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Migraine
Migraine is a type of headache disorder that can significantly impact daily life, affecting approximately 1 in 7 adults in the UK. It involves severe head pain and other symptoms, often requiring specific management approaches.
Overview
Migraine is a prevalent neurological condition known for causing intense, throbbing headaches, which are often unilateral (affecting one side of the head). These headaches can last for several hours or even days. Beyond the pain, migraine attacks frequently involve other symptoms such as nausea, vomiting, and heightened sensitivity to light (photophobia) and sound (phonophobia) [PMID:23719054].
Around 15% of adults are estimated to experience migraine, making it a significant public health concern. The condition can significantly impair an individual's quality of life and ability to carry out daily activities. While the exact cause is complex and not fully understood, a combination of genetic predisposition and environmental factors is thought to contribute to its development.
Symptoms & clinical features
The primary symptom of migraine is a severe headache, typically described as throbbing or pulsating. This pain usually affects one side of the head but can sometimes be bilateral. Physical activity can often worsen the headache.
Many individuals also experience associated symptoms, including nausea and vomiting. Sensitivity to light and sound are very common, prompting many to seek quiet, dark environments during an attack. Some people experience an 'aura' before or during the headache phase. A migraine aura typically involves temporary visual disturbances, such as flashing lights, zigzag lines, or blind spots, but can also include other sensory or speech changes [PMID:33678531]. These aura symptoms usually develop gradually over 5 to 20 minutes and typically last less than an hour.
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Affected organs
Migraine primarily affects the brain and the nervous system. The symptoms experienced during a migraine attack arise from complex changes in brain activity, involving nerve pathways, brain chemicals, and blood vessels within the brain. While the pain is perceived in the head, it is a manifestation of these underlying neurological processes rather than a direct issue with the skull or its immediate structures.
Although migraine does not cause structural damage to the brain in most cases, severe and frequent attacks can sometimes be associated with changes in brain white matter visible on MRI scans. These changes are generally considered benign and do not typically lead to long-term neurological impairment.
Risks & severity
Migraine severity varies greatly among individuals, ranging from occasional, manageable attacks to chronic migraine, which involves headaches on 15 or more days per month, with at least eight of those fulfilling migraine criteria, for more than three months. The lifetime risk of experiencing migraine is significant, affecting a considerable proportion of the population.
While migraine can begin at any age, it most commonly starts in adolescence or early adulthood. Women are generally more affected than men, with hormonal fluctuations thought to play a role in this difference. Certain triggers, such as stress, lack of sleep, specific foods, or environmental changes, can increase the frequency and severity of attacks in susceptible individuals, though these triggers can vary widely.
Genetic causes
Migraine is considered a polygenic or complex condition, meaning it is influenced by multiple genes acting together, alongside environmental factors. While specific genes have been identified that contribute to migraine susceptibility, no single gene is solely responsible for most cases.
Genes such as ATP1A2 and CACNA1A have been implicated in some forms of migraine, particularly in familial hemiplegic migraine, a rare subtype [PMID:10629734]. ATP1A2 encodes a subunit of the sodium-potassium ATPase enzyme, crucial for ion transport across cell membranes, particularly in glial cells which support neuronal function. CACNA1A codes for a calcium channel subunit vital for nerve cell signalling. Variants in these genes can disrupt normal neuronal excitability and function, contributing to the mechanisms underlying migraine. However, for typical common migraine, the genetic landscape is much broader, involving many genes with small individual effects.
Inheritance pattern
Migraine typically follows a complex or polygenic inheritance pattern. This means that while there is often a family history of migraine, the condition is not usually passed down in a simple dominant or recessive manner. Instead, multiple genes, each contributing a small effect, interact with environmental and lifestyle factors to determine an individual's susceptibility.
If one or both parents have migraine, their children have an increased likelihood of developing the condition, but it is not a certainty. The risk is influenced by the number of predisposing genetic variants inherited and the presence of various triggers. For very rare, specific subtypes like Familial Hemiplegic Migraine, the inheritance pattern can be autosomal dominant, meaning a single altered copy of a gene (such as ATP1A2 or CACNA1A) is sufficient to cause the condition.
Diagnosis & testing
Diagnosing migraine primarily relies on a detailed clinical history, including the description of symptoms, their frequency, and duration, as reported by the patient. There are no specific blood tests or imaging scans that can definitively diagnose common migraine. A healthcare professional, typically a GP or neurologist, will assess the patient's symptoms against established diagnostic criteria, such as those from the International Headache Society.
