is a neurological syndrome
characterized by altered bodily perceptions, severe headaches
, and nausea
Physiologically, the migraine headache
neurological condition more common to women than to men . The word
was borrowed from Old
(originally as "megrim", but
respelled in 1777 on a contemporary French model). The French term
derived from a vulgar
the Late Latin
itself based on Greek
, from Greek roots for "half" and "skull".
The typical migraine headache is unilateral and pulsating, lasting
from 4 to 72 hours; symptoms include nausea
(increased sensitivity to light),
to sound). Approximately one-third of people who suffer migraine
headache perceive an aura
visual, olfactory, or other sensory experiences that are a sign
that the migraine will soon occur.
Initial treatment is with analgesics
the headache, an antiemetic
nausea, and the avoidance of triggering conditions. The cause of
migraine headache is unknown
; the most
common theory is a disorder of the serotonergic
There are migraine headache variants, some originate in the
brainstem (featuring intercellular transport dysfunction of calcium
and potassium ions) and some are genetically disposed. Studies of
twins indicate a 60 to 65 percent genetic influence upon their
propensity to develop migraine headache. Moreover, fluctuating
hormone levels indicate a migraine relation: 75 percent of adult
patients are women, although migraine affects approximately equal
numbers of prepubescent boys and girls; propensity to migraine
headache is known to disappear during pregnancy, although in some
women migraines may become more frequent during pregnancy.
(IHS) classifies migraine headache.
Defining pain severity
The IHS defines the intensity of pain
verbal, four-point scale:
||does not interfere with usual activities
||inhibits, but does not wholly prevent usual activities
||prevents all activities
Signs and symptoms
The signs and symptoms of migraine vary among patients. Therefore,
what a patient experiences before, during and after an attack
cannot be defined exactly. The four phases of a migraine attack
listed below are common but not necessarily experienced by all
migraine sufferers. Additionally, the phases experienced and the
symptoms experienced during them can vary from one migraine attack
to another in the same migraineur:
- The prodrome, which occurs hours or
days before the headache.
- The aura, which immediately
precedes the headache.
- The pain phase, also known as headache
- The postdrome.
Prodromal symptoms occur in 40–60% of migraineurs (migraine
sufferers). This phase may consist of altered mood, irritability,
excessive sleepiness, craving for certain food (e.g. chocolate
), stiff muscles (especially in the
neck), constipation or diarrhea, increased urination, and other
visceral symptoms. These symptoms usually precede the headache
phase of the migraine attack by several hours or days, and
experience teaches the patient or observant family how to detect
that a migraine attack is near.
For the 20–30% of individuals who suffer migraine with aura, this
aura comprises focal neurological phenomena that precede or
accompany the attack. They appear gradually over 5 to 20 minutes
and generally last fewer than 60 minutes. The headache phase of the
migraine attack usually begins within 60 minutes of the end of the
aura phase, but it is sometimes delayed up to several hours, and it
can be missing entirely. Symptoms of migraine aura can be visual,
sensory, or motor in nature.
is the most common of the
neurological events. There is a disturbance of vision consisting
usually of unformed flashes of white and/or black or rarely of
multicolored lights (photopsia
formations of dazzling zigzag lines (scintillating scotoma
; often arranged
like the battlements
of a castle, hence
the alternative terms "fortification spectra" or "teichopsia" ).
Some patients complain of blurred or shimmering or cloudy vision,
as though they were looking through thick or smoked glass
, or, in some cases, tunnel vision
. The somatosensory
aura of migraine consists of
digitolingual or cheiro-oral paresthesias
, a feeling of pins-and-needles
experienced in the hand and arm as well as in the nose-mouth area
on the same side. Paresthesia migrate up the arm and then extend to
involve the face, lips and tongue.
Other symptoms of the aura phase can include auditory or olfactory
hallucinations, temporary dysphasia
, tingling or numbness of
the face and extremities, and hypersensitivity to touch.
