Migraine#Classification

Migraine typically presents with self-limited, recurrent severe headache associated with autonomic symptoms.{{cite journal |vauthors=Bartleson JD, Cutrer FM |date=May 2010 |title=Migraine update. Diagnosis and treatment |journal=Minnesota Medicine |volume=93 |issue=5 |pages=36–41 |pmid=20572569}}{{cite journal|vauthors=Bigal ME, Lipton RB|date=June 2008|title=The prognosis of migraine|journal=Current Opinion in Neurology|volume=21|issue=3|pages=301–8|doi=10.1097/WCO.0b013e328300c6f5|pmid=18451714|s2cid=34805084}} About 15–30% of people living with migraine experience episodes with aura,{{cite book| vauthors = Gutman SA |title=Quick reference neuroscience for rehabilitation professionals: the essential neurologic principles underlying rehabilitation practice|year=2008|publisher=SLACK|location=Thorofare, NJ|isbn=9781556428005|page=231|url=https://books.google.com/books?id=Ea0czzNxpkQC&pg=PA231|edition=2nd |url-status=live|archive-url=https://web.archive.org/web/20170312220316/https://books.google.com/books?id=Ea0czzNxpkQC&pg=PA231|archive-date=12 March 2017}} and they also frequently experience episodes without aura. The severity of the pain, duration of the headache, and frequency of attacks are variable. A migraine attack lasting longer than 72 hours is termed status migrainosus.{{cite book| vauthors = Tfelt-Hansen P, Young WB, Silberstein | chapter = Antiemetic, Prokinetic, Neuroleptic and Miscellaneous Drugs in the Acute Treatment of Migraine | veditors = Olesen J |title=The Headaches |year=2006 |publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5400-2|page=512| chapter-url=https://books.google.com/books?id=F5VMlANd9iYC&pg=PA512|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20161222063613/https://books.google.com/books?id=F5VMlANd9iYC&pg=PA512|archive-date=22 December 2016}} There are four possible phases to a migraine attack, although not all the phases are necessarily experienced:{{cite journal |vauthors=((Headache Classification Subcommittee of the International Headache Society)) |year=2013 |title=The International Classification of Headache Disorders: 3rd edition |journal=Cephalalgia |volume=33 |issue=9 |pages=644–648 |doi=10.1177/0333102413485658 |pmid= 23771276|doi-access=free |title-link=doi}}

• The prodrome, which occurs hours or days before the headache
• The aura, which immediately precedes the headache
• The pain phase, also known as headache phase
• The postdrome, the effects experienced following the end of a migraine attack

Migraine is associated with major depression, bipolar disorder, anxiety disorders, and obsessive–compulsive disorder. These psychiatric disorders are approximately 2–5 times more common in people without aura, and 3–10 times more common in people with aura.{{cite journal | vauthors = Baskin SM, Lipchik GL, Smitherman TA | title = Mood and anxiety disorders in chronic headache | journal = Headache | volume = 46 | issue = Suppl 3 | pages = S76-87 | date = October 2006 | pmid = 17034402 | doi = 10.1111/j.1526-4610.2006.00559.x | s2cid = 35451906 | doi-access = free | title-link = doi }}

Prodromal or premonitory symptoms occur in about 60% of those with migraine,{{cite book |title=Clinical neurology |vauthors=Simon RP, Aminoff MJ, Greenberg DA |publisher=Lange Medical Books/McGraw-Hill |year=2009 |isbn=9780071664332 |edition=7 |location=New York, N.Y |pages=85–88}}{{cite book| vauthors = Lynn DJ, Newton HB, Rae-Grant A |title=The 5-minute neurology consult|year=2004|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=9780683307238|page=26|url=https://books.google.com/books?id=Atuv8-rVXRoC&pg=PA26|url-status=live|archive-url=https://web.archive.org/web/20170313021724/https://books.google.com/books?id=Atuv8-rVXRoC&pg=PA26|archive-date=13 March 2017}} with an onset that can range from two hours to two days before the start of pain or the aura.{{cite journal | vauthors = Buzzi MG, Cologno D, Formisano R, Rossi P | title = Prodromes and the early phase of the migraine attack: therapeutic relevance | journal = Functional Neurology | volume = 20 | issue = 4 | pages = 179–83 | date = October–December 2005 | pmid = 16483458 }} These symptoms may include a wide variety of phenomena,{{cite journal | vauthors = Rossi P, Ambrosini A, Buzzi MG | title = Prodromes and predictors of migraine attack | journal = Functional Neurology | volume = 20 | issue = 4 | pages = 185–91 | date = October–December 2005 | pmid = 16483459 }} including altered mood, irritability, depression or euphoria, fatigue, craving for certain food(s), stiff muscles (especially in the neck), constipation or diarrhea, and sensitivity to smells or noise. This may occur in those with either migraine with aura or migraine without aura.{{cite book| vauthors = Ropper AH, Adams RD, Victor M, Samuels MA |title=Adams and Victor's principles of neurology|year=2009|publisher=McGraw-Hill Medical|location=New York|isbn=9780071499927|pages=Chapter 10|edition=9}} Neuroimaging indicates the limbic system and hypothalamus as the origin of prodromal symptoms in migraine.{{cite journal | vauthors = May A, Burstein R | title = Hypothalamic regulation of headache and migraine | journal = Cephalalgia | volume = 39 | issue = 13 | pages = 1710–1719 | date = November 2019 | pmid = 31466456 | pmc = 7164212 | doi = 10.1177/0333102419867280 }}

