Migraine

What is migraine?

Migraine is a very prevalent disease, affecting 12% of the population in Spain, 80% of whom are women. It is the leading cause of disability in adults under 50 years of age. Migraine reduces the quality of life of people who suffer from it, not only because of the limitations caused by the pain and associated symptoms that appear during migraine attacks, but also because of the cognitive, psychological and emotional symptoms between attacks.

What are the symptoms of migraine?

It is characterized by recurrent episodes of headache of moderate or severe intensity, which if untreated can last for days. It usually affects half of the head and is accompanied by nausea, vomiting and/or intolerance to light and sound.

Often, in the days prior to the onset of pain, symptoms such as difficulty concentrating, cervical stiffness and excessive sensitivity to light or noise appear. This is known as the prodrome. The pain is followed by a “hangover” sensation that can last up to two days.

What types of migraine are there?

Depending on the frequency of migraine attacks, we classify it as episodic migraine (those with less than 15 days of pain per month) and chronic migraine (≥15 days of pain per month). About 20% of patients present migraine with aura that presents with impaired vision and less frequently impaired speech and/or sensation, before or during the pain.

Diagnosis is clinical, i.e. based on the symptoms reported by the patient, personal and family history and neurological examination. Complementary tests, such as a cranial MRI, are only indicated in those cases presenting atypical data.

What is the treatment of migraine?

The treatment is based on 3 pillars:

1. Education on the disease and management of triggering factors. Maintaining regular sleeping and eating schedules, avoiding fasting and excessive caffeine consumption, and regular physical exercise are habits that help to improve disease control.

2. Symptomatic treatment. It is aimed at controlling pain attacks and reducing associated symptoms (nausea and vomiting). Nonsteroidal anti-inflammatory drugs and more specific treatments such as triptans, gepants and ditanes are useful. Antiemetics associated with the above help to improve nausea.

3. Preventive treatment aims to reduce the frequency and intensity of migraine attacks. It is indicated in patients with 3 or more attacks per month or when they are less frequent but very intense and do not respond well to symptomatic treatment. It is an underused treatment, since it is estimated that, in Spain, less than 14% of patients who require it are receiving it. It includes a series of drugs administered orally, infiltration with botulinum toxin A in different points of the head and neck, and in the last 5 years several treatments have been approved that have a specific mechanism of action for migraine by blocking calcitonin gene-related peptide (CGRP), administered orally, subcutaneously or intravenously.