What are the common sensory disturbances associated with migraine headaches?

Migraine headaches are frequently associated with sensory disturbances such as nausea, sensitivity to light (photophobia), and sensitivity to sound (hyperacusis). Some individuals may also experience sensitivity to smells, vomiting, cognitive dysfunction, or dizziness.

What percentage of individuals experiencing migraines report experiencing aura?

Approximately one-third of people who experience migraines report having aura, which is a transient period of sensory disturbance that typically precedes or accompanies the headache. Aura is widely believed to be caused by cortical spreading depression.

How is migraine described in terms of its clinical presentation?

Migraine is considered a highly heterogeneous condition, meaning it presents differently in various individuals. Rather than a single distinct clinical entity, it is better understood as a spectrum disease.

What is the believed underlying cause of migraine?

The exact cause of migraine remains unknown, but it is thought to result from a combination of environmental factors and genetic predispositions. These factors influence the excitability and inhibition of nerve cells within the brain.

What are the initial recommended treatments for an acute migraine attack?

Initial treatments for acute migraine attacks typically involve over-the-counter pain relievers like ibuprofen or paracetamol (acetaminophen) for the headache, and anti-nausea medications (antiemetics) for nausea. Avoiding known migraine triggers is also a key part of the initial management strategy.

What specific medications might be used for migraines that don't respond to over-the-counter treatments?

For individuals whose migraines do not respond adequately to over-the-counter pain medications, specific treatments such as triptans, ergotamines, or calcitonin gene-related peptide (CGRP) inhibitors may be prescribed.

When is prophylactic (preventive) medication recommended for migraine sufferers?

Preventive medication is recommended for individuals who experience four or more migraine attacks per month, or for those who would otherwise benefit from prevention strategies. This aims to reduce the frequency and severity of attacks.

What are some examples of commonly prescribed prophylactic migraine medications?

Commonly prescribed prophylactic medications for migraine include beta-blockers like propranolol, anticonvulsants such as sodium valproate, and antidepressants like amitriptyline. Other medications from different classes may also be used off-label.

How do prophylactic migraine medications work?

Preventive medications work by inhibiting migraine pathophysiology through various mechanisms. These can include blocking calcium and sodium channels, inhibiting gap junctions, and interfering with matrix metalloproteinases, among other actions.

What non-pharmacological therapies can be used for migraine prevention?

Non-pharmacological preventive therapies for migraine include nutritional supplementation, dietary adjustments, improving sleep hygiene, and engaging in regular aerobic exercise.

What is the global prevalence of migraine?

Globally, migraine affects approximately 15% of the population, which translates to about one billion people. In the United States, about 6% of men and 18% of women experience a migraine in a given year.

How does the prevalence of migraine change with age?

Migraine prevalence typically rises sharply around puberty and remains high until middle age, after which it tends to decline. Before puberty, boys and girls are affected at similar rates, but after puberty, women experience migraines more frequently than men.

What are the four possible phases of a migraine attack?

A migraine attack can potentially involve four phases: the prodrome (occurring hours or days before), the aura (immediately preceding or during the headache), the pain phase (the headache itself), and the postdrome (symptoms experienced after the headache resolves).

What symptoms characterize the prodrome phase of a migraine?

The prodrome phase, which can occur hours or days before the headache or aura, may include symptoms such as altered mood (irritability, depression, or euphoria), fatigue, food cravings, stiff muscles (especially in the neck), constipation or diarrhea, and increased sensitivity to smells or noise.

What is aura in the context of a migraine?

Aura refers to transient focal neurological symptoms that typically occur before or during a migraine headache. These symptoms are usually visual, sensory, or motoric in nature and develop gradually over several minutes, generally lasting less than an hour.

What are the most common types of aura experienced during a migraine?

Visual disturbances are the most frequent type of aura, occurring in up to 99% of cases. These can include scintillating scotoma (flickering blind spots), zigzag lines resembling fortifications, or partial loss of the visual field (hemianopsia).

What is a scintillating scotoma?

A scintillating scotoma is a visual disturbance often experienced during migraine aura. It is described as an area of partial alteration in the field of vision that flickers and can interfere with activities like reading or driving.

What are sensory auras, and how common are they?

Sensory auras are the second most common type of aura, affecting 30-40% of individuals who experience auras. These often manifest as a tingling sensation, typically starting in the hand and arm on one side and spreading towards the face.

What is a hemiplegic migraine?

Hemiplegic migraine is a type of migraine characterized by motor symptoms, specifically weakness, which indicates motor involvement in the aura. Unlike other auras, this weakness often persists for longer than an hour.