Aura is a transient focal neurological phenomenon that occurs before or during the headache. Aura appears gradually over a number of minutes (usually occurring over 5–60 minutes) and generally lasts less than 60 minutes.{{cite journal | vauthors = Ashina M | title = Migraine | journal = The New England Journal of Medicine | volume = 383 | issue = 19 | pages = 1866–1876 | date = November 2020 | pmid = 33211930 | doi = 10.1056/NEJMra1915327 | s2cid = 227078662 }} Symptoms can be visual, sensory or motoric in nature, and many people experience more than one. Visual effects occur most frequently: they occur in up to 99% of cases and in more than 50% of cases are not accompanied by sensory or motor effects. If any symptom remains after 60 minutes, the state is known as persistent aura.{{cite journal | vauthors = Viana M, Sances G, Linde M, Nappi G, Khaliq F, Goadsby PJ, Tassorelli C | title = Prolonged migraine aura: new insights from a prospective diary-aided study | journal = The Journal of Headache and Pain | volume = 19 | issue = 1 | pages = 77 | date = August 2018 | pmid = 30171359 | pmc = 6119171 | doi = 10.1186/s10194-018-0910-y | doi-access = free | title-link = doi }}

Visual disturbances often consist of a scintillating scotoma (an area of partial alteration in the field of vision which flickers and may interfere with a person's ability to read or drive). These typically start near the center of vision and then spread out to the sides with zigzagging lines which have been described as looking like fortifications or walls of a castle. Usually the lines are in black and white but some people also see colored lines. Some people lose part of their field of vision known as hemianopsia while others experience blurring.

Sensory aura are the second most common type; they occur in 30–40% of people with auras. Often a feeling of pins-and-needles begins on one side in the hand and arm and spreads to the nose–mouth area on the same side. Numbness usually occurs after the tingling has passed with a loss of position sense. Other symptoms of the aura phase can include speech or language disturbances, world spinning, and less commonly motor problems. Motor symptoms indicate that this is a hemiplegic migraine, and weakness often lasts longer than one hour unlike other auras. Auditory hallucinations or delusions have also been described.{{cite book|vauthors = Slap, GB|title=Adolescent medicine|date=2008|publisher=Mosby/Elsevier|location=Philadelphia, PA|isbn=9780323040730|page=105|url=https://books.google.com/books?id=s4UGU7SQTQgC&pg=PA105|url-status=live|archive-url=https://web.archive.org/web/20170313025509/https://books.google.com/books?id=s4UGU7SQTQgC&pg=PA105|archive-date=13 March 2017}}

Classically the headache is unilateral, throbbing, and moderate to severe in intensity.{{cite book | vauthors = Tintinalli JE |title=Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)) |publisher=McGraw-Hill Companies |location=New York |year=2010 |pages=1116–1117 |isbn=978-0-07-148480-0 }} It usually comes on gradually and is aggravated by physical activity during a migraine attack. However, the effects of physical activity on migraine are complex, and some researchers have concluded that, while exercise can trigger migraine attacks, regular exercise may have a prophylactic effect and decrease frequency of attacks.{{cite journal |vauthors=Amin FM, Aristeidou S, Baraldi C, Czapinska-Ciepiela EK, Ariadni DD, Di Lenola D, Fenech C, Kampouris K, Karagiorgis G, Braschinsky M, Linde M |date=September 2018 |title=The association between migraine and physical exercise |journal=The Journal of Headache and Pain |volume=19 |issue=1 |pages=83 |doi=10.1186/s10194-018-0902-y |pmc=6134860 |pmid=30203180 |doi-access=free }} The feeling of pulsating pain is not in phase with the pulse.{{cite journal | vauthors = Qubty W, Patniyot I | title = Migraine Pathophysiology | journal = Pediatric Neurology | volume = 107 | pages = 1–6 | date = June 2020 | pmid = 32192818 | doi = 10.1016/j.pediatrneurol.2019.12.014 | s2cid = 213191464 }} In more than 40% of cases, however, the pain may be bilateral (both sides of the head), and neck pain is commonly associated with it.{{cite book| vauthors = Tepper SJ, Tepper DE |title=The Cleveland Clinic manual of headache therapy|publisher=Springer|location=New York|isbn=9781461401780|page=6|url=https://books.google.com/books?id=uaG08nAKG_wC&pg=PA6|date=1 January 2011|url-status=live|archive-url=https://web.archive.org/web/20161222073613/https://books.google.com/books?id=uaG08nAKG_wC&pg=PA6|archive-date=22 December 2016}} Bilateral pain is particularly common in those who have migraine without aura. Less commonly pain may occur primarily in the back or top of the head. The pain usually lasts 4 to 72 hours in adults; however, in young children frequently lasts less than 1 hour.{{cite journal | vauthors = Bigal ME, Arruda MA | title = Migraine in the pediatric population--evolving concepts | journal = Headache | volume = 50 | issue = 7 | pages = 1130–43 | date = July 2010 | pmid = 20572878 | doi = 10.1111/j.1526-4610.2010.01717.x | s2cid = 23256755 }} The frequency of attacks is variable, from a few in a lifetime to several a week, with the average being about one a month.{{cite book| vauthors = Rasmussen BK | chapter = Epidemiology of Migraine | veditors = Olesen J |title=The Headaches|year=2006|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5400-2|pages=238–240| chapter-url=https://books.google.com/books?id=F5VMlANd9iYC&pg=PA238|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20170313073938/https://books.google.com/books?id=F5VMlANd9iYC&pg=PA238|archive-date=13 March 2017}}{{cite book| vauthors = Dalessio DJ |veditors = Silberstein SD, Lipton RB, Dalessio DJ|title=Wolff's headache and other head pain|year=2001|publisher=Oxford University Press|location=Oxford|isbn=9780195135183|page=122|url=https://books.google.com/books?id=aJRV199FZcoC&pg=PA122|edition=7}}

