Updated: Sep 18, 2020
Learn about causes, available treatments and preventative measures that can be taken to improve your quality of life with migraine.
Quick Facts about Migraine
Migraine has been listed as the sixth most disabling disorder by the World Health Organization.
Global 1-year prevalence is approximately 15 percent
Migraine costs the United States 19.6 billion annually in both direct and indirect costs such as lost productivity to the workforce
Migraine affects females to males 3:1
Characteristics of Migraine
unilateral pain (pain on one side of the head)
moderate to severe in nature
exacerbated by physical activity
associated with nausea and/or vomiting
associated with sensitivity to light and/or sound
Causes of Migraine
Over the years, there have been many theories regarding the cause of migraine. The first theory noted that migraine may have been secondary to dilation of the cranial vessels, which led to the use of ergotamine in migraine and the development of the triptans, a class of medications known to be effective in migraine.
Currently, migraine is seen as a neurovascular disorder with many factors coming into play regarding the cause of migraine such as: sensitization of neurons that respond to pain as well as brainstem and hypothalamic dysfunction.
Another theory is related to the activation of the trigeminovascular system which results in the release of neuropeptides such as calcium gene related peptide (CGRP). CGRP has been found to be released during migraine attacks. CGRP’s mechanism is unclear, but it has been shown to cause vessel dilation and modulate neuronal function. CGRP and other neuropeptides are now targets for new migraine drugs.
Treatment for Acute Migraine
Acute treatment for migraine includes: triptans, ergotamine, and nonsteroidal anti-inflammatory drugs (NSAIDs). Caution is used with triptans and ergotamine (these medications are avoided in cardiovascular disease) and overuse of NSAIDs can lead to peptic ulcer disease and renal impairment. When acute medications are used frequently, there is also a risk of medication overuse headache, and a daily medication used to prevent migraines may be considered.
Commonly used preventative medications include divalproex, gabapentin, tricyclic anti-depressants, and beta blockers.
Once a preventative medication is considered for migraine, drug-drug interactions, adverse effects, medical contraindications and patient tolerability are taken into consideration before use.
Treatment for Chronic Migraine
Botulinum toxin may be an option in patients with chronic migraine, which is defined as having a headache more than 15 days per month. Of those 15 days, at least 8 headaches have the features of migraine headaches. The CGRP receptor antibody, erenumab, has also been shown to be effective for migraine and has been approved for use in chronic migraine.
Risk factors for transformation from episodic migraine to chronic migraine include the following: medication overuse (especially opiates and barbiturates), high caffeine consumption, anxiety, depression, obesity, female gender, injuries to the head and neck, snoring and sleep apnea.
Basic Preventative Tips and Self-Care for Migraine
Keep a record of triggers for migraine (dietary triggers, sleep habits, stress, alcohol use, etc.)
Stay hydrated daily
Avoid excessive caffeine – alternatively caffeine withdrawal can trigger migraines as well
Practice good sleep hygiene
Limit usage of acute migraine medications to 1-2 times per week
If migraines are an ongoing issue in your life, contact your neurologist to learn your treatment options.
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Goadsby, Peter J., Philip R. Holland, Margarida Martins-Oliveira, Jan Hoffmann, Christoph Schankin, and Simon
Akerman. "Pathophysiology of Migraine: A Disorder of Sensory Processing." Physiological Reviews 97.2 (2017): 553-622. Web.
Goadsby, Peter J. "Vascular Theory of Migraine-a Great Story Wrecked by the Facts | Brain | Oxford Academic." OUP Academic. Oxford University Press, 22 Jan. 2009. Web.
“ICHD-3 The International Classification of Headache Disorders 3rd Edition.” ICHD-3 The International Classification of Headache Disorders 3rd Edition, Classification Committee of The International Headache Society, 2018, www.ichd-3.org/.
Marmura, Michael J., Stephen D. Silberstein, and Todd J. Schwedt. "The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies." Headache: The Journal of Head and Face Pain. Wiley Periodicals, Inc., 20 Jan. 2015. Web.
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