WHAT IS MIGRAINE?

Migraine is a complex neurobiological disease. Although head pain is the most common symptom, symptoms can range from nausea and light sensitivity, to paralysis and vision loss. Migraine is a primary headache disorder, which means that it is not caused by another condition (1).

What causes migraine?

Well, we don’t know.

A long-standing theory was that migraine was primarily caused by changes in the blood vessels surrounding the head. This idea was centered on the belief that migraine pain was triggered by blood vessel dilation. However, dilation increases blood flow to the head and there is no correlation between increased blood flow and migraine pain (2, 3, 4, 5). Thus, these vascular phenomena are less likely to be the cause of migraine and more likely to be a consequence of migraine pathophysiology.

Migraine is most likely caused by a combination of genetic, environmental and lifestyle factors that result in altered neural signaling. Someone is more likely to have migraine if they have a family history of migraine, and while large-scale genetic studies have identified a broad set of genetic variants associated with migraine, the sheer number of migraine-associated genetic alterations (more than 38) highlights the complexity of the disease and the range of potential genetic mechanisms (6, 7).

Who suffers from migraine?

Migraine affects more than 1 billion people world wide, or 1 in 7 people, and two-thirds of migraine sufferers are women (8). The 2016 Global Burden of Disease (GBD) study reported that in the age group of 15-49 years, migraine is the top cause of years lost to disability (8, 9). Keep in mind that these are the most productive and prosperous years of an individual’s life, and the impact of migraine on physical, mental, social and economic health can be catastrophic.

How do you know if you have migraine?

Migraine attacks can cause severe throbbing pain or pulsing sensation on one side of the head and are often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

According to the World Health Organization (10), you may have migraine if you experience the following symptoms:

• headache, which is:
  • of severe or moderate intensity
  • one-sided
  • pulsating in quality
  • aggravated by routine physical activity
  • with duration of hours to 2-3 days
• nausea
• attack frequency anywhere between once a year and once a week
• in children, attacks are commonly shorter in duration and present with abdominal symptoms

There are two major types of migraine: Migraine without aura and migraine with aura. To learn more about the types of migraine click here.

References

1. Olesen, Jes, et al. “The international classification of headache disorders, (beta version).” Cephalalgia 33.9 (2013): 629-808.
2. Olesen, J, Friberg, L, Olsen, TS. Timing and topography of cerebral blood flow, aura, and headache during migraine attacks. Ann Neurol 1990; 28: 791–798. 
3. Schoonman, GG, van der Grond, J, Kortmann, C. Migraine headache is not associated with cerebral or meningeal vasodilatation – a 3T magnetic resonance angiography study. Brain 2008; 131: 2192–2200. 
4. Nagata, E, Moriguchi, H, Takizawa, S. The middle meningial artery during a migraine attack: 3T magnetic resonance angiography study. Intern Med 2009; 48: 2133–2135. Spadaro, Maria, et al. “A G301R Na+/K+-ATPase mutation causes familial hemiplegic migraine type 2 with cerebellar signs.” Neurogenetics 5.3 (2004): 177-185.
5. Amin, F. M., Asghar, M. S., Hougaard, A., Hansen, A. E., Larsen, V. A., de Koning, P. J., … & Ashina, M. (2013). Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study. The Lancet Neurology, 12(5), 454-461.
6. Nyholt, Dale R., and Arn MJM Van Den Maagdenberg. “Genome-wide association studies in migraine: current state and route to follow.” Current Opinion in Neurology 29.3 (2016): 302-308.
7. P Gormley, V Anttila, BS Winsvold, et al.Meta-analysis of 375,000 individuals identifies 38 susceptibility loci for migraine. Nat Genet, 48 (2016), pp. 856-866.
8. Vos, Theo, et al. “Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.” The Lancet 390.10100 (2017): 1211-1259.
9. Steiner, Timothy J et al. “Migraine is first cause of disability in under 50s: will health politicians now take notice?.” The journal of headache and pain vol. 19,1 17. 21 Feb. 2018, doi:10.1186/s10194-018-0846-2
10. Headache disorders. (n.d.). Retrieved August 17, 2020, from https://www.who.int/news-room/fact-sheets/detail/headache-disorders