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Migraine is a neurological disorder that is typically defined as recurring attacks of moderate to severe headaches and accompanying symptoms (particularly neurological and sensory symptoms). Migraine may be a primary condition, or it may be caused by another health condition (secondary). Migraine headaches are usually one-sided (unilateral) but can affect both sides. Migraine affects approximately 15% of people at some stage during their lives and most commonly affects those aged between 30 and 40.
Depending on how often and how long migraine attacks occur, migraine is defined as either:
Further classification of migraine depends on whether sensory symptoms, known as aura, are experienced or not:
Auras are discussed in the next section.
Migraine is more than just a headache. It is a series of changing symptoms, not just pain, that have different mechanisms and that occur in phases. The phases and their symptoms vary depending on the type of migraine and differ between individuals. The four possible phases of a migraine attack are known as prodrome, aura, migraine headache and postdrome.
Most people with migraine will experience a pre-migraine attack phase, during which early symptoms / signs of migraine occur before any headache. This phase can act as a warning. Prodrome symptoms may occur hours or even days before a migraine attack. Symptoms include:
Auras are disturbances to the senses that may occur before a migraine headache in people who experience “migraine with aura”. Some people experience auras even without headache – this is known as silent migraine.
The most common auras are visual, but also include auditory auras and other sensations, such as the following:
| Visual | Auditory | Other |
|---|---|---|
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Most migraine attacks involve a headache phase. The pain is usually moderate to severe, but can be mild or even absent (i.e. silent migraine). Over 50% of migraine headaches are one-sided. Common features of migraine headache and other accompanying symptoms include the following:
| Headache Features | Other Symptoms |
|---|---|
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Many migraineurs will experience a “hangover” phase at the end of a migraine attack. How long it lasts for will vary from person to person. Typical symptoms include:
Things that can bring on migraine are known as triggers. Common triggers include:
Migraine may be a primary condition, or it may be a secondary condition – meaning it is caused by another medical condition. Chronic migraine is considered a primary condition, however certain conditions can increase the risk. Conditions that may be associated with migraine or are risk factors include:
Many migraine triggers or medical conditions associated with migraine cause imbalances in the body’s normal biology (e.g. change in hormone levels, sleep disturbances, change in diet). These imbalances cause specific areas of the brain to be activated. These areas of the brain may be responsible for controlling biological processes or pathways that have been linked to prodrome symptoms or migraine headache, for example, pain processing and signaling, changes in brain blood flow, processing of light, sound and smell signals.
Genetic mechanisms have also been heavily implicated in migraine, with most migraines (especially migraine with aura) appearing to run in families.
Migraine auras specifically are said to be caused by “cortical spreading depression”. This is a pathophysiological (disease-related) event in the brain that may be described as a slow-moving wave of altered brain cell activity. This is also associated with changes in brain blood flow (known as cortical spreading ischemia) which is likely related to migraine headache.
Migraine naturally varies considerably between individuals, particularly in terms of symptoms experienced. There are, however, certain sets of symptoms and factors that can indicate a specific migraine subtype / diagnosis, such as the following:
Preventative treatments (prophylactic agents) are recommended for people who experience at least 2 migraines per month. They rarely completely stop migraines, but they should reduce how often they occur, how long they last and how severe they are. There are many prophylactic agents for migraine, they include:
Medications for acute treatment of migraine are best when taken early when the pain is mild. It is important to find the most effective medication or combination of medications, and the right dose, as overuse or ineffective treatments can worsen migraine and increase the risk of chronic migraine. Contraindications also need to be considered (e.g. triptans may not be safe in patients with vascular risk factors). Acute treatments include:
There is a small amount of evidence that some forms of neuromodulation / neurostimulation may help migraine when other treatments fail. More studies are needed. Neuromodulation therapies include:
Genesis Research Services conducts clinical trials for a range of neurological conditions, including migraine. To view currently recruiting studies or register your interest for future studies, click here or call us on (02) 4985 1860.
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