File:Fortifikation (Migräne).jpg|Enhancements reminiscent of a
zigzag fort structureFile:Negatives Skotom (Brandenburger Tor Blaue
Stunde) 1.jpg|Negative scotoma, loss of awareness of local
structuresFile:Positives Skotom (Brandenburger Tor Blaue Stunde)
1.jpg|Positive scotoma, local perception of additional
structuresFile:Gesichtsfeldausfall (Brandenburger Tor Blaue Stunde)
1.jpg|Mostly one-sided loss of perception
The typical migraine headache is unilateral, throbbing, and
moderate to severe and can be aggravated by physical activity. Not
all these features are necessary. The pain may be bilateral at the
onset or start on one side and become generalized, and usually it
alternates sides from one attack to the next. The onset is usually
gradual. The pain peaks and then subsides and usually lasts 4 to 72
hours in adults and 1 to 48 hours in children. The frequency of
attacks is extremely variable, from a few in a lifetime to several
a week, and the average migraineur experiences one to three
headaches a month. The head pain varies greatly in intensity.
The pain of migraine is invariably accompanied by other features.
occurs in almost 90 percent of
patients, and vomiting occurs in about one third of patients. Many
patients experience sensory hyperexcitability manifested by
, and osmophobia
and seek a dark and quiet room.
Blurred vision, nasal stuffiness, diarrhea, polyuria
, or sweating
may be noted during the headache phase. There may be localized
of the scalp or face, scalp tenderness,
prominence of a vein or artery in the temple, or stiffness and
tenderness of the neck. Impairment of concentration and mood are
common. The extremities tend to feel cold and moist. Vertigo
may be experienced; a variation of
the typical migraine, called vestibular migraine
, has also been
described. Lightheadedness, rather than true vertigo, and a feeling
of faintness may occur.
The patient may feel tired or "hungover" and have head pain,
cognitive difficulties, gastrointestinal symptoms, mood changes,
and weakness. Some people feel unusually refreshed or euphoric
after an attack, whereas others note depression and malaise
. Often, some of the minor headache phase
symptoms may continue, such as loss of appetite, photophobia, and
lightheadedness. For some patients, a 5- to 6-hour nap may reduce
the pain, but slight headaches may still occur when the patient
stands or sits quickly. These symptoms may go away after a good
night's rest, although there is no guarantee. Some people may
suffer and recover differently than others.
A migraine trigger is any factor that, on exposure or withdrawal,
leads to the development of an acute migraine headache. Triggers
may be categorized as behavioral, environmental, infectious,
dietary, chemical, or hormonal. In the medical literature, these
factors are known as 'precipitants.'
The MedlinePlus Medical
, for example, offers the following list of
Sometimes the migraine occurs with no apparent "cause". The trigger
theory supposes that exposure to various environmental factors
precipitates, or triggers, individual migraine episodes. Migraine
patients have long been advised to try to identify personal
headache triggers by looking for associations between their
headaches and various suspected trigger factors and keeping a
"headache diary" recording migraine incidents and diet to look for
in order to avoid trigger
foods. It must be mentioned, that some trigger factors are
quantitative in nature, i.e., a small block of dark chocolate may
not cause a migraine, but half a slab of dark chocolate almost
definitely will, in a susceptible person. In addition, being
exposed to more than one trigger factor simultaneously will more
likely cause a migraine, than a single trigger factor in isolation,
e.g., drinking and eating various known dietary trigger factors on
a hot, humid day, when feeling stressed and having had little sleep
will probably result in a migraine in a susceptible person, but
consuming a single trigger factor on a cool day, after a good
night's rest with minimal environmental stress may mean that the
sufferer will not develop a migraine after all. Migraines can be
complex to avoid, but keeping an accurate migraine diary and making
suitable lifestyle changes can have a very positive effect on the
sufferer's quality of life. Some trigger factors are virtually
impossible to avoid, e.g. the weather or emotions, but by limiting
the avoidable trigger factors, the unavoidable ones may have less
of an impact on the sufferer.
Many migraine sufferers report reduced incidence of migraines due
to identifying and avoiding their individual food triggers.
However, more studies are needed.
One food elimination that has proven to
reduce or eliminate migraines in a percentage of patients is
. For those with (often undiagnosed)
or other forms of
gluten sensitivity, migraines may be a symptom of gluten
intolerance. One study found that migraine sufferers were ten times
more likely than the general population to have celiac disease, and
that a gluten-free diet eliminated or reduced migraines in these
patients. Another study of 10 patients with a long history of
chronic headaches that had recently worsened or were resistant to
treatment found that all 10 patients were sensitive to gluten. MRI
scans determined that each had inflammation in their central
nervous systems caused by gluten-sensitivity. Seven out of nine of
these patients that went on a gluten-free diet stopped having
While some people believe that aspartame
triggers migraines, and anecdotal evidence is present, this has not
been medically proven.