The pain is frequently accompanied by nausea, vomiting, sensitivity to light, sensitivity to sound, sensitivity to smells, fatigue, and irritability. Many thus seek a dark and quiet room. In a basilar migraine, a migraine with neurological symptoms related to the brain stem or with neurological symptoms on both sides of the body,{{cite journal | vauthors = Kaniecki RG | title = Basilar-type migraine | journal = Current Pain and Headache Reports | volume = 13 | issue = 3 | pages = 217–20 | date = June 2009 | pmid = 19457282 | doi = 10.1007/s11916-009-0036-7 | s2cid = 22242504 }} common effects include a sense of the world spinning, light-headedness, and confusion. Nausea occurs in almost 90% of people, and vomiting occurs in about one-third.{{cite book| vauthors = Lisak RP, Truong DD, Carroll W, Bhidayasiri R |title=International neurology: a clinical approach|year=2009|publisher=Wiley-Blackwell|location=Chichester, UK|isbn=9781405157384|page=670|url=https://books.google.com/books?id=L6_L75yvaPQC&pg=PA670}} Other symptoms may include blurred vision, nasal stuffiness, diarrhea, frequent urination, pallor, or sweating.{{cite book| vauthors = Glaser JS |title=Neuro-ophthalmology|year=1999|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=9780781717298|page=555|url=https://books.google.com/books?id=eVU2CODGj98C&pg=PA555|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20170313073802/https://books.google.com/books?id=eVU2CODGj98C&pg=PA555|archive-date=13 March 2017}} Swelling or tenderness of the scalp may occur as can neck stiffness. Associated symptoms are less common in the elderly.

Sometimes, aura occurs without a subsequent headache.{{cite book | vauthors = Cutrer FM, Olesen J | chapter = Migraines with Aura and Their Subforms | veditors = Olesen J |title=The Headaches|year=2006|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5400-2|pages=238–240| chapter-url=https://books.google.com/books?id=F5VMlANd9iYC&pg=PA238 |edition=3rd |url-status=live |archive-url= https://web.archive.org/web/20170313073938/https://books.google.com/books?id=F5VMlANd9iYC&pg=238|archive-date=13 March 2017 }} This is known in modern classification as a typical aura without headache, or acephalgic migraine in previous classification, or commonly as a silent migraine.{{cite web |vauthors=Robblee J |title=Silent Migraine: A Guide |url=https://americanmigrainefoundation.org/resource-library/silent-migraine/ |website=American Migraine Foundation |access-date=22 January 2021 |date=21 August 2019 |archive-date=28 January 2021 |archive-url=https://web.archive.org/web/20210128132026/https://americanmigrainefoundation.org/resource-library/silent-migraine/ |url-status=live }}{{cite journal | vauthors = He Y, Li Y, Nie Z | title = Typical aura without headache: a case report and review of the literature | journal = Journal of Medical Case Reports | volume = 9 | issue = 1 | pages = 40 | date = February 2015 | pmid = 25884682 | pmc = 4344793 | doi = 10.1186/s13256-014-0510-7 | doi-access = free | title-link = doi }} However, silent migraine can still produce debilitating symptoms, with visual disturbance, vision loss in half of both eyes, alterations in color perception, and other sensory problems, like sensitivity to light, sound, and odors.{{cite web |vauthors=Leonard J |veditors=Han S |title=Silent migraine: Symptoms, causes, treatment, prevention |url=https://www.medicalnewstoday.com/articles/323011 |work=Medical News Today |access-date=22 January 2021 |date=7 September 2018 |archive-date=19 January 2021 |archive-url=https://web.archive.org/web/20210119184614/https://www.medicalnewstoday.com/articles/323011 |url-status=live }} It can last from 15 to 30 minutes, usually no longer than 60 minutes, and it can recur or appear as an isolated event.

The migraine postdrome could be defined as that constellation of symptoms occurring once the acute headache has settled.{{cite journal | vauthors = Bose P, Goadsby PJ | title = The migraine postdrome | journal = Current Opinion in Neurology | volume = 29 | issue = 3 | pages = 299–301 | date = June 2016 | pmid = 26886356 | doi = 10.1097/WCO.0000000000000310 | s2cid = 22445093 }} Many report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed. The person may feel tired or "hung over" and have head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness.{{cite journal | vauthors = Kelman L | title = The postdrome of the acute migraine attack | journal = Cephalalgia | volume = 26 | issue = 2 | pages = 214–20 | date = February 2006 | pmid = 16426278 | doi = 10.1111/j.1468-2982.2005.01026.x | s2cid = 21519111 }} According to one summary, "Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise."{{cite book |vauthors=Halpern AL, Silberstein SD |chapter=Ch. 9: The Migraine Attack—A Clinical Description |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK7326/ |veditors=Kaplan PW, Fisher RS |title=Imitators of Epilepsy |publisher=Demos Medical |location=New York |year=2005 |isbn=978-1-888799-83-5 |url=https://www.ncbi.nlm.nih.gov/books/NBK7321/ |edition=2 |id=NBK7326 |access-date=5 September 2017 |archive-date=27 August 2011 |archive-url=https://web.archive.org/web/20110827074456/http://www.ncbi.nlm.nih.gov/books/NBK7321/ |url-status=dead }}{{Unreliable medical source|date=August 2023}}

The underlying cause of migraine is unknown.{{cite journal | vauthors = Robbins MS, Lipton RB | title = The epidemiology of primary headache disorders | journal = Seminars in Neurology | volume = 30 | issue = 2 | pages = 107–19 | date = April 2010 | pmid = 20352581 | doi = 10.1055/s-0030-1249220 | s2cid = 260317083 }} However, it is believed to be related to a mix of environmental and genetic factors. Migraine runs in families in about two-thirds of cases and rarely occur due to a single gene defect. While migraine attacks were once believed to be more common in those of high intelligence, this does not appear to be true. A number of psychological conditions are associated, including depression, anxiety, and bipolar disorder.The Headaches, pp. 246–247

