Migraine (MGN)
Migraine (MGN) is a complex neurological disorder characterized by recurrent episodes of moderate-to-severe headache pain, typically pulsating and often unilateral (one side of the head). It is frequently accompanied by symptoms such as nausea, vomiting, and heightened sensitivity to light (photophobia) and sound (phonophobia)123.
Symptoms
- Severe throbbing or pulsing headache, usually on one side of the head
- Nausea and vomiting
- Sensitivity to light, sound, and sometimes smell or touch
- Aura in some cases: transient neurological symptoms such as visual disturbances, sensory changes, or speech difficulties that precede or accompany the headache
- Other symptoms may include dizziness, difficulty concentrating, and mood changes
- Migraine attacks can last from 4 to 72 hours and vary in frequency and intensity1367
Types of Migraine
- Migraine without aura: Most common type, characterized by headache attacks with typical migraine symptoms but no preceding neurological symptoms6.
- Migraine with aura: Includes reversible neurological symptoms (visual, sensory, speech, motor, or brainstem disturbances) before or during headache6.
- Chronic migraine: Headaches occurring on 15 or more days per month for over 3 months, with migraine features on at least 8 days per month6.
- Probable migraine: Migraine-like attacks missing one feature required for full diagnosis6.
Causes and Triggers
- Genetics: Strong hereditary component; multiple genes likely involved6.
- Neurological mechanisms: Abnormal brain activity involving nerve pathways and chemicals, leading to changes in blood flow and inflammation of pain-sensitive structures in the brain567.
- Common triggers include:
- Hormonal changes (menstrual cycle, birth control pills)
- Stress and anxiety
- Sleep disturbances or changes in sleep patterns
- Certain foods and additives (alcohol, caffeine withdrawal, chocolate, nuts, cheese, citrus fruits, MSG, tyramine)
- Environmental factors (bright lights, loud noises, strong smells, temperature changes)
- Physical exertion
- Skipped meals or dehydration578
Pathophysiology
- Current understanding rejects the older vascular theory; instead, migraines involve complex neuronal dysfunction.
- Activation of trigeminal nerve afferents leads to release of proinflammatory mediators and neurogenic inflammation in meninges.
- Cortical spreading depression underlies aura phenomena.
- Central and peripheral sensitization contribute to pain and associated symptoms67.
Diagnosis
- Based primarily on clinical history and symptom pattern.
- Diagnostic criteria established by the International Headache Society.
- Important to rule out secondary causes of headache.
Management
- Acute treatment: NSAIDs, triptans, antiemetics, and other pain-relieving medications.
- Preventive treatment: Beta-blockers, antiepileptics, antidepressants, CGRP antagonists, lifestyle modifications, and trigger avoidance.
- Non-pharmacological: Stress management, regular sleep, hydration, and dietary adjustments.
Summary Table
| Aspect | Details |
|---|---|
| Definition | Recurrent moderate-to-severe headaches with neurological and systemic symptoms |
| Common Symptoms | Unilateral throbbing headache, nausea, vomiting, photophobia, phonophobia, aura |
| Types | Migraine without aura, migraine with aura, chronic migraine, probable migraine |
| Causes/Triggers | Genetic predisposition, hormonal changes, stress, sleep changes, diet, environmental factors |
| Pathophysiology | Neuronal dysfunction, trigeminal activation, cortical spreading depression, neurogenic inflammation |
| Diagnosis | Clinical criteria based on history and symptoms |
| Treatment | Acute (NSAIDs, triptans), preventive medications, lifestyle changes |
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References
- Mayo Clinic. Migraine – Symptoms and causes.
https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201 - Cleveland Clinic. Migraine headaches.
https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches - WebMD. Migraine: Symptoms, Causes, and Treatment.
https://www.webmd.com/migraines-headaches/migraines-headaches-migraines - MedlinePlus. Migraine: Medical Encyclopedia.
https://medlineplus.gov/ency/article/000709.htm - StatPearls. Migraine Headache.
https://www.ncbi.nlm.nih.gov/books/NBK560787/ - Healthline. Migraine: Symptoms, Causes, Treatment, Triggers, and More.
https://www.healthline.com/health/migraine - Medical News Today. Migraine: Symptoms, causes, treatment, and more.
https://www.medicalnewstoday.com/articles/148373
Migraine is a prevalent neurological disorder causing disabling headaches and associated symptoms. Understanding triggers and pathophysiology guides effective management to reduce attack frequency and severity.