What are the typical characteristics of the pain phase of a migraine headache?

The pain phase of a migraine is classically described as unilateral (affecting one side of the head), pulsating, and moderate to severe in intensity. The pain typically worsens with physical activity.

Can migraine pain be bilateral?

Yes, while classically unilateral, migraine pain can be bilateral (affecting both sides of the head) in over 40% of cases. Neck pain is also commonly associated with migraine headaches, particularly in those experiencing bilateral pain.

What is status migrainosus?

Status migrainosus refers to a migraine attack that lasts longer than 72 hours. This is a prolonged and severe form of the condition.

What is a silent migraine?

A silent migraine, also known as typical aura without headache or acephalgic migraine in older classifications, occurs when a person experiences aura symptoms without a subsequent headache. These symptoms can still be debilitating.

What is the role of genetics in migraine?

Genetics plays a significant role in migraine, with studies indicating a 34-51% genetic influence. While most common forms of migraine are polygenetic (influenced by multiple genes), rare single-gene disorders like familial hemiplegic migraine also exist.

What are some identified genes associated with familial hemiplegic migraine?

Four genes have been identified as involved in familial hemiplegic migraine: three related to ion transport and one encoding the axonal protein PRRT2, which is linked to the exocytosis complex.

What are common triggers reported for migraine attacks?

Commonly reported migraine triggers include psychological stress, hunger, fatigue, certain foods (like those containing tyramine or MSG), alcohol, weather changes (temperature and barometric pressure), and sensory stimuli like bright or flickering lights and strong odors. Sleep quality also plays a significant role.

What is the proposed pathophysiological mechanism for migraine aura?

Cortical spreading depression (CSD) is the accepted mechanism believed to cause the aura experienced during migraine attacks. CSD involves a wave of neuronal excitation followed by a period of inactivity, which can affect blood flow in the brain.

What is the role of CGRP in migraine pathophysiology?

Calcitonin gene-related peptide (CGRP) is a neuropeptide implicated in migraine. Elevated levels of CGRP are detected during migraine attacks, leading to vasodilation of cerebral blood vessels and the release of inflammatory mediators, which contribute to pain transmission.

How is migraine diagnosed according to the International Headache Society's criteria?

The diagnosis of migraine without aura, according to the International Headache Society's '5, 4, 3, 2, 1 criteria', requires five or more attacks lasting 4-72 hours, with at least two of the following characteristics: unilateral location, pulsating quality, moderate-to-severe intensity, or aggravation by physical activity. Additionally, one or more associated symptoms like nausea/vomiting or photophobia/phonophobia must be present.

What are the main subclasses of migraine according to the International Classification of Headache Disorders?

The International Classification of Headache Disorders divides migraine into six main subclasses: migraine without aura, migraine with aura (including subtypes like hemiplegic and basilar-type), childhood periodic syndromes, complications of migraine, probable migraine, and chronic migraine.

What is chronic migraine defined as?

Chronic migraine is defined as a complication of migraine where headache occurs on 15 or more days per month for longer than three months, and the headache fulfills the diagnostic criteria for migraine headache during at least 8 of those days.

What conditions are considered in the differential diagnosis of migraine?

Conditions considered in the differential diagnosis of migraine include temporal arteritis, cluster headaches, acute glaucoma, meningitis, and subarachnoid hemorrhage. Tension headaches are also differentiated due to their typically bilateral, non-pulsating, and less disabling nature.

What are the key aspects of migraine management?

Migraine management involves three main aspects: trigger avoidance, acute (or abortive) treatment for attacks, and preventive (or prophylactic) control for frequent or severe migraines. Lifestyle modifications and addressing comorbidities are also foundational.

What is the significance of migraine as a cause of disability?

Migraine is recognized as a significant cause of disability worldwide. The World Health Organization ranks severe migraine among the highest categories of disability, comparable to conditions like severe depression, active psychosis, quadriplegia, and terminal-stage cancer.

What is the historical origin of the term 'migraine'?

The term 'migraine' originates from the Greek word 'hemikrania', meaning 'pain in half of the head'. This term was derived from 'hemi-' (half) and 'kranion' (skull).

What early medical texts described symptoms consistent with migraine?

Early descriptions consistent with migraine can be found in the Ebers Papyrus from ancient Egypt around 1500 BCE, and writings from the Hippocratic school of medicine around 200 BCE, which noted visual aura and relief through vomiting.

What was the historical understanding of migraine pain mechanisms?

