Migraine

Migraine is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically, the headache affects one half of the head, is pulsating in nature, and lasts from 4 to 72 hours.

The exact cause of migraines is unknown, but they are thought to result from abnormal brain activity temporarily affecting nerve signals, chemicals, and blood vessels in the brain.

• Genetic factors: Family history of migraine.
• Environmental factors: Stress, certain foods, hormonal changes.

Migraine pathophysiology involves a complex interplay between the nervous and vascular systems. Key aspects include:

• Cortical spreading depression: A wave of neuronal and glial depolarisation.
• Trigeminovascular system activation: Leads to the release of vasoactive neuropeptides.
• Sensitisation: Increased response to stimuli.

• Prodrome: Symptoms that occur hours or days before the headache, such as mood changes, neck stiffness, and food cravings.
• Aura: Visual disturbances (e.g., flashing lights, zigzag lines), sensory changes (e.g., tingling), or speech disturbances.
• Headache: Unilateral, pulsating pain, often accompanied by nausea, vomiting, photophobia, and phonophobia.
• Postdrome: Feeling drained or refreshed, mood changes, and mild head pain.

Diagnosis is primarily clinical based on history and physical examination.

• Imaging: MRI or CT scan if atypical features are present or secondary headache is suspected.
• Blood tests: To rule out other conditions if indicated.

• Acute treatment: NSAIDs, triptans, antiemetics.
• Preventive treatment: Beta-blockers, antiepileptics, antidepressants.
• Lifestyle modifications: Regular sleep, diet, and exercise; stress management.
• Non-pharmacological treatments: Cognitive behavioural therapy, biofeedback, acupuncture.

• Status migrainosus: Severe migraine lasting more than 72 hours.
• Medication-overuse headache: Resulting from chronic use of headache medications.
• Increased risk of stroke: Especially in women with aura.

• Migraines are a common and disabling headache disorder.
• Diagnosis is clinical, but imaging may be necessary in atypical cases.
• Management includes acute treatment, preventive strategies, and lifestyle modifications.
• Understanding triggers and individualising treatment are key to effective management.