What We Know About Migraines

Migraines are a major cause of pain and disability to a lot of people, but more recent research is shedding more light on what causes migraines and what can be done about them.

True migraines are consistent of 3 distinct parts:

• Premonitory phase (prodrome) – Which can be symptoms such as mood changes, neck stiffness and yawning. It can also be accompanied by a “feeling” that something bad is about to happen.
• The migraine itself – This is often debilitating pain, often preceded by sensory symptoms such as disturbances in vision, speech and/movement (Aura). These symptoms can last anything from a few minutes to a few days.
• The postdrome – After the migraine, the feeling of tiredness or being unwell can continue for a few days.

Symptoms can be very variable between different people, however, tend to effect women at a ratio of 3 to 1 compared to men, often beginning in puberty.

The previous theory that migraine is due to uncontrolled opening (dilation) of the blood vessels of the brain, however, this seems to be a symptoms of the problem, not the cause. A hormone called calcitonin gene-related peptide (CGRP) released from the trigeminal nerve of the face (5th cranial nerve) seems to proceed a migraine and be the trigger.

At the aura phase of the migraine, a wave of brain activity switching the nerves from the back of the brain (occipital lobe) on and off. This wave of activity “moves” from the back of the brain to the front. This process irritates the pain sensitive receptors of membrane surrounding the brain and causes the trigeminal nerve to release CGRP. Therefore, the pain associated with migraine is an outcome of this process, rather than the cause.

Medications that block the release of CGRP (e.g. monoclonal antibodies) are showing promising signs in helping prevent migraine. At present, watch this space, however this provides hope for the future of sufferers of migraines.

Hamzelou, J (2022) Taming Migraine, 29th January 2022, No. 3371. P38-42.

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