Galen of Pergamon, in the second century CE, proposed that migraine pain arose from the meninges and blood vessels of the head, a concept that influenced understanding for centuries.

When were the two main types of migraine (with and without aura) first distinguished?

The distinction between migraine with aura ('migraine ophthalmique') and migraine without aura ('migraine vulgaire') was first made in 1887 by Louis Hyacinthe Thomas, a French librarian.

What historical medical procedure was sometimes recommended for migraine?

Trepanation, the practice of drilling holes into the skull, was recommended by William Harvey in the 17th century as a treatment for migraine, although its historical use was likely more related to superstition than medical efficacy.

What medication, derived from ergot, became effective for migraine treatment?

Ergotamine, derived from the ergot fungus, was found to be effective for migraine treatment. It was isolated in 1918 and first used for migraines in 1925.

What is the economic impact of migraine?

Migraine has a significant economic impact due to both direct medical costs and indirect costs from lost productivity. In the European Community, it is estimated to be the most costly neurological disorder, with billions of Euros spent annually. In the US, indirect costs related to missed work are substantial.

What are some emerging research areas for migraine prevention?

Current research is exploring the potential of transcranial magnetic stimulation (TMS) and transcutaneous supraorbital nerve stimulation as preventive mechanisms for migraine. Preliminary evidence also suggests a ketogenic diet may help prevent migraine attacks.

What is the relationship between migraine and sex hormones?

Hormonal influences, particularly estrogen fluctuations, are believed to play a considerable role in provoking migraine pain, especially in women. Migraine episodes are often more likely to occur around menstruation and may be affected by other hormonal changes like menopause.

Does migraine with aura increase the risk of stroke?

Yes, migraine with aura appears to be a risk factor for ischemic stroke, potentially doubling the risk. Factors like being a young adult, female sex, hormonal birth control use, and smoking can further increase this risk.

What is the significance of CGRP in migraine treatment?

CGRP (Calcitonin gene-related peptide) is a neuropeptide that plays a role in migraine pathophysiology. Targeting CGRP or its receptors has become a promising therapeutic strategy, leading to the development of new preventive and acute treatments for migraine.

Migraine Wiki: Migraine Unveiled: Navigating Neurological Complexities

Dive in with Flashcard Learning!

When you are ready...
🎮 Play the Wiki2Web Clarity Challenge Game🎮

What is Migraine?

A Complex Neurological Disorder

Migraine is a complex neurological disorder characterized by recurrent episodes of moderate-to-severe headache, typically unilateral and often accompanied by sensory disturbances such as nausea, sensitivity to light (photophobia), and sound (phonophobia).^[3]^[4] Other symptoms may include vomiting, cognitive dysfunction, allodynia (pain from stimuli that are not normally painful), and dizziness.^[3] Worsening of headache symptoms during physical activity is another distinguishing feature.^[5]

Spectrum of Presentation

While often categorized as a headache disorder, migraine is better understood as a spectrum disease due to its highly heterogeneous clinical presentation.^[6] Disease burden can range from episodic attacks to chronic conditions, impacting individuals significantly.^[6]^[7]

Global Health Impact

Globally, migraine affects approximately 15% of the population, making it one of the most prevalent disorders worldwide.^[19] It is a leading cause of disability, significantly impacting quality of life and economic productivity.^[22]

Signs and Symptoms

Phases of an Attack

A migraine attack can involve up to four distinct phases, though not all are experienced by every individual:

Prodrome: Occurs hours or days before the headache, with symptoms like altered mood, fatigue, food cravings, or stiff muscles.^[30]
Aura: Transient neurological phenomena, typically visual, sensory, or motor, occurring before or during the headache.^[30]
Pain Phase: The headache itself, characterized by moderate to severe intensity, often pulsating and unilateral, aggravated by physical activity.^[36]
Postdrome: The effects experienced after the headache subsides, which can include fatigue, cognitive difficulties, or mood changes.^[55]

Aura Manifestations

Aura, experienced by 15-30% of migraine sufferers, typically develops gradually over minutes and lasts less than an hour.^[10]^[25] Visual disturbances are most common, including scintillating scotomas (flickering blind spots) and zigzag lines.^[30] Sensory auras, such as tingling or numbness, and speech disturbances can also occur.^[38]

Associated Symptoms

Beyond headache, common accompanying symptoms include nausea (in nearly 90% of cases), vomiting (in about one-third), photophobia, phonophobia, and osmophobia (sensitivity to smells).^[47] Many individuals seek relief in dark, quiet environments.^[47]