In some cases, especially if there are unusual symptoms, a sudden change in headache pattern, or neurological signs, brain imaging (such as MRI) might be performed to rule out other conditions. Genetic testing is generally not used for common migraine diagnosis but may be considered for rare, atypical forms, such as Familial Hemiplegic Migraine, where specific gene variants are known to be causative. Referrals for such genetic testing in the UK would typically be through a clinical genetics service, often following an R-code evaluation.
Management & lifestyle
Managing migraine aims to reduce the frequency and severity of attacks, and to alleviate symptoms when they occur. This often involves a combination of acute treatments for individual attacks and preventative therapies to reduce overall migraine burden. Acute treatments include over-the-counter pain relievers, non-steroidal anti-inflammatory drugs (NSAIDs), and migraine-specific medications called triptans.
Preventative treatments may include certain beta-blockers, anti-depressants, anti-epileptic drugs, and more recently, calcitonin gene-related peptide (CGRP) pathway inhibitors. Lifestyle adjustments, such as managing stress, maintaining a regular sleep schedule, identifying and avoiding personal triggers, and regular exercise, can also play a crucial role. Management plans are highly individualised and developed in consultation with a GP or neurologist. In the UK, patients can access specialist headache clinics if their migraine is severe and difficult to manage.
UK care pathway
In the UK, individuals with suspected migraine typically begin their care journey with their General Practitioner (GP). The GP can provide an initial diagnosis and suggest first-line treatments and lifestyle advice. If migraine symptoms are severe, frequent, or challenging to manage, the GP may refer the patient to a neurologist or a specialist headache clinic for further assessment and advanced treatment options.
For genetic forms of migraine, such as Familial Hemiplegic Migraine, referral to a Clinical Genetics service would be appropriate. This pathway involves assessing eligibility for genomic testing, which may be initiated via the NHS Genomic Medicine Service (GMS) pathways, potentially utilising relevant R-codes for rare neurological conditions. Genetic counsellors within these services provide information and support to individuals and families regarding genetic inheritance and testing.
Frequently asked questions
What is the difference between a migraine and a regular headache?
Migraine headaches are generally much more severe and often come with additional symptoms like nausea, vomiting, and sensitivity to light and sound. Regular or tension-type headaches are typically less intense, without these accompanying symptoms, and usually respond well to standard pain relief.
Can migraine be cured?
Currently, there is no cure for migraine. However, effective treatments are available to manage symptoms during an attack and to reduce the frequency and severity of future attacks. Management often involves a combination of medication and lifestyle adjustments.
Are migraines hereditary?
Yes, there is often a genetic component to migraine. If you have close relatives with migraine, you have an increased likelihood of developing the condition. However, it's a complex inheritance pattern, meaning multiple genes and environmental factors play a role, not just a single gene.
What should I do during a migraine attack?
During a migraine attack, many people find relief by resting in a quiet, dark room. Over-the-counter pain relievers or specific migraine medications (triptans) can help. Applying a cold pack to the head or neck may also provide some comfort. It's best to follow the management plan advised by your doctor.
Can diet trigger migraines?
For some individuals, certain foods or drinks can act as migraine triggers. Common examples include aged cheeses, processed meats, chocolate, and alcohol (especially red wine). Keeping a migraine diary to track potential triggers can help identify personal dietary patterns associated with attacks.
References
- Aguilar-Shea AL, Membrilla Md JA, Diaz-de-Teran J. Migraine review for general practice. Atencion primaria. 2022. PMID: 34798397
- Cheema S, Matharu M. Abdominal migraine and cyclical vomiting syndrome. Handbook of clinical neurology. 2023. PMID: 38043963
- Martinelli D, De Icco R, Al-Khazali HM. Advances in migraine prevention. The Lancet. Neurology. 2026. PMID: 41722594
- Shah DR, Dilwali S, Friedman DI. Migraine Aura Without Headache [corrected]. Current pain and headache reports. 2018. PMID: 30225597
- Paemeleire K, Vandenbussche N, Stark R. Migraine without aura. Handbook of clinical neurology. 2023. PMID: 38043959
- Ornello R, Andreou AP, De Matteis E. Resistant and refractory migraine: clinical presentation, pathophysiology, and management. EBioMedicine. 2024. PMID: 38142636
- Cortel-LeBlanc MA, Orr SL, Dunn M. Managing and Preventing Migraine in the Emergency Department: A Review. Annals of emergency medicine. 2023. PMID: 37436346
- Pescador Ruschel MA, De Jesus O. Migraine Headache. 2024. PMID: 32809622