Migraine

Migraine is a common neurological disorder characterised by episodes of headache and sensory sensitivity (light, sounds, smell and motion). The headache in migraine is typically on one side, and episodes usually last 4 to 72 hours (in adults).

Migraine is a primary disorder, meaning it is not due to another problem or a structural problem within the head. Headaches similar in character to migraine can occur as a result of other problems such as head injury or in meningitis. In those scenarios the headache is said to be secondary (to another disorder), and we describe a “migraine-like” headache.

Below are common questions that patients ask of neurologists in clinic.

What triggers a migraine attack?

The timing of an individual migraine attack is mostly due to chance, under the influence of factors which have been called “triggers”. Common triggers noticed by patients include: skipping meals, poor sleep, or excess alcohol.

Why do I have migraine?

This question has two interpretations:

• why do I have migraine at all?

• why do I have migraine headaches/attacks now?

The second question is answered later.

The question of why any human being has migraine at all, I would suggest is reasonably answered as with the following statement:

“because human beings have a strong general tendency to (primary) headaches, of which migraine is a major form”.

There is no doubt about the general human tendency to headaches. The reasons for this are unclear, but the facts are unarguable. A questionnaire study of 8,217 people across European countries in 2014 for example found that more than 9 in 10 people experience headaches in their lifetime, and in any year around 4 in 5 people report one or more headaches (Steiner et al. 2014, J Headache Pain).

Migraine is the commonest singular pattern identified in patients presenting to doctors with headache. Around 12 in 100 adults experience migraine. Key predictors of whether an individual gets migraine headaches include: age (migraine is most commonly diagnosed in individuals aged 18 to 49 years), having a relative with migraine (4 in 5 people with migraine have a relative with migraine), and being female (the ratio of females to males is 3:1, likely related to oestrogen).

Why do I have migraine headaches/attacks now?

Migraine commonly emerges in early adulthood or late teenage years. The emergence of migraine is seldom attributable to any one factor, but is best understood as being due to chance under the influence of established risk factors such as age, sex and family history.

The randomness in the timing of migraine attacks, or the emergence of the diagnosis does not dissuade from the common experience of many patients that migraine emerged following a period of stress or change in routine.

It is important to note that headaches with features similar to migraine (e.g. light-sensitivity) are common after other health problems such as idiopathic intracranial headache, head trauma, intracranial aneurysm and stroke. These *secondary *headaches are best referred to as being migraine-like (and not migraine - which is by definition a primary headache disorder). This distinction is important, as the secondary migraine-like headaches commonly have a poorer treatment response to standard anti-migraine medication. Where possible, the underlying problem should be addressed.

Can migraine be cured?

An individual’s tendency to migraine can be modified by lifestyle changes and medical treatments. Doctors and neurologists therefore aim to control, rather than cure migraine.