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Success of the surgical migraine treatment by decompression of extracranial sensory nerves adjacent to vessels{{cite journal | vauthors = Bink T, Duraku LS, Ter Louw RP, Zuidam JM, Mathijssen IM, Driessen C | title = The Cutting Edge of Headache Surgery: A Systematic Review on the Value of Extracranial Surgery in the Treatment of Chronic Headache | journal = Plastic and Reconstructive Surgery | volume = 144 | issue = 6 | pages = 1431–1448 | date = December 2019 | pmid = 31764666 | doi = 10.1097/PRS.0000000000006270 | s2cid = 208273535 }} suggests that people with migraine may have anatomical predisposition for neurovascular compression{{cite journal | vauthors = Szmyd B, Sołek J, Błaszczyk M, Jankowski J, Liberski PP, Jaskólski DJ, Wysiadecki G, Karuga FF, Gabryelska A, Sochal M, Tubbs RS, Radek M | title = The Underlying Pathogenesis of Neurovascular Compression Syndromes: A Systematic Review | language = English | journal = Frontiers in Molecular Neuroscience | volume = 15 | pages = 923089 | date = 2022-07-04 | pmid = 35860499 | pmc = 9289473 | doi = 10.3389/fnmol.2022.923089 | doi-access = free }} that may be caused by both intracranial and extracranial vasodilation due to migraine triggers.{{cite journal | vauthors = Macionis V | title = Neurovascular Compression-Induced Intracranial Allodynia May Be the True Nature of Migraine Headache: an Interpretative Review | journal = Current Pain and Headache Reports | volume = 27 | issue = 11 | pages = 775–791 | date = November 2023 | pmid = 37837483 | doi = 10.1007/s11916-023-01174-7 }} This, along with the existence of numerous cranial neural interconnections,{{cite journal | vauthors = Adair D, Truong D, Esmaeilpour Z, Gebodh N, Borges H, Ho L, Bremner JD, Badran BW, Napadow V, Clark VP, Bikson M | title = Electrical stimulation of cranial nerves in cognition and disease | journal = Brain Stimulation | volume = 13 | issue = 3 | pages = 717–750 | date = May 2020 | pmid = 32289703 | pmc = 7196013 | doi = 10.1016/j.brs.2020.02.019 }} may explain the multiple cranial nerve involvement and consequent diversity of migraine symptoms.{{cite journal | vauthors = Villar-Martinez MD, Goadsby PJ | title = Pathophysiology and Therapy of Associated Features of Migraine | journal = Cells | volume = 11 | issue = 17 | pages = 2767 | date = September 2022 | pmid = 36078174 | pmc = 9455236 | doi = 10.3390/cells11172767 | doi-access = free }}

{{Main|Genetics of migraine}}

Studies of twins indicate a 34–51% genetic influence on the likelihood of developing migraine. This genetic relationship is stronger for migraine with aura than for migraine without aura. It is clear from family and populations studies that migraine is a complex disorder, where numerous genetic risk variants exist, and where each variant increases the risk of migraine marginally.{{cite journal | vauthors = Gormley P, Kurki MI, Hiekkala ME, Veerapen K, Häppölä P, Mitchell AA, Lal D, Palta P, Surakka I, Kaunisto MA, Hämäläinen E, Vepsäläinen S, Havanka H, Harno H, Ilmavirta M, Nissilä M, Säkö E, Sumelahti ML, Liukkonen J, Sillanpää M, Metsähonkala L, Koskinen S, Lehtimäki T, Raitakari O, Männikkö M, Ran C, Belin AC, Jousilahti P, Anttila V, Salomaa V, Artto V, Färkkilä M, Runz H, Daly MJ, Neale BM, Ripatti S, Kallela M, Wessman M, Palotie A | title = Common Variant Burden Contributes to the Familial Aggregation of Migraine in 1,589 Families | journal = Neuron | volume = 98 | issue = 4 | pages = 743–753.e4 | date = May 2018 | pmid = 29731251 | pmc = 5967411 | doi = 10.1016/j.neuron.2018.04.014 }}{{cite journal | vauthors = Harder AV, Terwindt GM, Nyholt DR, van den Maagdenberg AM | title = Migraine genetics: Status and road forward | journal = Cephalalgia | volume = 43 | issue = 2 | pages = 3331024221145962 | date = February 2023 | pmid = 36759319 | doi = 10.1177/03331024221145962 | doi-access = free }} It is also known that having several of these risk variants increases the risk by a small to moderate amount.

