Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T17:52:32.207Z Has data issue: false hasContentIssue false

Chapter 12 - Migraines

from Part III - Chronic Pain Conditions Head and Neck

Published online by Cambridge University Press:  01 December 2023

By
Noushad Mamun  and
Ruben Schwartz
Edited by
Omar Viswanath  and
Ivan Urits
Omar Viswanath
Affiliation:
Creighton University, Omaha
Ivan Urits
Affiliation:
Southcoast Brain & Spine Center, Wareham
Get access

Summary

Migraine headache is a highly prevalent and disabling neurological primary headache disorder. It is characterized by disabling, throbbing, episodic, unilateral headaches associated with neurologic features such as photophobia, phonophobia, or autonomic symptoms like nausea and vomiting lasting 4 to 72 hours at a time. Patients will often avoid bright lights or loud noises. About 30% of migraine patients experience auras which are unilateral focal neurological disturbances prior the headache onset, often manifested as visual, sensory, or motor symptoms. Pathophysiology of migraine headache is still unclear and is being studied; however, calcitonin gene-related peptide (CGRP) is believed to play a major and important role, and therefore has become a primary therapeutic target. This was supported by the finding of CGRP release during acute migraine attacks and then subsequent normalization of CGRP levels after efficacious sumatriptan treatment. These findings have been a focal point in recent pharmacological developments in managing migraine headaches.

Keywords

migrainesheadachesCGRPvisualaura
Type
Chapter
Information
Cambridge Handbook of Pain Medicine , pp. 75 - 80
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Charles, A. The pathophysiology of migraine: Implications for clinical management. Lancet Neurol. 2018;17(2):174–182. https://doi.org/10.1016/S1474-4422(17)30435-0.CrossRefGoogle ScholarPubMed
Burch, RC, Buse, DC, Lipton, RB. Migraine: Epidemiology, burden, and comorbidity. Neurol. Clin. 2019;37(4): 631–649. https://doi.org/10.1016/j.ncl.2019.06.001.CrossRefGoogle ScholarPubMed
Buse, DC, Loder, EW, Gorman, JA et al. Sex differences in the prevalence, symptoms, and associated features of migraine, probable migraine and other severe headache: Results of the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2013;53(8):1278–1299. https://doi.org/10.1111/head.12150.CrossRefGoogle ScholarPubMed
GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: A systematic analysis for the global burden of disease study 2016. Lancet Neurol. 2018;17(11):954–976. https://doi.org/10.1016/S1474-4422(18)30322-3.CrossRefGoogle Scholar
Scher, AI, Bigal, ME, Lipton, RB. Comorbidity of migraine. Curr. Opin. Neurol. 2005;18(3), 305–310. https://doi.org/10.1097/01.wco.0000169750.52406.a2.CrossRefGoogle ScholarPubMed
Gormley, P, Anttila, V, Winsvold, BS et al. Meta-analysis of 375,000 individuals identifies 38 susceptibility loci for migraine. Nat. Genet. 2016;48(8):856–866. https://doi.org/10.1038/ng.3598.CrossRefGoogle Scholar
Gribbin, CL, Dani, KA, Tyagi, A. Chronic Migraine: An Update on Diagnosis and Management. Neurol. India. n.d.;69(Supplement):S67–S75. https://doi.org/10.4103/0028-3886.315972.Google Scholar
Deen, M, Correnti, E, Kamm, K et al. Blocking CGRP in migraine patients – a review of pros and cons. J. Headache Pain. 2017;18(1):96. https://doi.org/10.1186/s10194-017-0807-1.CrossRefGoogle ScholarPubMed
Goadsby, PJ, Edvinsson, L. The trigeminovascular system and migraine: Studies characterizing cerebrovascular and neuropeptide changes seen in humans and cats. Ann. Neurol. 1993;33(1):48–56. https://doi.org/10.1002/ana.410330109.CrossRefGoogle Scholar
Goadsby, PJ, Holland, PR. An update: Pathophysiology of migraine. Neurol. Clin. 2019;37(4):651–671. https://doi.org/10.1016/j.ncl.2019.07.008.CrossRefGoogle ScholarPubMed
Iyengar, S, Johnson, KW, Ossipov, MH, Aurora, SK. CGRP and the trigeminal system in migraine. Headache. 2019;59(5):659–681. https://doi.org/10.1111/head.13529CrossRefGoogle ScholarPubMed
Mungoven, TJ, Henderson, LA, Meylakh, N. Chronic migraine pathophysiology and treatment: A review of current perspectives. Front. Pain Res. (Lausanne, Switzerland). 2021;2:705276. https://doi.org/10.3389/fpain.2021.705276.CrossRefGoogle ScholarPubMed
Khan, J, Asoom, LIal, Sunni, Aal et al. Genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine. Biomed. Pharmacother. 2021;139:111557. https://doi.org/10.1016/j.biopha.2021.111557.CrossRefGoogle ScholarPubMed
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. Cephalalgia: J Headache Pain. 2018;38(1):1–211. https://doi.org/10.1177/0333102417738202CrossRefGoogle Scholar
Hsu, Y-C, Lin, K-C, Taiwan, HST. Medical treatment guidelines for acute migraine attacks. Acta Neurologica Taiwanica. 2017;26(2):78–96.Google ScholarPubMed
Cameron, C, Kelly, S, Hsieh, S-C et al. Triptans in the acute treatment of migraine: A systematic review and network meta-analysis. Headache. n.d.;55(Suppl 4):221–235. https://doi.org/10.1111/head.12601.CrossRefGoogle Scholar
Lee, S, Staatz, CE, Han, N, Baek, IH. Safety evaluation of oral calcitonin-gene-related peptide receptor antagonists in patients with acute migraine: A systematic review and meta-analysis. Eur. J. Clin. Pharmacol. 2022;78(9): 1365–1376. https://doi.org/10.1007/s00228-022-03347-6.CrossRefGoogle Scholar
Dodick, DW, Lipton, RB, Ailani, J et al. Ubrogepant for the treatment of migraine. New England J. Med. 2019;381(23): 2230–2241. https://doi.org/10.1056/NEJMoa1813049CrossRefGoogle ScholarPubMed
Edvinsson, L. Role of CGRP in migraine. Handb. Exp. Pharmacol. 2019;255:121–130. https://doi.org/10.1007/164_2018_201CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×