Migraine is one of the most prevalent headache disorders in the TMD population. This presentation will discuss the significance of this clinical co-morbidity and highlight the need for a better understanding of its underlying mechanisms to support evidence based novel treatments. Our most recent published and unpublished preclinical studies will be presented, supporting recent advances in our understanding of the neural and molecular mechanisms involved. Potential novel avenues for treatment of this comorbidity will be highlighted.

Migraine is more prevalent in women, which is often attributed to an influence of hormones on migraine pathology, but the mechanisms by which this occurs are complex and not dependent on any single hormone. We have shown previously using rodent headache models that prolactin receptor expression and function contribute to pain signaling from the meninges in females but not males. The work presented here was aimed at testing a link between stress exposure and prolactin release in the development of headache-like behavioral responses in female and male mice. Stress is well known to promote release of prolactin from the pituitary. Here, we tested the hypothesis that suppression of prolactin release from the pituitary using the dopamine D2 receptor agonist bromocriptine, or genetic deletion of prolactin receptors from peripheral sensory neurons, would attenuate the effects of stress predominantly in females. Repeated stress exposure caused periorbital hypersensitivity in both female and male mice. However, treatment with bromocriptine or conditional knockout of prolactin receptors from sensory neurons attenuated these stress responses only in females. These data support the hypothesis that stress may contribute to migraine pathology in females in part through prolactin-dependent mechanisms.

In this presentation there will be some historical elements to headache treatment. We will discuss trials of agents such a histamine, orexins, earlier gepants and more. What were the pitfalls? What can we learn from these past investigations. We will also briefly discuss future potential targets.

Apps and wearables have the potential to be easily scaled interventions for migraine and other headache disorders. In this talk I discuss the landscape of migraine apps in general, specifically the limited evidence/research studies that exist for migraine apps, and then I discuss how apps and wearables have been developed to help deliver biofeedback and relaxation for migraine.