Single gene disorders that result in migraine are rare.{{cite journal | vauthors = Schürks M | title = Genetics of migraine in the age of genome-wide association studies | journal = The Journal of Headache and Pain | volume = 13 | issue = 1 | pages = 1–9 | date = January 2012 | pmid = 22072275 | pmc = 3253157 | doi = 10.1007/s10194-011-0399-0 }} One of these is known as familial hemiplegic migraine, a type of migraine with aura, which is inherited in an autosomal dominant fashion.{{cite journal | vauthors = de Vries B, Frants RR, Ferrari MD, van den Maagdenberg AM | title = Molecular genetics of migraine | journal = Human Genetics | volume = 126 | issue = 1 | pages = 115–32 | date = July 2009 | pmid = 19455354 | doi = 10.1007/s00439-009-0684-z | s2cid = 20119237 }}{{cite journal | vauthors = Montagna P | title = Migraine genetics | journal = Expert Review of Neurotherapeutics | volume = 8 | issue = 9 | pages = 1321–30 | date = September 2008 | pmid = 18759544 | doi = 10.1586/14737175.8.9.1321 | s2cid = 207195127 }} Four genes have been shown to be involved in familial hemiplegic migraine.{{cite journal | vauthors = Ducros A | title = [Genetics of migraine] | journal = Revue Neurologique | volume = 169 | issue = 5 | pages = 360–71 | date = May 2013 | pmid = 23618705 | doi = 10.1016/j.neurol.2012.11.010 }} Three of these genes are involved in ion transport. The fourth is the axonal protein PRRT2, associated with the exocytosis complex. Another genetic disorder associated with migraine is CADASIL syndrome or cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. One meta-analysis found a protective effect from angiotensin converting enzyme polymorphisms on migraine.{{cite journal | vauthors = Wan D, Wang C, Zhang X, Tang W, Chen M, Dong Z, Yu S | title = Association between angiotensin-converting enzyme insertion/deletion polymorphism and migraine: a meta-analysis | journal = The International Journal of Neuroscience | volume = 126 | issue = 5 | pages = 393–9 | date = 1 January 2016 | pmid = 26000817 | doi = 10.3109/00207454.2015.1025395 | s2cid = 34902092 }} The TRPM8 gene, which codes for a cation channel, has been linked to migraine.{{cite journal | vauthors = Dussor G, Cao YQ | title = TRPM8 and Migraine | journal = Headache | volume = 56 | issue = 9 | pages = 1406–1417 | date = October 2016 | pmid = 27634619 | pmc = 5335856 | doi = 10.1111/head.12948 }}

The common forms migraine are polygenetic, where common variants of numerous genes contributes to the predisposition for migraine. These genes can be placed in three categories increasing the risk of migraine in general, specifically migraine with aura, or migraine without aura.{{cite journal | vauthors = Bjornsdottir G, Chalmer MA, Stefansdottir L, Skuladottir AT, Einarsson G, Andresdottir M, Beyter D, Ferkingstad E, Gretarsdottir S, Halldorsson BV, Halldorsson GH, Helgadottir A, Helgason H, Hjorleifsson Eldjarn G, Jonasdottir A, Jonasdottir A, Jonsdottir I, Knowlton KU, Nadauld LD, Lund SH, Magnusson OT, Melsted P, Moore KH, Oddsson A, Olason PI, Sigurdsson A, Stefansson OA, Saemundsdottir J, Sveinbjornsson G, Tragante V, Unnsteinsdottir U, Walters GB, Zink F, Rødevand L, Andreassen OA, Igland J, Lie RT, Haavik J, Banasik K, Brunak S, Didriksen M, T Bruun M, Erikstrup C, Kogelman LJ, Nielsen KR, Sørensen E, Pedersen OB, Ullum H, Masson G, Thorsteinsdottir U, Olesen J, Ludvigsson P, Thorarensen O, Bjornsdottir A, Sigurdardottir GR, Sveinsson OA, Ostrowski SR, Holm H, Gudbjartsson DF, Thorleifsson G, Sulem P, Stefansson H, Thorgeirsson TE, Hansen TF, Stefansson K | title = Rare variants with large effects provide functional insights into the pathology of migraine subtypes, with and without aura | journal = Nature Genetics | volume = 55 | issue = 11 | pages = 1843–1853 | date = November 2023 | pmid = 37884687 | pmc = 10632135 | doi = 10.1038/s41588-023-01538-0 }}{{cite journal | vauthors = Hautakangas H, Winsvold BS, Ruotsalainen SE, Bjornsdottir G, Harder AV, Kogelman LJ, Thomas LF, Noordam R, Benner C, Gormley P, Artto V, Banasik K, Bjornsdottir A, Boomsma DI, Brumpton BM, Burgdorf KS, Buring JE, Chalmer MA, de Boer I, Dichgans M, Erikstrup C, Färkkilä M, Garbrielsen ME, Ghanbari M, Hagen K, Häppölä P, Hottenga JJ, Hrafnsdottir MG, Hveem K, Johnsen MB, Kähönen M, Kristoffersen ES, Kurth T, Lehtimäki T, Lighart L, Magnusson SH, Malik R, Pedersen OB, Pelzer N, Penninx BW, Ran C, Ridker PM, Rosendaal FR, Sigurdardottir GR, Skogholt AH, Sveinsson OA, Thorgeirsson TE, Ullum H, Vijfhuizen LS, Widén E, van Dijk KW, Aromaa A, Belin AC, Freilinger T, Ikram MA, Järvelin MR, Raitakari OT, Terwindt GM, Kallela M, Wessman M, Olesen J, Chasman DI, Nyholt DR, Stefánsson H, Stefansson K, van den Maagdenberg AM, Hansen TF, Ripatti S, Zwart JA, Palotie A, Pirinen M | title = Genome-wide analysis of 102,084 migraine cases identifies 123 risk loci and subtype-specific risk alleles | journal = Nature Genetics | volume = 54 | issue = 2 | pages = 152–160 | date = February 2022 | pmid = 35115687 | doi = 10.1038/s41588-021-00990-0 | pmc = 8837554 }} Three of these genes, CALCA, CALCB, and HTR1F are already target for migraine specific treatments. Five genes are specific risk to migraine with aura, PALMD, ABO, LRRK2, CACNA1A and PRRT2, and 13 genes are specific to migraine without aura. Using the accumulated genetic risk of the common variations, into a so-called polygenetic risk, it is possible to assess e.g. the treatment response to triptans.{{Cite journal | vauthors = Mikol DD, Picard H, Klatt J, Wang A, Peng C, Stefansson K |date=2020-04-14 |title=Migraine Polygenic Risk Score Is Associated with Severity of Migraine – Analysis of Genotypic Data from Four Placebo-controlled Trials of Erenumab (1214) |url=https://www.neurology.org/doi/10.1212/WNL.94.15_supplement.1214 |journal=Neurology |volume=94 |issue=15_supplement |doi=10.1212/WNL.94.15_supplement.1214 |issn=0028-3878}}{{cite journal | vauthors = Kogelman LJ, Esserlind AL, Francke Christensen A, Awasthi S, Ripke S, Ingason A, Davidsson OB, Erikstrup C, Hjalgrim H, Ullum H, Olesen J, Folkmann Hansen T | title = Migraine polygenic risk score associates with efficacy of migraine-specific drugs | journal = Neurology. Genetics | volume = 5 | issue = 6 | pages = e364 | date = December 2019 | pmid = 31872049 | pmc = 6878840 | doi = 10.1212/NXG.0000000000000364 }}

