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The aim of this paper is to review the advancement in pharmacotherapy of migraine in parallel with understanding of the pathophysiology of the disease. Currently, migraine treatment are classified as acute attack and preventive therapies. The acute attack treatment is based on the fact that the migraine pain develops from nociceptive activation of trigeminal cranial afferents. In addition to recent review of triptans, specific agents with trigeminovascular pro- perties, recent development of acute treatment, CGRP receptor and glutamate antagonist, will be discussed. Till now, the exact mechanism of migraine preventive drugs is still unraveled. Recent study shows that most of preventive drugs are effective in reducing cortical spreading depression, corresponding to migraine aura. Newly introduced gap junction blocker, tonabersat, and glutamate antagonist would help for more sussessful management of migraine.
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