clinical Outcome Assessment System (MiCOAS) qualitative study of people living with migraine. Headache, 2023. https://pubmed.ncbi.nlm.nih.gov/37140142/
- [8] Iatrogenic harm in paediatric and adolescent populations of patients with migraine: A systematic review with meta-analysis. Cephalalgia : an international journal of headache, 2026. https://pubmed.ncbi.nlm.nih.gov/42412005/
The information presented in this article is for reference purposes only and cannot replace professional medical advice. Always consult a qualified specialist for diagnosis and treatment.