Migraine may be induced by triggers, with some reporting it as an influence in a minority of cases and others the majority. Many things such as fatigue, certain foods, alcohol, and weather have been labeled as triggers; however, the strength and significance of these relationships are uncertain.{{cite journal | vauthors = Levy D, Strassman AM, Burstein R | title = A critical view on the role of migraine triggers in the genesis of migraine pain | journal = Headache | volume = 49 | issue = 6 | pages = 953–7 | date = June 2009 | pmid = 19545256 | doi = 10.1111/j.1526-4610.2009.01444.x | s2cid = 31707887 }}{{cite journal | vauthors = Martin PR | title = Behavioral management of migraine headache triggers: learning to cope with triggers | journal = Current Pain and Headache Reports | volume = 14 | issue = 3 | pages = 221–7 | date = June 2010 | pmid = 20425190 | doi = 10.1007/s11916-010-0112-z | s2cid = 5511782 }} Most people with migraine report experiencing triggers.{{cite journal | vauthors = Pavlovic JM, Buse DC, Sollars CM, Haut S, Lipton RB | title = Trigger factors and premonitory features of migraine attacks: summary of studies | journal = Headache | volume = 54 | issue = 10 | pages = 1670–9 |year = 2014 | pmid = 25399858 | doi = 10.1111/head.12468 | s2cid = 25016889 }} Symptoms may start up to 24 hours after a trigger.

Also, evidence shows a strong association between migraine and the quality of sleep, particularly poor subjective quality of sleep. The relationship seems to be bidirectional, as migraine frequency increases with low quality of sleep yet the underlying mechanism of this correlation remains poorly understood.{{cite journal | vauthors = Stanyer EC, Creeney H, Nesbitt AD, Holland PR, Hoffmann J | title = Subjective Sleep Quality and Sleep Architecture in Patients With Migraine: A Meta-analysis | journal = Neurology | volume = 97 | issue = 16 | pages = e1620–e1631 | date = October 2021 | pmid = 34551985 | pmc = 8548957 | doi = 10.1212/WNL.0000000000012701 }}

Common triggers quoted are stress, hunger, and fatigue (these equally contribute to tension headaches). Psychological stress has been reported as a factor by 50–80% of people.{{cite journal | vauthors = Radat F | title = [Stress and migraine] | journal = Revue Neurologique | volume = 169 | issue = 5 | pages = 406–12 | date = May 2013 | pmid = 23608071 | doi = 10.1016/j.neurol.2012.11.008 }} Migraine has also been associated with post-traumatic stress disorder and abuse.{{cite journal | vauthors = Peterlin BL, Katsnelson MJ, Calhoun AH | title = The associations between migraine, unipolar psychiatric comorbidities, and stress-related disorders and the role of estrogen | journal = Current Pain and Headache Reports | volume = 13 | issue = 5 | pages = 404–12 | date = October 2009 | pmid = 19728969 | pmc = 3972495 | doi = 10.1007/s11916-009-0066-1 }} Migraine episodes are more likely to occur around menstruation. Other hormonal influences, such as menarche, oral contraceptive use, pregnancy, perimenopause, and menopause, also play a role.{{cite journal | vauthors = Chai NC, Peterlin BL, Calhoun AH | title = Migraine and estrogen | journal = Current Opinion in Neurology | volume = 27 | issue = 3 | pages = 315–24 | date = June 2014 | pmid = 24792340 | pmc = 4102139 | doi = 10.1097/WCO.0000000000000091 }} These hormonal influences seem to play a greater role in migraine without aura. Migraine episodes typically do not occur during the second and third trimesters of pregnancy, or following menopause.

Between 12% and 60% of people report foods as triggers.{{cite journal | vauthors = Finocchi C, Sivori G | title = Food as trigger and aggravating factor of migraine | journal = Neurological Sciences | volume = 33 | issue = Suppl 1 | pages = S77-80 | date = May 2012 | pmid = 22644176 | doi = 10.1007/s10072-012-1046-5 | s2cid = 19582697 }}{{cite journal | vauthors = Rockett FC, de Oliveira VR, Castro K, Chaves ML, Perla A, Perry ID | title = Dietary aspects of migraine trigger factors | journal = Nutrition Reviews | volume = 70 | issue = 6 | pages = 337–56 | date = June 2012 | pmid = 22646127 | doi = 10.1111/j.1753-4887.2012.00468.x | doi-access = free }}

