Migraine

A migraine is a complex neurological disorder characterized by moderate-to-severe headaches.

These attacks are typically recurrent and often present as a pulsating or throbbing pain on one side of the head. However, in about 40% of cases, the pain may affect both sides. Beyond the headache itself, many people experience nausea, which occurs in nearly 90% of sufferers, and vomiting in about one-third of cases. Other common symptoms include extreme sensitivity to light, sound, and smells. Because these symptoms can last for hours or even days, migraine is a major cause of disability worldwide.

Scientists believe migraines result from a combination of genetic, environmental, and neurological factors. These factors influence how nerve cells function and how chemical signals move through the brain. An attack is theorized to occur when the brain exceeds an individual's specific sensitivity threshold. Genetics play a significant role, as the condition often runs in families. Studies of twins suggest a genetic influence of 0.36 to 0.48 on the likelihood of developing the disorder. While most cases are polygenetic—meaning many different gene variants contribute small amounts of risk—some rare forms are caused by single gene mutations. For example, familial hemiplegic migraine involves specific genes like CACNA1A, ATP1A2, and SCN1A which affect ion transport.

A single migraine attack can progress through four distinct stages. The first is the prodrome phase, or premonitory phase, which can begin up to 48 hours before the headache. During this time, people may experience mood changes, fatigue, food cravings, or neck stiffness. Some also report irritability, depression, or even euphoria. About 29% of people in population studies report these early warning symptoms. The second stage is the aura phase. This involves reversible neurological disturbances that last between 5 and 60 minutes.

About 30% of people living with migraine experience these disturbances. Visual effects are the most frequent, occurring in up to 99% of those with aura.

During the aura phase, a person might experience a scintillating scotoma, which looks like flickering or zigzagging lines in their field of vision.

These lines may be black and white or colored and can interfere with tasks like driving. Some people experience a negative scotoma, which is a loss of awareness of certain parts of their vision.

Others might experience sensory auras, such as a pins-and-needles sensation that spreads from the hand to the face. In rare cases, motor symptoms occur, which is a sign of hemiplegic migraine. The third stage is the pain phase, or headache phase. This stage typically lasts from 4 to 72 hours in adults. If an attack lasts longer than 72 hours despite treatment, it is called status migrainosus.

The final stage is the postdrome phase, often called the "migraine hangover." This period occurs in the 48 hours following the end of the pain phase. Common symptoms include intense tiredness, difficulty concentrating, dizziness, and thirst. Some people even experience feelings of euphoria during this time. It is important to note that some people experience a "silent migraine." This is a type of attack where the aura occurs, but the actual headache phase does not follow. Even without pain, the visual or sensory disturbances can be significant enough to interfere with daily life.

Migraine is a massive global health issue, affecting approximately 1.16 billion people, or 14% of the world's population. It is ranked as the third most disabling condition affecting the nervous system. There are significant differences in how the disorder affects different genders. Women are more likely to experience migraines, and they often experience longer and more disabling attacks. Starting at puberty, migraines frequently begin after a girl's first period. Between the ages of 30 and 50, women experience attacks up to four times as often as men.

The frequency often peaks during perimenopause and tends to decrease after menopause.

Management of migraine involves both treating active attacks and preventing future ones. For mild to moderate attacks, over-the-counter medicines like ibuprofen or paracetamol are often used. For moderate to severe attacks, triptans are recommended as a first-line therapy. The approval of gepants represents a major recent advance in treatment options. To prevent attacks, doctors may prescribe beta blockers, anticonvulsants, or certain antidepressants. Lifestyle modifications are also crucial for management. Maintaining regular sleep patterns, eating consistent meals, managing stress, and regular exercise can help reduce the frequency of attacks and manage triggers.