Migraine
Migraine is a complex neurological disorder characterised by recurrent episodes of moderate to severe headache, typically accompanied by a range of other symptoms that can be deeply disabling. It is far more than a bad headache — during an attack, many people are unable to work, care for their families, or carry out basic daily activities. Migraine is one of the world's most prevalent and disabling conditions, affecting approximately one billion people globally, with women affected roughly three times more often than men.
Types and phases
The most common type is migraine without aura — a throbbing, usually one-sided headache lasting between 4 and 72 hours. Migraine with aura affects around a third of sufferers and involves neurological symptoms — most commonly visual disturbances such as flashing lights, zigzag patterns, or blind spots — that typically precede the headache by 20 to 60 minutes. A migraine attack progresses through distinct phases: a prodrome (subtle changes in mood, energy, appetite, or neck stiffness hours or days beforehand), the aura phase (when present), the headache phase, and a postdrome ("hangover") phase of fatigue and cognitive difficulty.
Causes and triggers
The underlying mechanisms of migraine involve complex changes in brain chemistry and cortical activity, particularly involving the trigeminal nerve system and the neurotransmitter serotonin. Genetic factors play a strong role. Triggers — which vary considerably between individuals — may include hormonal changes (particularly around menstruation), disrupted sleep, stress or its release, certain foods and drinks (including alcohol, caffeine, aged cheese, and processed meats), dehydration, bright lights, strong smells, and changes in weather or barometric pressure.
Diagnosis
Migraine is a clinical diagnosis based on the pattern and characteristics of attacks. The International Headache Society criteria provide a standardised framework. Neuroimaging is not routinely required but may be performed to exclude secondary causes if there are atypical features, sudden onset, progressive worsening, or neurological signs.
Treatment
Treatment has two pillars: acute (relief during an attack) and preventive (reducing frequency and severity). For acute attacks, triptans (serotonin receptor agonists) are the most effective class of medication for moderate to severe migraine. Simple analgesics and anti-emetics are useful for milder attacks. Preventive treatments — including beta-blockers, amitriptyline, topiramate, valproate, and the newer CGRP antagonists and monoclonal antibodies — are considered when attacks are frequent, prolonged, or significantly disabling. Identifying and managing personal triggers, maintaining consistent sleep and hydration, and stress management are important lifestyle measures.
Choosing where to be treated
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