Migraine is a headache disorder that is characterized by headaches that are severe and recurrent (happen more than once). Migraine is a common condition that affects 15% of the adult population. It is more common in women and tends to run in families. The exact causes of migraine headaches are not well understood. There are specific nerves in the blood vessels of the head that send pain signals to the brain. These are thought to play a role in migraine. Some common triggers are hormone changes, stress, caffeine, lights, skipping meals and food sensitivities.
The pain of migraines is typically described as pulsating or throbbing in one side of the head. The International Headache Society criteria to diagnose a migraine uses its pain (one sided, throbbing) and it’s duration (4-72 hours if untreated). Additional symptoms such as nausea and vomiting or sensitivity to light and sound must also be present to diagnose migraines.
Four Phases Associated With Migraines
Prodrome "pre-headache"
- Difficulty concentrating
- Trouble sleeping
- Yawning
Aura
Some people with migraines don't have an aura but when present serves as a “warning signal” for migraine.
- Vision disturbances
- Changes in speech
- "Funny feeling"
Headache
- Light and sound sensitivity
- Nausea and vomiting
Postdrome
- Being unable to concentrate
- Feeling depressed
Are There Treatments?
Migraine treatments are divided into two different groups: abortive and prophylactic. Abortive treatments (acute treatment) are taken to stop a migraine once it has already started. Prophylactic treatments (chronic treatment) are taken regularly to prevent migraines from happening.
Abortive Treatments
Abortive treatments include acetaminophen, non-steroidal anti-inflammatory drugs (ibuprofen, naproxen), triptans (like sumatriptan), ergot alkaloids (ergotamine, dihydroergotamine:DHE) and anti-emetics (reglan, compazine).
Prophylactic Treatments
Prophylactic treatments are preferred for those having frequent migraines (as defined as more than 4 attacks per month). There are many different groups of medications used to treat migraines prophylactically. These include beta blockers (propranolol), antidepressants (amitriptyline), anticonvulsants (topiramate, depakote), calcium channel blockers (verapamil) and botox.
Preventative Therapy
One of the newer categories of preventative therapy for migraines is the Calcitonin gene-related peptide (CGRP) inhibitors. These work by blocking CGRP which has been associated with pain of migraines and thought to be the cause of migraine. There are several different medications in the CGRP receptor agonist category. Most of these newer medications are injection formulations (Ajovy, Aimovig, Emgality, Vyepti).
Clinical Trials
It is important to find more preventative options for treatment of people with chronic migraine as these can be debilitating. If you are interested in participating in a migraine trial or any one of our other enrolling trials, don't hesitate to check out our website for currently enrolling trials.
References:
- Mayans, Laura, and Anne Walling. “Acute Migraine Headache: Treatment Strategies.” American Family Physician, 15 Feb. 2018, www.aafp.org/afp/2018/0215/p243.html.
- “Migraine Diagnosis.” Migraine Diagnosis Criteria | Science of Migraine, www.scienceofmigraine.com/management/migraine-diagnosis-criteria.
- “Migraine Facts.” Migraine Research Foundation, 15 Jan. 2021, migraineresearchfoundation.org/about-migraine/migraine-facts/.
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“Migraine Information Page.” National Institute of Neurological Disorders and Stroke, U.S. Department of Health and Human Services, www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page#:~:text=People%20with%20migraine%20tend%20to,one%20area%20of%20the%20head.
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“What Are the Stages of a Migraine?” Mayo Clinic Health System, www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/what-are-the-stages-of-a%20migraine.
