Migraine is a disabling neurovascular disorder among people of all ages, with the highest prevalence in the fertile years, and in women. Migraine impacts the quality of life of affected individuals tremendously and, in addition, it is associated with highly prevalent metabolic diseases, such as obesity, diabetes mellitus and thyroid dysfunction. Also, the clinical response to drugs might be affected in patients with metabolic disease due to body composition and metabolic change. Therefore, the efficacy of antimigraine drugs could be altered in patients with both migraine and metabolic disease. However, knowledge of the pharmacology and the related clinical effects of antimigraine drugs in patients with metabolic disease are limited. Therefore, and given the clinical relevance, this article provides a comprehensive overview of the current research and hypotheses related to the influence of metabolic state and body composition on the action of antimigraine drugs. In addition, the influence of antimigraine drugs on metabolic functioning and, vice versa, the influence of metabolic diseases and its hormonal modulating medication on migraine activity is outlined. Future exploration on personalizing migraine treatment to individual characteristics is necessary to enhance therapeutic strategies, especially given its increasing significance in recent decades.

Casa Di Cura Santa Maria Maddalena Neurology and Neurophysiology Service Occhiobello Italy

Department of Applied Clinical Sciences and Biotechnology Neuroscience Section University of L'Aquila L'Aquila Italy

Department of Human Neurosciences Sapienza University of Rome Rome Italy

Department of Internal Medicine Division of Vascular Medicine and Pharmacology Erasmus MC Erasmus University Medical Center Rotterdam PO Box 2040 3000 CA Rotterdam The Netherlands

Department of Medico Surgical Sciences and Biotechnologies Sapienza University of Rome Polo Pontino ICOT Latina Italy

Department of Neurology Charité Universitätsmedizin Berlin Berlin Germany

Department of Neurology University Hospital Wroclaw Medical University Wroclaw Poland

Neurology Department Vall d'Hebron University Hospital Barcelona Spain

St Anne's University Hospital Faculty of Medicine Masaryk University Czech Republic Brno Czech Republic

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