What is migraine ?

 

Migraine is a disabling neurological disorder which affects 12%-15% of the population. Migraine shows a 3:1 prevalence ratio in women vs. men (18% women, 6% men). The difference in migraine prevalence becomes significantly higher in women after puberty and before menopause and peaks at mid-life. The higher prevalence of migraine in women is associated with fluctuations in sex hormones, mainly estrogen. Migraine attacks are incapacitating and primarily affect people in their working and child-rearing years. The economic costs of migraine, driven mainly by chronic migraine, range between $20 and $30 billion a year in the US. 

 

Is every headache considered a migraine ? 

 

No. There are specific classifications distinguishing between a headache and a migraine according to the International Classification of Headache Disorders (ICHD-3 beta). 

 

Identify your headache:
 

Although clinical diagnosis is the best and most accurate way to detemine a migraine, research has indicated that if a person answers "Yes" to 2 out of the following 3 questions there is ~ 90% chance of them having a migraine :

1. Are you nauseated or sick to your stomach when you have a headache? 

2. Did the headache limit your activity for a day or more in the last 3 months? 

3. Are you bothered by light during your headache ? 

 

What causes migraines ? 

 

The specific causes of migraine are not entirely understood. Migraine is thought to result from a summation of both genetic and environmental factors. Two of the major reported triggers for migraine are sex hormones and stress, however other triggers have also been reported such as certain types of food, food deprivation, sleep deprivation, and trauma.

 

 

How is migraine treated?

 

There are several options for migraine treatment:

Medications: Medications are frequently used for treating migraine and include both acute and preventive treatments. 

Acute treatment usually involves the use of over the counter analgesics and non-steroidal anti-inflammatory drugs (NSAIDs e.g. Aspirin, Excedrin), and a more specific treatment such as the use of triptans (Imitrex, Relpax etc.) and the ergot alkaloids (e.g. Migranal, DHE, Ergomar etc.). 

Preventive treatments include antiepileptics, anti-depressants, calcium channel blockers, beta blockers, and antihypertensive drugs. 

Botox has been FDA approved for the treatment of chronic migraine. 

 

Supplements and vitamins: Several lines of evidence indicate the addition of some vitamins and supplements to help manage migraines. These include: Vitamin B2, Vitamin D3, Magnesium oxide, butterbur, feverfew, and coenzyme Q-10. 

 

Complementary medicine: The use of complimentary medicine intervention has been growing in use. There is a strong link connecting the occurrence of migraine with anxiety disorders, depression and PTSD. The use of behavioral interventions (e.g. biofeedback, hypnosis, yoga, meditaion, cognitive behavioral therapy) combined with the use of anti-migraine medications has been shown to be significantly more efficacious to treat migraine compared to medications alone. This might indicate the strong "affective" component of migraine which is important to address.