Metabolomic insights into migraine: mechanisms and biomarkers from in vivo and clinical studies.

Migraine is a complex neurological disorder with recurrent moderate to severe headaches. Symptoms often include nausea, photophobia, and phonophobia. Despite advances in neuroimaging, diagnosis still relies on clinical symptoms. Metabolomics analyzes small-molecule metabolites, offering insights into migraine's neuro-pathophysiology. This approach can help identify new biomarkers and therapeutic targets. In vivo studies show migraine is linked to metabolic changes. These include impaired energy metabolism and altered glucose utilization. High-energy phosphate intermediates are decreased, while lactate concentrations are increased. Elevated excitatory neurotransmitters and reduced inhibitory neurotransmitters are also noted. Increased oxidative stress and lower antioxidant levels are present in migraine models. Clinical studies confirm changes in metabolomic profiles during ictal and interictal phases. Disrupted lipid and amino acid metabolism is evident. Interventions like acupuncture and ibuprofen can partially reverse metabolic derangements. This review summarizes findings from in vivo and clinical studies on migraine metabolomics. Clinical relevance: This review highlights potential biomarkers and therapeutic targets for effective migraine management.