After 35 years since the introduction of the International Classification of Headache Disorders (ICHD), we are living in the era of the second great revolution in migraine therapies. First, discoveries of triptans provided a breakthrough in acute migraine treatment utilizing bench-to-bedside research results on the role of serotonin in migraine. Next, the discovery of the role of neuropeptides, more specifically calcitonin gene-related peptide (CGRP) in migraine attack led to the development of anti-CGRP therapies that are effective both in acute and preventive treatment, and are also able to reduce migraine-related burden. Here, we reviewed the most recent clinical studies and real-world data on available migraine-specific medications, including triptans, ditants, gepants and anti-CGRP monoclonal antibodies. Novel drug targets, such as PACAP and amylins were also discussed. To address the main challenges of migraine therapy, the high heterogeneity of people with migraine, the prevalent presence of various comorbid disorders, and the insufficient medical care of migraine patients were covered. Promising novel approaches from the fields of omics, blood and saliva biomarker, imaging and provocation studies might bring solutions for these challenges with the potential to identify further drug targets, distinguish more homogeneous patient subgroups, contribute to more optimal drug selection strategies, and detect biomarkers in association with headache features or predicting treatment efficacy. In the future, the combined analysis of data of different biomarker modalities with machine learning algorithms may serve precision medicine in migraine treatment.

自国际头痛疾病分类 (ICHD) 推出 35 年后，我们生活在偏头痛治疗的第二次伟大革命的时代。首先，曲坦类药物的发现为急性偏头痛治疗提供了突破，利用了血清素在偏头痛中作用的实验室到临床研究结果。接下来，神经肽，更具体地说是降钙素基因相关肽（CGRP）在偏头痛发作中的作用的发现导致了抗 CGRP 疗法的开发，该疗法在急性和预防性治疗中均有效，并且还能够减少偏头痛。相关负担。在这里，我们回顾了现有偏头痛特异性药物的最新临床研究和真实数据，包括曲坦类、ditants、gepants 和抗 CGRP 单克隆抗体。还讨论了新的药物靶标，例如 PACAP 和胰岛淀粉样多肽。为了解决偏头痛治疗的主要挑战，解决了偏头痛患者的高度异质性、各种合并症的普遍存在以及偏头痛患者医疗护理不足的问题。来自组学、血液和唾液生物标志物、成像和激发研究领域的有前途的新方法可能会为这些挑战带来解决方案，并有可能确定更多的药物靶点，区分更同质的患者亚组，有助于制定更优化的药物选择策略，并检测生物标志物与头痛特征或预测治疗效果相关。未来，将不同生物标志物模式的数据与机器学习算法相结合的分析可能会为偏头痛治疗的精准医疗服务。