Migraine as a Public Health Challenge: Contemporary Perspectives on Pathophysiology, Diagnosis and Treatment

Abstract

Introduction and purpose: Migraine is a common and disabling neurological disorder with substantial public health relevance. It affects education, work productivity, social functioning, and quality of life, particularly among adolescents and adults of working age. The aim of this review is to summarize contemporary perspectives on migraine epidemiology, risk factors, pathophysiology, clinical classification, comorbidities, and current treatment strategies. 

Brief description of the state of knowledge: Current evidence presents migraine as a complex disorder of sensory processing and neural network dysfunction rather than a purely vascular disease. Important mechanisms include activation of the trigeminovascular system, altered cortical and brainstem excitability, calcitonin gene-related peptide signaling, cortical spreading depression in migraine with aura, and peripheral and central sensitization. Diagnosis remains primarily clinical and should follow the International Classification of Headache Disorders criteria. Treatment includes acute pharmacotherapy, preventive drugs, anti-CGRP therapies, neuromodulation, education, lifestyle modification, regular physical activity, sleep regulation, and management of comorbid psychiatric, vestibular, sleep-related, and cardiovascular conditions. 

Summary: Migraine should be understood both as a neurological disease and as a public health challenge. Effective care requires individualized, multidisciplinary management that combines evidence-based pharmacological treatment with non-pharmacological support and long-term patient education.