Migraine: from a new concept of triggers to effective acute attack relief

Migraine: from a new concept of triggers to effective acute attack relief

A.V. Sergeev¹, E.V. Ekusheva²

Evgenia V. Ekusheva, e-mail: ekushevaev@mail.ru

¹Sechenov First Moscow State Medical University, Moscow

²Academy of Postgraduate Education of the Federal Scientific and Clinical Center of the Federal Medical Biological Agency of Russian Federation, Moscow

Migraine is a chronic neurological disorder characterized by recurrent attacks of moderate to severe headache and affects up to 20% of the adult population, with the highest prevalence observed in young women. Inadequately treated migraine attacks are associated not only with temporary disability and impaired quality of life, but also with an increased risk of disease chronification. In real-world practice, up to 70% of patients with migraine either self-medicate or do not receive optimal therapy for acute attack relief and prevention of disease progression. According to the current pathophysiological model, migraine triggers should not be regarded as independent etiological factors, but rather as modulators acting in the setting of genetically determined dysfunction of the hypothalamic–trigeminal axis, dishabituation, and a reduced threshold for cortical spreading depression. This concept accounts for the episodic course of migraine, interindividual variability in provoking factors, and the high efficacy of therapies targeting calcitonin gene-related peptide (CGRP) signaling and stabilization of hypothalamic function. Triptans, selective serotonin 5-HT1B/1D receptor agonists, remain among the most effective pathogenetically based agents for the acute treatment of migraine attacks. Intranasal zolmitriptan offers faster absorption than oral formulations because it is partially absorbed through the nasal mucosa, thereby bypassing the gastrointestinal tract. The drug can be detected in plasma as early as 5 minutes after administration, with a clinically meaningful effect observed within 15 minutes. This route of administration is particularly advantageous in patients with nausea, vomiting, or gastroparesis, conditions in which the absorption of oral agents may be delayed.

Keywords: migraine, neurobiology, migraine triggers, triptans, acute attack relief, zolmitriptan.

For citation: Sergeev A.V., Ekusheva E.V. Migraine: from a new concept of triggers to effective acute attack relief. RMJ. 2026;4:13–17. DOI: 10.32364/2225-2282-2026-4-3