Migraine

Migraine is a common neurological disorder defined by recurrent headaches of moderate to severe intensity that are often unilateral and pulsating. Attacks typically last 4 to 72 hours and are frequently accompanied by nausea, vomiting, and sensitivity to light and sound. A subset of people experiences an aura—transient visual, sensory, or speech disturbances—that can precede the headache.

Migraine is categorized as with aura or without aura. Chronic migraine is defined as 15 or more headache days per month for more than three months, with migraine features on at least eight days.

Genetic factors and alterations in brainstem pain pathways and the trigeminovascular system contribute to migraine. The release of calcitonin gene-related peptide (CGRP) and related inflammatory processes are involved, while aura is linked to waves of cortical spreading depression.

Diagnosis is clinical, based on history and criteria from the ICHD-3; there are no routine laboratory tests for migraine. Red flags prompting evaluation for other conditions include sudden onset, neurologic deficits outside typical aura, or new headaches in people over 50. Common triggers include stress, disrupted sleep, hormonal changes, certain foods, alcohol, caffeine, weather changes, and dehydration.

Acute treatment aims to relieve symptoms during attacks and may include NSAIDs and triptans, with antiemetics for nausea. Novel options such as CGRP receptor antagonists (gepants) and ditans are available in some settings. Preventive therapy is considered for frequent or disabling migraine and includes beta-blockers, anticonvulsants, antidepressants, and CGRP monoclonal antibodies. Lifestyle measures—regular sleep, hydration, meals, exercise, and trigger management—support overall treatment. Many people achieve good control with appropriate therapy, though migraine can remain a chronic condition for some.