Migraine

Migraine is a common, often familial disorder characterised by paroxysms of unilateral throbbing headache. Onset usually occurs in childhood or early adult life.

Two forms exist. Migraine with aura is well localised, associated with nausea, vomiting and photophobia, and relieved by sleep. An aura or warning of visual, sensory or motor type precedes the headache. In common migraine there is no aura, but the other features are essentially the same.

Migraine headaches last from 2-48 hours, and rarely occur more frequently than twice weekly. Migraine is precipitated by dietary factors (e.g. alcohol, chocolate and cheese), hormonal imbalances (especially estrogens in women), stress, fatigue, exercise, and sleep deprivation and head trauma. For many years it has been believed that migraines are linked to dilation and constriction of cranial blood vessels. However, thanks to technological advances like CT, transcranial Doppler and PET scanning, researchers have now found the changes occurring to be more complex than was previously thought. Now experts generally agree that migraine is a complex brain disorder and that all of its symptoms, including head pain, aura, nausea and vomiting, are the result of inherited abnormalities in certain cell populations in the brain, and that there is a “migraine pain centre” located in the brain stem. Signals generated from here before a migraine attack communicate with intra- and extracranial blood vessels to provoke a neurogenic inflammatory response that causes vascular changes and pain.

Migraine occurs in 12-15% of the UK population, in women more than men in a ratio of 3:1. An estimated 187,000 attacks are experienced every day, with three quarters of those affected reporting disability at least sometimes. Whilst migraine occurs in children (in whom the diagnosis is often missed) and in the elderly, it is most troublesome during the productive years (late teens to 50’s). As a result, almost 90,000 people are absent from work or school because of migraine every working day. The cost to the economy through migraine alone of lost work time and impaired working effectiveness may be £1.5 billion per annum.

Migraine Action Association

The Migraine Trust

Headache; information for patients