Understanding Migraines: A Neurological Disorder
Migraines are a primary headache disorder, not caused by an underlying structural issue. They result from activation of the trigeminovascular system, a network of nerves and blood vessels that detects pain in the brain. The trigeminal nerve releases a chemical called CGRP (calcitonin gene-related peptide), which activates the brain's pain network, leading to moderate to crippling headaches.
Historical Misconceptions and Progress
Historically, treatments for migraines ranged from anointing the scalp with fried catfish (as mentioned in the Ebers Papyrus from 1550 BC) to blood-letting by the Roman physician Galen. In the 20th century, repressed emotions were blamed, and women sufferers were often dismissed as fragile or neurotic. The vascular theory, which attributed migraines to blood vessel expansion and contraction, persisted until recently. Over the last decade, understanding of the neurological basis of migraines has advanced significantly, leading to better treatments and reduced stigma.
Phases of a Migraine
Migraines typically occur in four phases. The prodrome phase includes symptoms like excessive yawning, urination, fatigue, and food cravings. According to Professor Alexandra Sinclair, a neurology professor at the University of Birmingham, functional brain imaging shows that brain areas involved in craving food are activated up to 24 hours before the pain, meaning the migraine causes the craving, not the other way around. About 30% of sufferers experience an aura phase, with visual disturbances, numbness, or speech difficulties. The migraine itself lasts 4 to 72 hours, followed by a postdrome phase of exhaustion lasting up to two days.
Triggers and Risk Factors
Common triggers include lack of sleep, too much sleep, caffeine withdrawal, dehydration, and significant stress. Alcohol can trigger cluster headaches within minutes. Screen time is not conclusively linked to migraine onset, though sufferers are often sensitive to light. Hormonal differences mean about twice as many women suffer from migraines as men, contributing to historical under-treatment.
New Treatments: CGRP Inhibitors
The identification of CGRP has led to new treatments. Gepants are tablets that block the CGRP receptor, while CGRP monoclonal antibodies (Mabs) are administered via monthly injection. Professor Sinclair notes that these have "truly revolutionised headache care over the last four or five years." However, these treatments are expensive and difficult to access. She advocates for more healthcare professionals trained in headache management and simpler prescribing processes to help patients recover faster.
Impact and Outlook
Migraines are among the top 10 most disabling diseases globally, according to the World Health Organization, affecting people during their most productive years. Effective management can be crucial for employment and quality of life. Professor Sinclair emphasizes that understanding and treatment have changed dramatically, and sufferers should seek help: "if you're a migraine sufferer, things really have changed."
