How do the currently used prophylactic agents work in migraine?

Since migraine attacks are often frequent they require management with agents that reduce their number. Such agents, although often effective, are mechanistically ill-understood. They have been suggested to work through four main mechanisms, 5HT2 antagonism, modulation of plasma protein extravasation, modulation of central aminergic control mechanisms and membrane stabilizing effects through actions at voltage-sensitive channels. The evidence for these mechanisms, except plasma protein extravasation (see Cutrer, this supplement) is examined in the light of current thoughts concerning the pathophysiology of migraine.