Modern pharmacotherapeutic strategies in the treatment of migraine: from the signaling pathways of calcitonin gene-related peptide (CGRP) to novel therapeutic agents

Background. Migraine is a chronic neurological disorder that significantly reduces the quality of life of patients and is a major cause of disability. Treating migraines is challenging and requires an individualized approach due to the variety of clinical manifestations and resistance to traditional therapy. One of the key aspects of the pathogenesis of migraine is the role of calcitonin gene-related peptide (CGRP), which is actively studied as an essential element in the mechanism of migraine development and in therapeutic strategies. Purpose – to characterize the current understanding of the pathogenesis and pharmacotherapeutic strategies in the treatment of migraine through the lens of the signaling pathways of calcitonin gene-related peptide (CGRP). Materials and methods. Publications were selected from the PubMed, Clinical Key Elsevier, Cochrane Library databases, among others, which highlighted information about the pathogenesis and pharmacotherapeutic strategies in the treatment of migraine. The review was prepared following the key principles of the PRISMA guidelines. Results. The mechanism of migraine development is closely linked to the activation of the trigeminovascular system and meningeal sensory system. A central factor in the pathogenesis of migraine is the CGRP peptide, which plays a crucial role in vasodilation and pain activation. The review showed that new pharmacological strategies, particularly monoclonal antibodies targeting CGRP or its receptors, are promising for the treatment of migraine. In recent years, significant progress has been made in the use of monoclonal antibodies, triptans, antidepressants, antiepileptic drugs, and gepants for the prevention and treatment of migraine attacks, significantly improving clinical outcomes. Conclusions. The relevance of studying the mechanisms of CGRP in the pathogenesis of migraine is supported by new pharmacotherapeutic approaches, including the use of monoclonal antibodies and gepants. These drugs have shown high therapeutic efficacy in patients with resistant and chronic migraines. The prospects for further research lie in further exploring molecular mechanisms and improving treatment strategies aimed at enhancing the quality of life for patients.