In a placebo-controlled trial, monosodium glutamate
(MSG) in large
doses (2.5 grams) taken on an empty stomach was associated with
adverse symptoms including headache more often than was placebo
. However another trial found no effect when
3.5g of MSG was given with food.
The National Headache Foundation has a
specific list of triggers based on the tyramine theory, detailing
allowed, with caution and avoid triggers. However, a 2003 review
article concluded that there was no scientific evidence for an
effect of tyramine on migraine.
A 2005 literature review
found that the available
information about dietary trigger factors relies mostly on the
subjective assessments of patients. Some suspected dietary trigger
factors appear to genuinely promote or precipitate migraine
episodes, but many other suspected dietary triggers have never been
demonstrated to trigger migraines. The review authors found that
, and missing meals are the most important dietary
migraine precipitants, that dehydration deserved more attention,
and that some patients report sensitivity to red wine. Little or no
evidence associated notorious suspected triggers like chocolate,
, nitrates, or nitrites with migraines.
However, the review authors also note that while general dietary
restriction has not been demonstrated to be an effective migraine
therapy, it is beneficial for the individual to avoid what has been
a definite cause of the migraine.
Several studies have found some migraines are triggered by changes
in weather. One study noted 62% of the subjects thought weather was
a factor but only 51% were sensitive to weather changes. Among
those whose migraines did occur during a change in weather, the
subjects often picked a weather change other than the actual
weather data recorded. Most likely to trigger a migraine were, in
- Temperature mixed with humidity. High humidity plus high or low
temperature was the biggest cause.
- Significant changes in weather
- Changes in barometric
Another study examined the effects of warm chinook winds
on migraines, with many patients
reporting increased incidence of migraines immediately before
and/or during the chinook winds. The number of people reporting
migrainous episodes during the chinook winds was higher on
high-wind chinook days. The probable cause was thought to be an
increase in positive ions
in the air.
One study found that for some migraineurs in India, washing hair in
a bath was a migraine trigger. The triggering effect also had to do
with how the hair was later dried.
Strong fragrances have also been identified as potential triggers,
and some sufferers report an increased sensitivity to scent as an
Migraines were once thought to be initiated exclusively by problems
with blood vessels
. The vascular
theory of migraines is now considered secondary to brain
dysfunction and claimed to have been discredited by others.
can be at least part
of the cause, and perpetuate most kinds of headaches.
The effects of migraine may persist for some days after the main
headache has ended. Many sufferers report a sore feeling in the
area where the migraine was, and some report impaired thinking for
a few days after the headache has passed.
Migraine headaches can be a symptom of Hypothyroidism
A phenomenon known as cortical spreading depression
can cause migraines. In cortical spreading depression
is depressed over an
area of the cortex
of the brain.
This situation results in the release of inflammatory
mediators leading to irritation of
roots, most particularly
the trigeminal nerve
, which conveys
the sensory information for the face and much of the head.
This view is supported by neuroimaging
techniques, which appear to show that migraine is primarily a
disorder of the brain (neurological), not of the blood vessels
(vascular). A spreading depolarization (electrical change) may
begin 24 hours before the attack, with onset of the headache
occurring around the time when the largest area of the brain is
depolarized. A French study in 2007, using the Positron Emission Tomography
(PET) technique identified the hypothalamus
as being critically involved in
the early stages.
Migraines can begin when blood vessels
in the brain contract and expand inappropriately. This may start in
the occipital lobe, in the back of the brain, as arteries spasm.
The reduced flow of blood from the occipital lobe triggers the aura
that some individuals who have migraines experience because the
visual cortex is in the occipital area.
When the constriction stops and the blood
dilate, they become too wide. The once solid walls of
the blood vessels become permeable and some fluid leaks out. This
leakage is recognized by pain receptors in the blood vessels
of surrounding tissue. In
response, the body supplies the area with chemicals which cause
inflammation. With each heart beat, blood passes through this
sensitive area causing a throb of pain.