Cause & Triggers

Multifactorial Etiology

The precise cause of migraine remains unknown, but it is understood to result from a complex interplay of environmental and genetic factors.^[57]^[8] Studies indicate a significant genetic influence, with migraine often running in families.^[23]

Potential Triggers

Numerous factors are reported as potential migraine triggers, though their significance can vary greatly among individuals. These include:

Physiological: Fatigue, stress, changes in sleep patterns, hormonal fluctuations (especially estrogen levels).^[76]^[80]
Dietary: Certain foods (e.g., those containing tyramine, MSG), alcohol, skipping meals.^[83]
Environmental: Weather changes (barometric pressure, temperature), bright or flickering lights, strong odors.^[92]

While anecdotal evidence is strong, scientific validation of many triggers is ongoing. The relationship between migraine and sleep quality is particularly noted, often being bidirectional.^[79] Hormonal influences, such as those related to menstruation, pregnancy, and menopause, are significant, particularly for migraine without aura.^[82]

Associated Conditions

Migraine is frequently comorbid with other conditions, notably mood and anxiety disorders like depression and bipolar disorder.^[29] These associations are more pronounced in individuals experiencing migraine with aura.^[29]

Pathophysiology

Neurological Basis

Migraine is primarily considered a neurological disorder, though neurovascular interactions are also recognized as important.^[95]^[96] Key mechanisms involve increased neuronal excitability in the cerebral cortex and abnormal modulation of pain pathways within the trigeminal system.^[105]

Cortical Spreading Depression (CSD)

CSD, a wave of neuronal excitation followed by a period of inactivity, is strongly implicated in the aura phase of migraine.^[108] This process, involving NMDA receptor activation and subsequent changes in blood flow, is thought to trigger pain-sensing nerves in the head and neck.^[108]

Role of CGRP

Calcitonin gene-related peptide (CGRP), a neuropeptide, plays a significant role in migraine pathogenesis. Elevated CGRP levels during attacks contribute to vasodilation and the release of inflammatory mediators, facilitating pain signaling.^[10]^[42] This understanding has led to the development of CGRP-targeted therapies.

Diagnosis

Clinical Assessment

Migraine diagnosis is primarily based on a detailed patient history and the characteristic signs and symptoms experienced.^[23] Neuroimaging is generally not required for diagnosis unless other conditions are suspected.

ICHD Criteria

The International Classification of Headache Disorders (ICHD) provides diagnostic criteria. For migraine without aura, key features include:

Five or more attacks.
Duration of 4–72 hours.
Two or more characteristics: unilateral location, pulsating quality, moderate-to-severe intensity, or aggravation by physical activity.
Presence of nausea/vomiting or photophobia/phonophobia.

The ICHD classification further categorizes migraine into subtypes, including migraine with aura (further divided into familial hemiplegic migraine, sporadic hemiplegic migraine, and migraine with brainstem aura), childhood periodic syndromes, complications of migraine (like chronic migraine), and probable migraine.^[28]^[121]

Management & Treatment

Acute Attack Treatment

Initial treatment for acute attacks often involves over-the-counter analgesics like ibuprofen or paracetamol, antiemetics for nausea, and trigger avoidance.^[10] For more severe or refractory attacks, specific medications such as triptans, ergotamines, or newer CGRP antagonists are employed.^[11]

Preventive Strategies

For individuals experiencing frequent or debilitating migraines (typically four or more per month), prophylactic treatment is recommended.^[12] Common preventive medications include beta-blockers (e.g., propranolol), anticonvulsants (e.g., topiramate), antidepressants (e.g., amitriptyline), and specific CGRP inhibitors.^[13]

Lifestyle and Behavioral Approaches

Non-pharmacological interventions are crucial. These include lifestyle modifications, trigger management, and behavioral therapies like Cognitive Behavioral Therapy (CBT), biofeedback, and mindfulness.^[16]^[129] Nutritional supplements such as magnesium and riboflavin may also offer benefits.^[128]

Prognosis & Epidemiology

Long-Term Impact

Migraine is a chronic condition that typically begins around puberty and can persist throughout adulthood, often declining in severity after age 50.^[147] While many experience episodic migraines, a significant minority develop chronic migraine, characterized by frequent headaches and profound disability.^[138]

Disability Burden

Migraine is recognized as a major cause of disability globally, comparable to conditions like severe depression or active psychosis.^[139] It significantly impacts personal well-being, social functioning, and economic productivity.

