Migraines

Migraines are a common neurological disorder defined by recurrent headache attacks that are often moderate to severe in intensity and have a distinctive throbbing quality. Attacks last from four to 72 hours in adults and are frequently accompanied by nausea, vomiting, and sensitivity to light (photophobia) and sound (phonophobia). Many sufferers experience a prodrome or postdrome phase, and in about one-fifth to one-third of cases headaches begin with visual or sensory disturbances known as aura.

Migraine is categorized as migraine with aura and migraine without aura; chronic migraine is diagnosed when a person experiences 15 or more headache days per month for at least three months, with at least eight days bearing migrainous features. Diagnosis is clinical; imaging is reserved for red flags or when the presentation is unusual.

The exact cause is not fully understood, but migraine is thought to involve genetic susceptibility and abnormal brainstem trigeminovascular system activity. Calcitonin gene-related peptide (CGRP) and related neuropeptides play a key role. Triggers vary and can include stress, sleep disruption, hormonal changes, certain foods, alcohol, weather, and medications.

Treatment focuses on acute relief and prevention. Acute therapies include NSAIDs, triptans, and newer options such as gepants and ditans, sometimes with antiemetics. Preventive options include beta-blockers, anticonvulsants, antidepressants, CGRP monoclonal antibodies, and botulinum toxin for chronic migraine. Lifestyle measures and trigger management are also important.

Migraine affects an estimated 12–15% of people worldwide, with higher prevalence in women. It often begins in adolescence or early adulthood and may persist as a chronic condition for some. With appropriate treatment and lifestyle changes, many people experience reduced frequency and intensity and improved quality of life.