he persistent notion that migraine is “just a headache” is surprising, given the many symptoms other than headache that can accompany a migraine attack. Pain matters, and when in pain, many of us often find it hard to focus on anything other than our pain and suffering. Anything that undermines daily functioning and the ability to work, focus, parent and be a significant family member or community participant should be taken seriously. A brain in pain is an organ in distress, and an active brain in pain has clear metabolic changes that need addressing. Despite its widespread impact, many people who suffer from migraines have never consulted a physician for this condition.

Migraine is a prevalent and debilitating neurological disorder that affects a significant portion of the global population. The epidemiology of migraine reveals that it impacts over 12 per cent of adults in the USA, with a staggering three-fold higher prevalence in women compared to men, likely due to hormonal influences. The condition often begins in adolescence or early adulthood and peaks in the 30s and 40s. Geographical differences in migraine prevalence may be influenced by factors such as family history, environment and lifestyle. Migraine triggers vary widely but commonly include stress, hormonal changes, sleep disturbances and certain foods like chocolate or processed meats. Bright lights, strong smells and loud noises can also provoke attacks. Additionally, weather changes, dehydration and excessive caffeine or alcohol consumption are known to increase the likelihood of a migraine.

Migraine is characterised by a wide spectrum of clinical symptoms, including severe and persistent headaches often accompanied by sensory and motor dysfunctions.

Migraines usually follow a recognisable four-phase pattern, beginning with a pro-drome phase, which begins hours or even days before the headache. It is marked by subtle changes like mood shifts, neck stiffness, food craving, constipation and increased thirst with frequent urination. Some individuals then experience an aura phase, typically lasting between 5 and 60 minutes. During this time, they may face sensory disturbances such as visual distortions, numbness, heightened sensitivity to smells and sounds, or speech difficulties. While not everyone experiences auras, they can be an early warning sign, allowing individuals to prepare for what follows. The hallmark of migraine is a throbbing or pulsating headache that usually affects one side of the head, though it can also be bilateral. The pain typically ranges from moderate to severe and if untreated can last from 4 to 72 hours. Physical activity, even minor movements, may exacerbate the pain. The post-drome phase occurs after the headache subsides. It is often characterised by fatigue, confusion and mood changes. However, not all migraine sufferers experience all four phases, and the severity and duration of each phase can vary significantly among individuals.

Understanding the different types of migraines helps in managing symptoms more effectively and seeking targeted treatment. 

Migraines come in various forms, each with distinct characteristics. They can occur with aura or without aura. The most common form is a migraine without aura. It involves intense, throbbing headaches without sensory disturbances, typically lasting hours to days, often causing nausea. Migraine with aura is characterised by neurological symptoms such as visual disturbances, numbness or speech issues that occur before or during the headache phase. Chronic migraine occurs when a person experiences migraines on 15 or more days per month for at least three consecutive months. This type can severely impact daily life due to its frequency. Menstrual migraines are linked to hormonal fluctuations and often occur around a woman’s menstrual cycle, influenced by estrogen levels. These migraines can be predictable but are no less disruptive. Hemiplegic migraine is a rare and severe type, marked by temporary paralysis or weakness on one side of the body during an attack. This form can be particularly alarming due to its stroke-like symptoms. Another common type is migraine with aura, where individuals experience sensory disturbances such as visual changes or numbness before the headache phase begins. Understanding the different types of migraines helps in managing symptoms more effectively and seeking targeted treatment. Each type presents its challenges, requiring personalised care.

The burden of migraine extends far beyond the individual. It is considered one of the leading causes of disability worldwide. The profound impact of this disorder is not limited to the affected individuals but also extends to their families, colleagues, employers and society as a whole.

Migraine is linked to a range of co-morbid conditions, including depression, clinical and subclinical vascular brain lesions and coronary heart disease, further exacerbating the challenges faced by those living with this chronic and debilitating condition.

For migraine treatment, we have two main types of medications: acute and preventive. Acute treatments, like triptans, NSAIDs or pain relievers, are used during an attack to reduce symptoms. Preventive medications, such as beta-blockers, anti-convulsants or CGRP inhibitors, are taken regularly to reduce the frequency and severity of migraines. The choice depends on one’s symptoms and migraine patterns. In addition to medications, lifestyle modifications can help prevent migraines. Regular sleep patterns, stress management, staying hydrated and avoiding known triggers (such as certain foods and environmental factors) can significantly reduce the likelihood of migraine attacks. Behavioural therapies like cognitive behavioural therapy, biofeedback and relaxation techniques have also proven effective in managing migraines. CBT has been shown to reduce the frequency and intensity of migraines by helping patients manage stress and anxiety more effectively. Biofeedback is another popular therapy, where individuals learn to control physiological functions such as muscle tension, heart rate and skin temperature. Biofeedback helps people become more aware of physical responses to stress and teaches techniques to regulate them, thereby reducing migraine frequency. Treatment plans are adapted to each individual’s symptoms, with adjustments made based on their response and any side-effects experienced. Working closely with a healthcare provider is therefore key to living a better life with migraines.

Recognition of migraine as a multifaceted and distinct neurological process, by patients, health care professionals and people in general, is at the core of addressing this disease. Understanding the clinical features and epidemiology of migraines is crucial for effective management and treatment. With ongoing research into their causes and triggers, healthcare providers can better support individuals affected by this challenging condition. Treating migraine with respect and understanding rather than as a frequent inconvenience can be transformational for both the patient and the community.

The writer is a family physician