Migraine is a very common neurological headache disorder caused by increased excitability of the central nervous system and is one of the most common disorders affecting daily life and work worldwide. The diagnosis is made based on the characteristics of the headache and the associated symptoms: migraine has considerable social and economic impact and can affect the quality of life, work, social activities and family life of the patient. There are many ways to treat migraine during acute attacks and prophylactically. Treatment during acute attacks can be either specific (tritans and ergot) or non-specific (analgesics): migraine that severely affects daily life and work should be treated with tritans. Frequent headache attacks are an indication for prophylactic treatment: Prophylactic treatment can reduce the frequency of attacks and improve quality of life, and more treatments are becoming available, offering hope to many patients whose migraines remain uncontrolled. Migraine attacks: Migraine attacks consist of a prodromal phase, an aura phase, a headache phase, and a remission phase. 20% to 60% of migraineurs may present with prodromal symptoms hours to days before a headache attack, including psychological, neurological, systemic, or autonomic features, such as depression, cognitive dysfunction, and bulimia. Patients with prodromal symptoms accurately predict 72% of full-blown episodic headaches, with the most common symptoms being feeling tired or fatigued (72%), difficulty concentrating (51%), and neck stiffness (50%). Poorer status is usually predictive of headache. Aura: The aura usually lasts 5 to 20 minutes, lasts no more than 60 minutes, can be visual, sensory and motor, and can include language or brainstem disturbances. Headaches usually appear within 60 minutes of the end of the aura period: simple visual aura includes dark spots in the visual field, simple flashes (optical hallucinations), spots, geometric figures, and flashes. More complex visual auras include flashing dark spots or castle-like spectra (characteristic migraine aura), visual distortion, visual magnification, zoom phantoms, and mosaic phantoms. Sensory abnormalities are usually hand aura: numbness starts in the hands and moves up the arms, then jumps to the face, lips and tongue. Weakness is rare, usually accompanied by sensory symptoms and is unilateral . Disuse, aphasia and dysarthria, altered states of consciousness with déjà vu or old-as-new sensations, complex dreams, nightmares, somnambulism or delirium may also occur. Headache phase: The typical headache is unilateral, gradual and throbbing (85%), with moderate to severe headache, which can be aggravated by activity. The headache may also be bilateral (40%) or may start on one side and progress to both sides. The headache lasts from 4 to 72 h in adults and from 1 to 72 h in children. loss of appetite is common. Nausea occurs in almost 90% of patients and vomiting in 1/3 of patients. Sensory hypersensitivity may cause patients to choose dark, quiet rooms. Patients may also experience blurred vision, nasal congestion, anorexia, hunger, urgency, diarrhea, abdominal cramps, polyuria, pallor, feeling hot or cold, and sweating. Depression, fatigue, anxiety, nervousness, irritability, and inattention are also common. Various combinations of symptoms may be associated with the neuronal modules involved. In remission: After a headache, patients often feel tired, weak, irritable, or lethargic, and may have difficulty concentrating, scalp pressure, or mood changes. Some patients experience an unusual sense of mental exhilaration or euphoria after a headache attack, others experience depression and fit. Treatment: Treatment of migraine should begin with making a diagnosis, explaining the disorder to the patient, and developing a treatment plan that takes into account the accompanying symptoms. A headache diary should be kept, including the duration, severity, and outcome of the headache attack. Comorbidity means that there is an association between the two disorders, not just a co-occurrence. Disorders that occur more frequently than expected in migraineurs include stroke, epilepsy, Raynaud’s syndrome, and affective disorders (including depression, mania, anxiety, and panic). Disorders that may be associated include idiopathic tremor, mitral valve prolapse, and irritable bowel syndrome. Pharmacologic treatment can be either acute onset treatment or prophylactic treatment, and patients may need both. Once a headache has started, acute attack treatment should be used to reverse or stop the progression of the headache. Prophylactic treatment aims to reduce the number and severity of attacks. Acute attack therapy is indicated for most attacks but should be limited to 2 to 3 days per week. A. Pharmacotherapy for acute migraine: a. Non-specific drugs: (1) Analgesics, non-steroidal anti-inflammatory drugs: aspirin, ibuprofen, tolfenamic acid, naproxen sodium, acetaminophen and acetaminophen, aspirin combined with caffeine are effective in the treatment of acute attacks of migraine. (2) Barbiturate hypnotics: less commonly used. (3) Opioid-like substances: opioid-like substances are very effective . However, because of the risk of drug overuse, they should only be used in patients with infrequent severe headaches who do not take more than 2 times a week. (4) Psychostimulants and antiemetics: b. Specific drugs: (1) Selective 5-HT. agonists (triton): The first triton is sumatriptan, followed by zolmitriptan, naratriptan, rizatriptan, almotriptan, frotratriptan and irinotriptan that are marketed. These drugs have a better central permeability than sumatriptan. All of these drugs are effective, even when applied after a migraine attack, and tend to be more effective when the pain is milder than when it is more severe . They may relieve headache, nausea and vomiting. Common adverse effects include subcutaneous injection site pain, tingling, flushing, burning or fever, dizziness, abnormal sensation, drowsiness, fatigue, heaviness, neck pain, and irritability. (2) Ergotamine and dihydroergotamine. (3) Corticosteroids. B. Prophylactic treatment: including beta-blockers, antidepressants, calcium channel antagonists, 5-HT antagonists, anticonvulsants and nonsteroidal anti-inflammatory drugs.