There are many reports{{cite journal | vauthors = Ghose K, Carroll JD | title = Mechanism of tyramine-induced migraine: similarity with dopamine and interactions with disulfiram and propranolol in migraine patients | journal = Neuropsychobiology | volume = 12 | issue = 2–3 | pages = 122–126 |year = 1984 | pmid = 6527752 | doi = 10.1159/000118123 }}{{cite journal | vauthors = Moffett A, Swash M, Scott DF | title = Effect of tyramine in migraine: a double-blind study | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 35 | issue = 4 | pages = 496–499 | date = August 1972 | pmid = 4559027 | pmc = 494110 | doi = 10.1136/jnnp.35.4.496 }}{{cite web |title=Tyramine and Migraines: What You Need to Know |url=https://www.excedrin.com/migraines/causes/tyramine-and-migraines/ |access-date=4 March 2022 |website=excedrin.com }}{{cite book |title=Encyclopedia of Food Sciences and Nutrition |publisher=Academic Press |year=2003 |isbn=978-0-12-227055-0|edition=Second }}{{cite journal |vauthors=Özturan A, Şanlıer N, Coşkun Ö |title=The Relationship Between Migraine and Nutrition |url=https://jag.journalagent.com/tjn/pdfs/TJN_22_2_44_50[A].pdf |journal=Turk J Neurol |year=2016 |volume=22 |issue=2 |pages=44–50 |doi=10.4274/tnd.37132 |access-date=4 March 2022 |archive-date=23 August 2023 |archive-url=https://web.archive.org/web/20230823051112/https://jag.journalagent.com/tjn/pdfs/TJN_22_2_44_50%5BA%5D.pdf |url-status=live }} that tyramine – which is naturally present in chocolate, alcoholic beverages, most cheeses, processed meats, and other foods – can trigger migraine symptoms in some individuals. Monosodium glutamate (MSG) has been reported as a trigger for migraine,{{cite journal | vauthors = Sun-Edelstein C, Mauskop A | title = Foods and supplements in the management of migraine headaches | journal = The Clinical Journal of Pain | volume = 25 | issue = 5 | pages = 446–452 | date = June 2009 | pmid = 19454881 | doi = 10.1097/AJP.0b013e31819a6f65 |url=http://www.trigemin.com/download/food-and-supplements-in-migraine-management.pdf | url-status = dead | s2cid = 3042635 | citeseerx = 10.1.1.530.1223 | archive-url=https://web.archive.org/web/20170813031041/http://www.trigemin.com/download/food-and-supplements-in-migraine-management.pdf | archive-date = 13 August 2017 }} but a systematic review concluded that "a causal relationship between MSG and headache has not been proven... It would seem premature to conclude that the MSG present in food causes headache".{{cite journal | vauthors = Obayashi Y, Nagamura Y | title = Does monosodium glutamate really cause headache? : a systematic review of human studies | journal = The Journal of Headache and Pain | volume = 17 | issue = 1 | pages = 54 | date = 17 May 2016 | pmid = 27189588 | pmc = 4870486 | doi = 10.1186/s10194-016-0639-4 | doi-access = free | title-link = doi }}

A 2009 review on potential triggers in the indoor and outdoor environment concluded that while there were insufficient studies to confirm environmental factors as causing migraine, "migraineurs worldwide consistently report similar environmental triggers ... such as barometric pressure change, bright sunlight, flickering lights, air quality and odors".{{cite journal |vauthors=Friedman DI, De ver Dye T |date=June 2009 |title=Migraine and the environment |journal=Headache |volume=49 |issue=6 |pages=941–52 |doi=10.1111/j.1526-4610.2009.01443.x |pmid=19545255 |doi-access=free |s2cid=29764274}}

File:Cortical spreading depression.gif]]

Migraine is believed to be primarily a neurological disorder,{{cite journal | vauthors = Andreou AP, Edvinsson L | title = Mechanisms of migraine as a chronic evolutive condition | journal = The Journal of Headache and Pain | volume = 20 | issue = 1 | pages = 117 | date = December 2019 | pmid = 31870279 | pmc = 6929435 | doi = 10.1186/s10194-019-1066-0 | doi-access = free | title-link = doi }}{{cite web | title=Migraine | website=National Institute of Neurological Disorders and Stroke | date=11 July 2023 | url=https://www.ninds.nih.gov/health-information/disorders/migraine | access-date=25 August 2023}} while others believe it to be a neurovascular disorder with blood vessels playing the key role, although evidence does not support this completely.{{cite journal | vauthors = Hoffmann J, Baca SM, Akerman S | title = Neurovascular mechanisms of migraine and cluster headache | journal = Journal of Cerebral Blood Flow and Metabolism | volume = 39 | issue = 4 | pages = 573–594 | date = April 2019 | pmid = 28948863 | pmc = 6446418 | doi = 10.1177/0271678x17733655 }}{{cite journal | vauthors = Brennan KC, Charles A | title = An update on the blood vessel in migraine | journal = Current Opinion in Neurology | volume = 23 | issue = 3 | pages = 266–74 | date = June 2010 | pmid = 20216215 | pmc = 5500293 | doi = 10.1097/WCO.0b013e32833821c1 }}{{cite journal| vauthors = Spiri D, Titomanlio L, Pogliani L, Zuccotti G |date= January 2012|title=Pathophysiology of migraine: The neurovascular theory|url=https://www.researchgate.net/publication/288611640|journal=Headaches: Causes, Treatment and Prevention|pages=51–64}}{{cite journal | vauthors = Goadsby PJ | title = The vascular theory of migraine--a great story wrecked by the facts | journal = Brain | volume = 132 | issue = Pt 1 | pages = 6–7 | date = January 2009 | pmid = 19098031 | doi = 10.1093/brain/awn321 | doi-access = free | title-link = doi }} Others believe both are likely important.{{cite journal | vauthors = Dodick DW | title = Examining the essence of migraine--is it the blood vessel or the brain? A debate | journal = Headache | volume = 48 | issue = 4 | pages = 661–7 | date = April 2008 | pmid = 18377395 | doi = 10.1111/j.1526-4610.2008.01079.x | s2cid = 6272233 }}{{cite journal | vauthors = Chen D, Willis-Parker M, Lundberg GP | title = Migraine headache: Is it only a neurological disorder? Links between migraine and cardiovascular disorders | journal = Trends in Cardiovascular Medicine | volume = 30 | issue = 7 | pages = 424–430 | date = October 2020 | pmid = 31679956 | doi = 10.1016/j.tcm.2019.10.005 | doi-access = free | title-link = doi }}{{cite journal | vauthors = Jacobs B, Dussor G | title = Neurovascular contributions to migraine: Moving beyond vasodilation | journal = Neuroscience | volume = 338 | pages = 130–144 | date = December 2016 | pmid = 27312704 | pmc = 5083225 | doi = 10.1016/j.neuroscience.2016.06.012 }}{{cite journal | vauthors = Mason BN, Russo AF | title = Vascular Contributions to Migraine: Time to Revisit? | journal = Frontiers in Cellular Neuroscience | volume = 12 | pages = 233 |year = 2018 | pmid = 30127722 | pmc = 6088188 | doi = 10.3389/fncel.2018.00233 | doi-access = free | title-link = doi }} One theory is related to increased excitability of the cerebral cortex and abnormal control of pain neurons in the trigeminal nucleus of the brainstem.{{cite journal | vauthors = Dodick DW, Gargus JJ | title = Why migraines strike | journal = Scientific American | volume = 299 | issue = 2 | pages = 56–63 | date = August 2008 | pmid = 18666680 | doi = 10.1038/scientificamerican0808-56 | bibcode = 2008SciAm.299b..56D }}

