2024 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Neurology / Migraine Headache / Neurology / Migraine Headache 2024 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Neurology / Migraine Headache 2024 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Neurology / Migraine Headache 1 A Clinician’s Handbook on Migraine Indunil Karunarathna 1 , Sanjaya Godage 1 , PN Rodrigo 1 , Asoka Jayawardana 1 , U Vidanagama 1 , C Fernando 1 , U Ekanayake 1 , T Hapuarachchi 1 , P Gunasena 1 , P Aluthge 1 , N Perera 1 , S Gunathilake 1 , Kapila DeAlvis 1 , K Gunawardana 1 , S Rajapaksha 1 , A Warnakulasooriya 1 , P Athulgama 1 , Sanjeewa Dius 1 , R Ranwala 1 , Sau Bandara 1 , 1. Ministry of Health / Teaching Hospital Badulla / University of Colombo. 2024 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Neurology / Migraine Headache Abstract: Migraine is a complex neurological condition that significantly impacts the quality of life of millions worldwide. Acute and preventive therapies aim to alleviate symptoms and reduce the frequency and severity of attacks. This review examines pharmacological strategies, including NSAIDs, triptans, CGRP antagonists, and preventive options like β-adrenoceptor blockers, antidepressants, antiepileptic drugs, and botulinum toxin. Emphasis is placed on efficacy, safety, contraindications, and emerging treatments. Understanding these therapies is crucial for tailoring migraine management to individual patient needs and optimizing clinical outcomes. Key Words: Migraine therapy, NSAIDs, Triptans, CGRP antagonists, Preventive migraine treatment, Acute migraine management, Botulinum toxin, Antidepressants, β-adrenoceptor blockers, Evidence-based treatment Key Points: Acute Therapy: NSAIDs and triptans remain first-line therapies for immediate symptom relief, with CGRP antagonists emerging as alternatives for triptan-intolerant patients. Preventive Therapy: β-adrenoceptor blockers, antidepressants, antiepileptic drugs, and botulinum toxin are effective for reducing attack frequency and severity. Contraindications: Many drugs require caution in patients with comorbid conditions such as cardiovascular disease, hepatic or renal impairment, and pregnancy. Personalized Care: Tailoring therapy based on patient- specific factors enhances treatment efficacy and safety. Emerging Trends: The role of CGRP monoclonal antibodies and novel receptor agonists like lasmiditan reflects advancements in migraine management. Introduction Migraine is a complex, genetically influenced neurological disorder characterized by episodes of moderate-to-severe headaches. These headaches are often unilateral and pulsatile and are frequently accompanied by nausea, vomiting, and heightened sensitivity to light (photophobia) and sound (phonophobia). The term "migraine" originates from the Greek word hemikrania (meaning "half of the skull"), which evolved into the Latin hemigranea before being adopted in French as migraine. Migraine is among the leading causes of disability worldwide, significantly impacting individuals' quality of life and productivity. The World Health Organization ranks severe migraine attacks as one of the most disabling conditions, often resulting in loss of workdays and a diminished ability to perform daily activities. Migraines are not merely "bad headaches"; they are complex neurological events that unfold over hours or even days and can recur regularly, creating a chronic burden for many sufferers. The most prevalent type of migraine, accounting for approximately 75% of cases, is migraine without aura. This form manifests as episodic headaches without any preceding sensory disturbances, such as visual or auditory changes. Migraines are highly heterogeneous, with various subtypes and presentations influenced by genetic predispositions, environmental factors, and individual triggers. Subtypes of Migraine The International Headache Society (IHS) classifies migraines into several subtypes, including: Migraine Without Aura: Characterized by recurrent headaches lasting 4 to 72 hours. Pain is typically