The vascular theory of migraines is now seen as secondary to brain
is a type of neurotransmitter,
or "communication chemical" which passes messages between nerve
cells. It helps to control mood, pain sensation, sexual behaviour,
sleep, as well as dilation and constriction of the blood vessels
among other things. Low serotonin
in the brain may lead to a process of constriction and dilation of
the blood vessels which trigger a migraine. Triptans
activate serotonin receptors to stop a
When certain nerves or an area in the brain
become irritated, a migraine begins. In response to the
irritation, the body releases chemicals which cause inflammation of
the blood vessels. These chemicals cause further irritation of the
nerves and blood vessels and results in pain. Substance P
is one of the substances released
with first irritation. Pain then increases because substance P aids
in sending pain signals to the brain.
Both vascular and neural influences cause migraines.
- stress triggers changes in the brain
- these changes cause serotonin to be released
- blood vessels constrict and dilate
- chemicals including substance P irritate nerves and blood
vessels causing pain
Migraines are underdiagnosed and misdiagnosed. The diagnosis of
migraine without aura, according to the International Headache
, can be made according to the following criteria, the
"5, 4, 3, 2, 1 criteria":
- 5 or more attacks
- 4 hours to 3 days in duration
- 2 or more of - unilateral location, pulsating quality, moderate
to severe pain, aggravation by or avoidance of routine physical
- 1 or more accompanying symptoms - nausea and/or vomiting,
For migraine with aura, only two attacks are required to justify
The mnemonic POUNDing (P
ulsating, duration of 4–72
isabling) can help
diagnose migraine. If 4 of the 5 criteria are met, then the
positive likelihood ratio
diagnosing migraine is 24.
The presence of either disability, nausea or sensitivity, can
diagnose migraine with:
Migraine should be differentiated
from other causes of
headaches such as cluster
. These are extremely painful, unilateral headaches of
a piercing quality. The duration of the common attack is 15 minutes
to three hours. Onset of an attack is rapid, and most often without
the preliminary signs that are characteristic of a migraine.
Preventive (also called prophylactic
treatment of migraines can be an important component of migraine
management. Such treatments can take many forms, including
everything from taking certain drugs or nutritional supplements, to
lifestyle alterations such as increased exercise and avoidance of
The goals of preventive therapy are to reduce the frequency,
painfulness, and/or duration of migraines, and to increase the
effectiveness of abortive therapy. Another reason to pursue these
goals is to avoid medication overuse headache (MOH), otherwise
known as rebound headache
, which is
a common problem among migraneurs. This is believed to occur in
part due to overuse of pain medications, and can result in chronic
Many of the preventive treatments are quite effective: Even with a
(sham treatment), one-quarter of
patients find that their migraine frequency is reduced by half or
more, and actual treatments often far exceed this figure.
Conventional treatment focuses on three areas: trigger avoidance,
symptomatic control, and prophylactic pharmacological drugs.
Patients who experience migraines often find that the recommended
migraine treatments are not 100% effective at preventing migraines,
and sometimes may not be effective at all. Pharmacological
treatments are considered effective
if they reduce the
frequency or severity of migraine attacks by 50%.
Children and adolescents are often first given drug treatment, but
the value of diet modification should not be overlooked. The simple
task of starting a diet journal to help modify the intake of
trigger foods like hot dogs, chocolate, cheese and ice cream could
help alleviate symptoms.
For patients who have been diagnosed with recurring migraines,
migraine abortive medications
can be used to treat the attack, and may be more effective if taken
early, losing effectiveness once the attack has begun. Treating the
attack at the onset can often abort it before it becomes serious,
and can reduce the near-term frequency of subsequent attacks.
Paracetamol or non-steroidal anti-inflammatory drug
The first line of treatment is over-the-counter abortive medication
- Regarding non-steroidal
anti-inflammatory drugs, a randomized controlled trial
found that naproxen can abort about one
third of migraine attacks, which was 5% less than the benefit of
- Paracetamol (known as acetaminophen
in North America) benefited over half of patients with mild or
moderate migraines in a randomized controlled
- Simple analgesics combined with caffeine may help. During a migraine attack,
emptying of the stomach is slowed, resulting in nausea and a delay
in absorbing medication. Caffeine has been shown to partially
reverse this effect. Excedrin is an example
of an aspirin with caffeine product. Caffeine is recognized by the
U.S. Food and Drug
Administration as an Over The Counter Drug (OTC) treatment for
migraine when compounded with aspirin and paracetamol. Even by
itself, caffeine can be helpful during an attack, despite the fact
that in general migraine-sufferers are advised to limit their
Patients themselves often start off with paracetamol
, or other simple analgesics
that are useful for tension headaches.
