Migraine affects approximately 39 million Americans — 18% of women and 6% of men — and is the second leading cause of disability globally. It is a complex neurological disorder involving cortical spreading depression, trigeminal nerve activation, and neurogenic inflammation. Up to one-third of patients experience aura — transient focal neurological symptoms — that precede the headache. Treatment distinguishes between acute (abortive) therapy — triptans, CGRP receptor antagonists (gepants), lasmiditan, NSAIDs — and preventive therapy for patients with frequent, severe, or disabling attacks. CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) represent a significant advance in migraine prevention, reducing monthly migraine days by 50% or more in approximately half of patients.
