Migraine

Migraine is a neurological disorder that causes moderate-to-severe headaches. The pain usually affects one side of the head and is generally associated with nausea, light sensitivity and sound sensitivity. Other symptoms may include dizziness, vomiting, and difficulty thinking. In some cases, a migraine attack begins with an aura, a period of sensory disturbance.

Migraine attacks vary between individuals. Some people experience occasional attacks, while others develop chronic migraine with frequent headaches. Migraine frequency can increase over time. In some cases, frequent use of pain medication for headaches can make migraines worse and lead to medication overuse headache. An attack can be triggered by various stressors, such as lack of sleep, skipped meals or hormonal fluctuations.

Migraine is believed to result from a combination of genetic, environmental, and neurological factors that affect the activity of nerve cells and chemical signals in the brain. Migraine attacks are theorized to occur when the brain exceeds an individual sensitivity threshold. Migraine attacks have multiple phases. The initial phase of a migraine attack can start 48 hours before the main headache phase and may cause early warning symptoms. The subsequent pain phase of a migraine attack may be linked to increased activity in the pain pathway from the trigeminal nerve to the brainstem. Release of a signalling molecule CGRP increases blood flow and the transmission of pain signals.

A migraine management plan often includes lifestyle modifications to cope with migraine triggers and reduce the impact of co-occurring conditions. Lifestyle changes that may prevent migraines include stress management, improving sleep habits, eating regularly, and exercise. Treatment for acute mild to moderate attacks begins with over-the-counter pain relievers such as ibuprofen and paracetamol. Triptans are recommended as a first-line therapy for moderate to severe attacks. The approval of CGRP inhibitors (gepants) is seen as a major advance in migraine treatment. Anti-nausea medications are used for migraine-related nausea. Ergotamines may be used by those experiencing headaches that do not respond to other medications. Several medications can help prevent migraines. These include CGRP inhibitors, but also beta blockers, anticonvulsants and certain antidepressants.

Approximately 14% (1.16 billion) of people worldwide are affected by migraine, making it the third most disabling condition affecting the nervous system and one of the most common causes of disability. Beginning at puberty, women experience more and longer migraines, and higher disability related to migraines. Migraines often start occuring after a girl's first period, with increased frequency over time, peaking during perimenopause and tending to decrease following menopause. From age 30 to 50, up to four times as many women experience migraine attacks as men.