<p>The diagnosis and therapeutic evaluation of migraine have long relied on subjective clinical descriptions, lacking objective, stable, and quantifiable biological markers. Extracellular vesicles (EVs), which carry specific bioactive molecules, have been recognized in recent years as a potential breakthrough in research due to their role in intercellular communication, the stability of their contents, and their reflection of pathological states. This article comprehensively evaluates studies on changes in EVs and their contents in migraine patients, discusses methods for isolating and characterizing EVs, sample sources, and other issues, and critically analyzes existing evidence regarding EVs as biomarkers and therapeutic carriers for migraine. Current research suggests alterations in miRNA and protein profiles in EVs of migraine patients, but these findings generally face reproducibility issues. Finally, the article also elaborates on the numerous challenges encountered during clinical translation. Overall, EVs provide a promising yet immature new perspective for migraine research.</p>