Stroke Risk

Migraine with aura has been identified as a risk factor for ischemic stroke, particularly in younger women who smoke or use hormonal contraceptives.^[140]^[140] Preventive treatment for migraine with aura may mitigate this risk.^[145]

History

Ancient Roots

Descriptions consistent with migraine date back to ancient Egypt (c. 1500 BCE) and were detailed by Greek physicians like Hippocrates and Galen.^[153] The term "migraine" itself derives from the Greek "hemikrania," meaning "pain in half of the head."^[154]

Evolving Understanding

Early medical texts distinguished between types of headaches, with Galen proposing vascular involvement. The modern classification into migraine with and without aura emerged in the late 19th century.^[156] Significant advancements in understanding and treatment, including the development of triptans and CGRP inhibitors, occurred in the late 20th and early 21st centuries.

Teacher's Corner

Edit and Print this course in the Wiki2Web Teacher Studio

Edit and Print Materials from this study in the wiki2web studio

Click here to open the "Migraine" Wiki2Web Studio curriculum kit

Use the free Wiki2web Studio to generate printable flashcards, worksheets, exams, and export your materials as a web page or an interactive game.

True or False?

Test Your Knowledge!

Gamer's Corner

Are you ready for the Wiki2Web Clarity Challenge?

Learn about migraine while playing the wiki2web Clarity Challenge game.

Unlock the mystery image and prove your knowledge by earning trophies. This simple game is addictively fun and is a great way to learn!

Play now

Explore More Topics

Discover other topics to study!

jean-jacques dessalines

agriculture water natural resources and environment commission of the islamic consultative assembly

References

Jenkins, B. Migraine management. Australian Prescriber. 2020; 43(5):148â151. https://doi.org/10.18773/austprescr.2020.047

A full list of references for this article are available at the Migraine Wikipedia page

Feedback & Support

To report an issue with this page, or to find out ways to support the mission, please click here.

Disclaimer

Important Medical Information

This page was generated by an Artificial Intelligence and is intended for informational and educational purposes only. The content is based on publicly available data and may not be entirely accurate, complete, or up-to-date.

This is not medical advice. The information provided on this website is not a substitute for professional medical consultation, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

The creators of this page are not responsible for any errors or omissions, or for any actions taken based on the information provided herein.

Migraine Unveiled

💡 Dive in with Flashcard Learning! 💡

What is Migraine? ℹ️

⚡ A Complex Neurological Disorder

🌟 Spectrum of Presentation

🌍 Global Health Impact

Signs and Symptoms 🩺

⏳ Phases of an Attack

💡 Aura Manifestations

😵 Associated Symptoms

Cause & Triggers 🧬

🔬 Multifactorial Etiology

❓ Potential Triggers

🔗 Associated Conditions

Pathophysiology 🔬

🧠 Neurological Basis

🌊 Cortical Spreading Depression (CSD)

🩸 Role of CGRP

Diagnosis 🔍

✅ Clinical Assessment

📝 ICHD Criteria

Management & Treatment 💊

🩹 Acute Attack Treatment

🛡️ Preventive Strategies

🧘 Lifestyle and Behavioral Approaches

Prognosis & Epidemiology 📊

📈 Long-Term Impact

⚖️ Disability Burden

⚠️ Stroke Risk

History 📜

🏛️ Ancient Roots

🔬 Evolving Understanding

Teacher's Corner 🧑‍🏫

Edit and Print this course in the Wiki2Web Teacher Studio

True or False? 🤔

❓ Test Your Knowledge! ❓

Gamer's Corner 🎮

Are you ready for the Wiki2Web Clarity Challenge?

Explore More Topics

📜 Discover other topics to study!

References

📜 References

Feedback & Support 👍

To report an issue with this page, or to find out ways to support the mission, please click here.

Disclaimer ⚠️

📜 Important Medical Information

Dive in with Flashcard Learning!

What is Migraine?

A Complex Neurological Disorder

Spectrum of Presentation

Global Health Impact

Signs and Symptoms

Phases of an Attack

Aura Manifestations

Associated Symptoms

Cause & Triggers

Multifactorial Etiology

Potential Triggers

Associated Conditions

Pathophysiology

Neurological Basis

Cortical Spreading Depression (CSD)

Role of CGRP

Diagnosis

Clinical Assessment

ICHD Criteria

Management & Treatment

Acute Attack Treatment

Preventive Strategies

Lifestyle and Behavioral Approaches

Prognosis & Epidemiology

Long-Term Impact

Disability Burden

Stroke Risk

History

Ancient Roots

Evolving Understanding

Teacher's Corner

True or False?

Test Your Knowledge!

Gamer's Corner

Discover other topics to study!

References

Feedback & Support

Disclaimer

Important Medical Information