OTC drugs may provide some relief, although they are typically not
effective for most sufferers.
In all, the U.S. Food and Drug Administration has approved three
OTC products specifically for migraine: Excedrin Migraine, Advil
Migraine, and Motrin Migraine Pain. Excedrin Migraine, as mentioned
above, is a combination of aspirin, acetaminophen, and caffeine.
Both Advil Migraine and Motrin Migraine Pain are straight NSAIDs,
as the only active
Analgesics combined with antiemetics
by mouth may help relieve
symtoms of nausea and help prevent vomiting, which can diminish the
effectiveness of orally taken analgesia. In addition some
antiemetics such as metoclopramide
and help gastric emptying
which is often impaired during episodes of migraine. In the UK
there are three combination antiemetic and analgesic preparations
available: MigraMax (aspirin
(paracetamol/codeine for analgesia, with buclizine
as the antiemetic) and paracetamol/metoclopramide
(Paramax in UK). The earlier these drugs are taken in the attack,
the better their effect.
Some patients find relief from taking other sedative antihistamines
which have anti-nausea properties, such as Benadryl
which in the US contains diphenhydramine
(but a different
non-sedative product in the UK).
and related selective
are excellent for severe migraines or those that do
not respond to NSAIDs
or other over-the-counter
are a mid-line treatment suitable for many
migraineurs with typical migraines. They may not work for atypical
or unusually severe migraines, transformed migraines, or status
specific reuptake inhibitors
(SSRIs) are not approved by the
U.S. Food and Drug
(FDA) for treatment of migraines, but have been
found to be effective by clinical consensus.
long established as highly efficacious prophylactic treatments.
These drugs, however, may give rise to undesirable side effects,
such as insomnia, sedation or sexual dysfunction. SSRIs
antidepressants are less established than
tricyclics for migraines prophylaxis. Despite the absence of FDA
approval for migraine treatment, antidepressants are widely
prescribed. In addition to tricyclics and SSRIs, the
may also be
beneficial in the prophylaxis of migraines due to its antagonistic
effects on the 5-HT2A and 5-HT2C receptors It has a more favorable
side effect profile than amitriptyline
, a tricyclic antidepressant
commonly used for migraine prophylaxis. Anti-depressants offer
advantages for treating migraine patients with comorbid
Until the introduction of sumatriptan in 1991, ergot
derivatives (see ergoline
) were the primary oral drugs available to
abort a migraine once it is established.
Ergot drugs can be used either as a preventive or abortive therapy,
though their relative expense and cumulative side effects suggest
reserving them as an abortive rescue medicine. However, ergotamine
tartrate tablets (usually with
caffeine), though highly effective, and long lasting (unlike
triptans), have fallen out of favour due to the problem of ergotism
. Oral ergotamine tablet absorption is
reliable unless the patient is nauseated. Anti-nausea
administration is available by ergotamine suppository (or Ergostat
sublingual tablets made until circa 1992). Ergot drugs themselves
can be so nauseating it is advisable for the sufferer to have
something at hand to counteract this effect when first using this
drug. Ergotamine-caffeine 1/100 mg fixed ratio tablets (like
are much less expensive per headache than triptans, and are
commonly available in Asia and Romania (Cofedol). They are
difficult to obtain in the USA. Ergotamine-caffeine can't be
regularly used to abort evening or night onset migraines due to
debilitating caffeine interference with sleep. Pure ergotamine
tartrate is highly effective for evening-night migraines, but is
rarely or never available in the USA. Dihydroergotamine
(DHE), which must be
injected or inhaled, can be as effective as ergotamine tartrate,
but is much more expensive than $2 USD Cafergot tablets.
