title: Pathophysiological targets for non-pharmacological treatment of migraine.
abstract: Background Migraine is the most prevalent neurological disorder worldwide and ranked sixth among all diseases in years lived with disability. Overall preventive anti-migraine therapies have an effect in one patient out of two at the most, many of them being endowed with disabling adverse effects. No new disease-modifying drugs have come into clinical practice since the application to migraine of topiramate and botulinum toxin, the latter for its chronic form. There is thus clearly a need for more effective treatments that are devoid of, or have acceptable side effects. In recent years, scientific progress in migraine research has led to substantial changes in our understanding of the pathophysiology of migraine and paved the way for novel non-drug pathophysiological-targeted treatment strategies. Overview Several such non-drug therapies have been tested in migraine, such as oxidative phosphorylation enhancers, diets and non-invasive central or peripheral neurostimulation. All of them are promising for preventive migraine treatment and are quasi-devoid of side effects. Their advantage is that they can in theory be selected for individual patients according to their pathophysiological profile and they can (and probably should) be combined with the classical pharmacological armamentarium. Conclusion We will review here how knowledge of the functional anatomy and physiology of migraine mechanisms holds the key for more specific and effective non-pharmacological treatments.
authors.affiliation: 1 G.B. Bietti Foundation IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Coppola
authors.affiliation: 2 Don Carlo Gnocchi Onlus Foundation, Italy.
authors.forename: Cherubino
authors.initials: C
authors.lastname: Di Lorenzo
authors.affiliation: 3 "Sapienza" University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Serrao
authors.affiliation: 1 G.B. Bietti Foundation IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Parisi
authors.affiliation: 4 Liège University, Headache Research Unit. University Department of Neurology, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Schoenen
authors.affiliation: 3 "Sapienza" University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Italy.|5 IRCCS Neuromed, Pozzilli (IS), Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pierelli
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D004035:Diet Therapy / Q000379:methods*; D019587:Dietary Supplements; D004599:Electric Stimulation Therapy / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis / Q000628:therapy*; D058765:Neurofeedback / Q000379:methods*; D016896:Treatment Outcome
keywords: Non-pharmacological treatment; diets; migraine pathophysiology; neurostimulation; nutraceuticals