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Migraines: New Insights for Clinical Management and Treatment

Recent research studies have provided important insights into genetic causes, anatomical and physiological features, and pharmacological mechanisms of migraine.

If you don’t get migraine headaches, you may know someone who does and how distressing they can be.

Migraine is one of the top three most prevalent illnesses in the world. Migraine is most common between the ages of 25 and 50 years, but it can trouble much younger people and even children.

Most people also suffer from neck pain, depression, and anxiety with migraines.

According to The International Classification of Headache Disorders (ICHD), migraine is not simply a bad headache.

It is a neurological disease with reoccurring premonitory symptoms, nausea, and aura.

Attacks usually last between 4 and 72 hours, up to eight days a month. Migraines, however, are not perceived seriously by the public as they are mostly episodic and are not contagious.

Recently, The World Health Organization has identified a lack of knowledge among healthcare providers as the main clinical barrier to the effective diagnosis and management of migraine.

This motivates scientists to investigate migraine pathophysiology to improve the diagnosis, management, and treatment of its clinical features from a new, complex, variable disorder of the nervous system perspective. In a recent edition of The Lancet Neurology, Dr. Charles provides a comprehensive review of the recent advances in the basic and clinical research of migraine.

Other Symptoms Associated with Migraine

A migraine attack can be categorized into a premonitory phase, aura phase, headache phase, and postdrome phase according to its temporal relationship to headache.

Those suffering from yawning, frequent urination, mood change, irritability, light sensitivity, neck pain, and difficulty concentrating, may be experiencing the early stage of migraine.

The researchers found that a diagnosis of migraine with aura is highly associated with an increased risk of other medical conditions such as stroke, restless legs syndrome, and panic disorder.

Genetic Implications

Recent advances in genetics and pathophysiology have identified new migraine-associated genes like 38 genomic loci, and neuropeptides including calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating polypeptide (PACAP) that significantly contribute to the initiation of an attack.

These findings open new doors to therapies that could eventually be tailored to specific genetic mechanisms responsible for migraine.

Scientists also recognized the key roles of environmental, metabolomic, hormonic, and medicinal factors that lead to a migraine attack.

Effective Treatment of Migraine Headaches

Scientists now understand that effective clinical management of migraine headaches requires the recognition and elimination of specific exacerbating factors and the personalization of acute and preventive treatment approaches.

Instead of the overuse of medication, the researchers found that early acute migraine therapy could efficiently alleviate the frequency and severity of migraines.

The effective treatment of migraine also requires the training of healthcare providers, adequate lifestyle modifications, accurate diagnosis, and appropriate acute and preventive treatments.

The pace of migraine progress is accelerating rapidly, with new research directions and clinical treatment techniques being brought to bear.

We can expect to see rapid progress in our understanding of migraine headaches in the very soon future.

Written by Man-tik Choy, Ph.D

Reference: Charles, A. The pathophysiology of migraine: implications for clinical management. The Lancet-Neurology, 17(2), 174-182. DOI 10.1016/S1474-4422(17)30435-0.


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