Many anecdotes indicate that LSD
, (and the related compounds in psychedelic
, although they are not ergot alkaloids)
are effective in preventing and treating migraines as well as
. The doses do not
have to be high enough to cause psychedelic
effects to have an effect on
Based on a recent meta analysis a single dose of IV dexamethasone
, when added to standard
treatment, is associated with a 26% decrease in headache
If over-the-counter medications do not work, or if triptans are
unaffordable, the next step for many doctors is to prescribe
, which is a combination of butalbital
(in Fioricet) or acetylsalicylic acid
known as aspirin
and present in Fiorinal),
. While the risk of addiction
is low, butalbital can be habit-forming if used daily, and it can
also lead to rebound headaches
Barbiturate-containing medications are not available in many
is a combination of acetaminophen
, and isometheptene
often prescribed for migraine
headaches. Some studies have recently shown that these drugs may
work better than sumatriptan for treating migraines.
may need to be given by
where vomiting dominates the
Recently it has been found that calcitonin gene related
(CGRPs) play a role in the pathogenesis of the pain
associated with migraine as triptans also decrease its release and
action. CGRP receptor
such as olcegepant
are being investigated both
in vitro and in clinical studies for the treatment of
Status migrainosus is characterized by migraine lasting more than
72 hours, with not more than four hours of relief during that
period. It is generally understood that status migrainosus has been
refractory to usual outpatient management upon presentation.
Treatment of status migrainosus consists of managing comorbidities
(i. e. correcting fluid and electrolyte abnormalities resulting
from anorexia and nausea/vomiting often accompanying status migr.),
and usually administering parenteral
medication to "break" (abort) the headache.
Although the literature is full of many case reports concerning
treatment of status migrainosus, first line therapy consists of
intravenous fluids, metoclopramide
The herbal supplement feverfew
commonly used for migraine prevention, see below) is marketed by
as an OTC migraine abortive, administered
sublingually (under the tongue) in a mixture with ginger
. An open-label study (funded by GelStat) found
some tentative evidence of the treatment's effectiveness, but no
scientifically sound study has been done. Cannabis
, in addition to prevention, is also known
to relieve pain during the onset of a migraine.
Regarding comparative effectiveness of these drugs used to abort
migraine attacks, a 2004 placebo-controlled trial reveals that high
dose acetylsalicylic acid (1000 mg), sumatriptan 50 mg
and ibuprofen 400 mg are equally effective at providing relief
from pain, although sumatriptan was superior in terms of the more
demanding outcome of rendering patients entirely free of pain and
all other migraine-related symptoms.
, funded by the manufacturer of the study drug,
found that a combination of sumatriptan
85 mg and naproxen
sodium 200 mg
was better than either drug alone.
Recently the combination of sumatriptan
85 mg and naproxen
sodium 500 mg
was demonstrated to be effective and well tolerated in an early
intervention paradigm for the acute treatment of migraine.
Significant pain-free responses in favor of sumatriptan
were demonstrated as early as 30 minutes, maintained at 1 hour, and
sustained from 2 to 24 hours. At 2 and 4 hours, sumatriptan
provided significantly lower rates of traditional
migraine-associated symptoms (nausea, photophobia, and phonophobia)
and nontraditional migraine-associated symptoms (neck
pain/discomfort and sinus pain/pressure).
The risk of stroke
may be increased two- to
threefold in migraine sufferers. Young adult sufferers and women
using hormonal contraception
appear to be at particular risk. The mechanism of any association
is unclear, but chronic abnormalities of cerebral blood vessel
tone may be involved. Women who
experience auras have been found to have twice the risk of strokes
and heart attacks over non-aura migraine sufferers and women who do
not have migraines. Migraine sufferers seem to be at risk for both
thrombotic and hemorrhagic stroke as well as transient ischemic attacks
from cardiovascular causes was higher in people with migraine with
aura in a Women's Health
study, but more research is needed to confirm
[[Image:Migraine world map - DALY - WHO2002.svg|thumb|Disability-adjusted life year
for migraines per 100,000 inhabitants in 2002.
Migraine is an extremely common condition which will affect 12–28%
of people at some point in their lives. However this figure — the
lifetime prevalence — does not provide a very clear picture of how
many patients there are with active migraine at any one time.
Typically, therefore, the burden of migraine in a population is
assessed by looking at the one-year prevalence — a figure that
defines the number of patients who have had one or more attacks in
the previous year. The third figure, which helps to clarify the
picture, is the incidence — this relates to the number of first
attacks occurring at any given age and helps understanding of how
the disease grows and shrinks over time.
