Pharmacogenetics of migraine

ffecting up to 12% of males and 24% of females in the general population, migraine is a primary headache disorder with a profound social and economic impact. In 2002, the World Health Organization (WHO) reported migraine among the world's top 20 leading causes of disability.

A variety of drugs are used to treat migraine headaches: pain-relieving medications, also known as acute or abortive treatment, which include triptans and ergotamine derivates, and preventive medications (e.g. amitryptiline, fluoxetine, valproate, topiramate, flunarizine, propanolol) which are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.

The term “medication-overuse headache” (MOH) has been recently introduced to describe a chronic daily headache usually occurring in people with migraine or tension-type headaches caused by an excessive use of medication taken for symptomatic headache relief.

The Center has undertaken a number of pharmacogenetic studies to evaluate the value of genetic polymorphisms as predictive factors for response respectively to triptan and prophylactic drugs, as well as risk factors for MOH.

Project leaders: Armando Genazzani, Salvatore Terrazzino, Michele Viana.

Clinical Centers: Istituto C. Mondino, Pavia; Centro Cefalee (Ospedale “Maggiore della Carità”, Novara).


Cargnin S, Viana M, Sances G, Tassorelli C, Terrazzino S. A systematic review and critical appraisal of gene polymorphism association studies in medication-overuse headache. Cephalalgia 2017, DOI: 10.1177/0333102417728244.

Cargnin S, Pautasso C, Viana M, Sances G, Mittino D, Cantello R, Tassorelli C, Nappi G, Terrazzino S. Association of RAMP1 rs7590387 with the risk of migraine transformation into medication overuse headache. Headache 2015;55:658-668.

Cargnin S, Viana M, Sances G, Bianchi M, Ghiotto N, Tassorelli C, Nappi G, Canonico PL, Genazzani AA, Terrazzino S. Combined effect of common gene variants on response to drug withdrawal therapy in medication overuse headache. Eur J Clin Pharmacol 2014;70:1195-202.

Cargnin S, Viana M, Ghiotto N, Bianchi M, Sances G, Tassorelli C, Nappi G, Canonico PL, Genazzani AA, Terrazzino S. Functional polymorphisms in COMT and SLC6A4 genes influence the prognosis of patients with medication overuse headache after withdrawal therapy. Eur J Neurol. 2014; 21(7):989-95.

Viana M, Terrazzino S, Genazzani AA, Grieco GS, Cargnin S, Santorelli FM, Pierelli F, Tassorelli C, Nappi G, Di Lorenzo C. Pharmacogenomics of episodic migraine: time has come for a step forward. Pharmacogenomics 2014;15(4):541-9.

Cargnin S, Viana M, Mittino D, Bellomo G, Tassorelli C, Nappi G, Canonico PL, Terrazzino S. Lack of association between GRIA1 polymorphisms and haplotypes with migraine without aura or response to triptans. Neurol Sci. 2014;35:421-7.

Cargnin S, Magnani F, Viana M, Tassorelli C, Mittino D, Cantello R, Sances G, Nappi G, Canonico PL, Genazzani AA, Raffaeli W, Terrazzino S. An Opposite-Direction Modulation of the COMT Val158Met Polymorphism on the Clinical Response to Intrathecal Morphine and Triptans. J Pain 2013;14:1097-1106.

Viana M, Genazzani AA, Terrazzino S, Nappi G, Goadsby PJ. Triptan nonresponders: Do they exist and who are they? Cephalalgia. 2013;33(11):891-6.

Terrazzino S, Tassorelli C, Sances G, Allena M, Viana M, Monaco F, Bellomo G, Nappi G, Canonico PL, Genazzani AA. Association of haplotype combination of serotonin transporter gene polymorphisms with monthly headache days in MOH patients. Eur J Neurol. 2012;19:69-75.

Terrazzino S, Sances G, Balsamo F, Viana M, Monaco F, Bellomo G, Martignoni E, Tassorelli C, Nappi G, Canonico PL, Genazzani AA. Role of 2 common variants of 5HT2A gene in medication overuse headache. Headache. 2010;50(10):1587-96.

Terrazzino S, Viana M, Floriddia E, Monaco F, Mittino D, Sances G, Tassorelli C, Nappi G, Rinaldi M, Canonico PL, Genazzani AA. The serotonin transporter gene polymorphism STin2 VNTR confers an increased risk of inconsistent response to triptans in migraine patients. Eur J Pharmacol. 2010;641:82-7.

Velati D, Viana M, Cresta S, Mantegazza P, Testa L, Bettucci D, Rinaldi M, Sances G, Tassorelli C, Nappi G, Canonico PL, Martignoni E, Genazzani AA. 5-hydroxytryptamine1B receptor and triptan response in migraine, lack of association with common polymorphisms. Eur J Pharmacol. 2008;580:43-7.