Based on the results of a number of studies, one year prevalence of
migraine ranges from 6–15% in adult men and from 14–35% in adult
women. These figures vary substantially with age: approximately
4–5% of children aged under 12 suffer from migraine, with little
apparent difference between boys and girls. There is then a rapid
growth in incidence amongst girls occurring after puberty, which
continues throughout early adult life. By early middle age, around
25% of women experience a migraine at least once a year, compared
with fewer than 10% of men. After menopause, attacks in women tend
to decline dramatically, so that in the over 70s there are
approximately equal numbers of male and female sufferers, with
prevalence returning to around 5%.
At all ages, migraine without aura is more common than migraine
with aura, with a ratio of between 1.5:1 and 2:1. Incidence figures
show that the excess of migraine seen in women of reproductive age
is mainly due to migraine without aura. Thus in pre-pubertal and
post-menopausal populations, migraine with aura is somewhat more
common than amongst 15–50 year olds.
There is a strong relationship between age, gender and type of
Geographical differences in migraine prevalence are not marked.
Studies in Asia and South America suggest that the rates there are
relatively low, but they do not fall outside the range of values
seen in European and North American studies.
The incidence of migraine is related to the incidence of epilepsy
in families, with migraine twice as
prevalent in family members of epilepsy sufferers, and more common
in epilepsy sufferers themselves.
9,000 year old skulls exist with evidence of trepanation
. It is hypothesized that this
drastic step was taken in response to headaches, though there is no
clear evidence proving this. . Headache with neuralgia
was recorded in the medical documents of
the ancient Egyptians as early as 1200 BC.
In 400 BC Hippocrates
that can precede the
migraine headache and the relief which can occur through vomiting.
of Cappadocia is credited as the "discoverer" of migraines
because of his second century description of the symptoms of a
unilateral headache associated with vomiting, with headache-free
intervals in between attacks.
of Pergamon used the term
"hemicrania" (half-head), from which the word "migraine" was
derived. He thought there was a connection between the stomach
and the brain because of the nausea and
vomiting that often accompany an attack. For relief of migraine,
Andalusian-born physician Abulcasis
known as Abu El Qasim, suggested application of a hot iron to the
head or insertion of garlic into an incision made in the
In the Middle Ages
recognized as a discrete medical disorder with treatment ranging
from hot irons to blood letting and even witchcraft . Followers of
Galenus explained migraine as caused by aggressive yellow bile
.Ebn Sina (Avicenna
) described migraine in his textbook "El
Qanoon fel teb" as "... small movements, drinking and eating,
and sounds provoke the pain... the patient cannot tolerate the
sound of speaking and light. He would like to rest in darkness
alone."Abu Bakr Mohamed Ibn Zakariya Râzi noted the association of
headache with different events in the lives of women, "...And such
a headache may be observed after delivery and abortion
or during menopause
Bibliotheca Anatomica, Medic, Chirurgica, published in
London in 1712, five major types of headaches are
described, including the "Megrim", recognizable as classic
Graham and Wolff
published their paper advocating ergotamine
tart for relieving migraine. Later in
the 20th century, Harold Wolff
developed the experimental approach to the study of headache and
elaborated the vascular theory of migraine, which has come under
attack as the pendulum again swings to the neurogenic theory.
Society and culture
In addition to being a major cause of pain and suffering, chronic
migraine attacks are a significant source of both medical costs and
lost productivity.It has been estimated to be the most costly
neurological disorder in the European Community, costing more than
€27 billion per year. Medical costs per migraine sufferer (mostly
physician and emergency room visits) averaged $107 USD
over six months in one 1988 study, with total costs
including lost productivity averaging $313. Annual employer cost of
lost productivity due to migraines was estimated at $3,309 per
sufferer. Total medical costs associated with migraines in the
United States amounted to one billion dollars in 1994, in addition
to lost productivity estimated at thirteen to seventeen billion
dollars per year. Employers may benefit from educating themselves
on the effects of migraines in order to facilitate a better
understanding in the workplace. The workplace model of 9–5, 5 days
a week may not be viable for a migraine sufferer. With education
and understanding an employer could compromise with an employee to
create a workable solution for both.
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