Sensitization of trigeminal pathways is a key pathophysiological phenomenon in migraine. It is debatable whether sensitization starts in the periphery or in the brain.{{cite journal | vauthors = Edvinsson L, Haanes KA |date=May 2020 |title=Views on migraine pathophysiology: Where does it start? |journal=Neurology and Clinical Neuroscience |volume=8 |issue=3 |pages=120–127 |doi=10.1111/ncn3.12356 |s2cid=214320892 |issn=2049-4173}}{{cite journal | vauthors = Do TP, Hougaard A, Dussor G, Brennan KC, Amin FM | title = Migraine attacks are of peripheral origin: the debate goes on | journal = The Journal of Headache and Pain | volume = 24 | issue = 1 | pages = 3 | date = January 2023 | pmid = 36627561 | pmc = 9830833 | doi = 10.1186/s10194-022-01538-1 | doi-access = free }}

Cortical spreading depression, or spreading depression according to Leão, is a burst of neuronal activity followed by a period of inactivity, which is seen in those with migraine with aura.The Headaches, Chp. 28, pp. 269–72 There are a number of explanations for its occurrence, including activation of NMDA receptors leading to calcium entering the cell. After the burst of activity, the blood flow to the cerebral cortex in the area affected is decreased for two to six hours. It is believed that when depolarization travels down the underside of the brain, nerves that sense pain in the head and neck are triggered.

The exact mechanism of the head pain which occurs during a migraine episode is unknown.{{cite journal | vauthors = Olesen J, Burstein R, Ashina M, Tfelt-Hansen P | title = Origin of pain in migraine: evidence for peripheral sensitisation | journal = The Lancet. Neurology | volume = 8 | issue = 7 | pages = 679–90 | date = July 2009 | pmid = 19539239 | doi = 10.1016/S1474-4422(09)70090-0 | s2cid = 20452008 }} Some evidence supports a primary role for central nervous system structures (such as the brainstem and diencephalon),{{cite journal | vauthors = Akerman S, Holland PR, Goadsby PJ | title = Diencephalic and brainstem mechanisms in migraine | journal = Nature Reviews. Neuroscience | volume = 12 | issue = 10 | pages = 570–84 | date = September 2011 | pmid = 21931334 | doi = 10.1038/nrn3057 | s2cid = 8472711 }} while other data support the role of peripheral activation (such as via the sensory nerves that surround blood vessels of the head and neck). The potential candidate vessels include dural arteries, pial arteries and extracranial arteries such as those of the scalp. The role of vasodilatation of the extracranial arteries, in particular, is believed to be significant.{{cite journal | vauthors = Shevel E | title = The extracranial vascular theory of migraine--a great story confirmed by the facts | journal = Headache | volume = 51 | issue = 3 | pages = 409–417 | date = March 2011 | pmid = 21352215 | doi = 10.1111/j.1526-4610.2011.01844.x | s2cid = 6939786 }}

Adenosine, a neuromodulator, may be involved. Released after the progressive cleavage of adenosine triphosphate (ATP), adenosine acts on adenosine receptors to put the body and brain in a low activity state by dilating blood vessels and slowing the heart rate, such as before and during the early stages of sleep. Adenosine levels have been found to be high during migraine attacks.{{cite book | vauthors = Burnstock G | title = Pharmacological Mechanisms and the Modulation of Pain | chapter = Purinergic Mechanisms and Pain | series = Advances in Pharmacology | volume = 75 | pages = 91–137 | date = January 2016 | pmid = 26920010 | doi = 10.1016/bs.apha.2015.09.001 | isbn = 9780128038833 | veditors = Barrett JE }}{{cite book |vauthors=Davidoff R |url=https://books.google.com/books?id=PAdn6xC3KlAC&q=migraine+adenosine&pg=PA223 |title=Migraine: Manifestations, Pathogenesis, and Management |date=14 February 2002 |publisher=Oxford University Press |isbn=978-0-19-803135-2 |access-date=12 November 2020 |archive-date=23 August 2023 |archive-url=https://web.archive.org/web/20230823051112/https://books.google.com/books?id=PAdn6xC3KlAC&q=migraine+adenosine&pg=PA223 |url-status=live }} Caffeine's role as an inhibitor of adenosine may explain its effect in reducing migraine.{{cite journal | vauthors = Lipton RB, Diener HC, Robbins MS, Garas SY, Patel K | title = Caffeine in the management of patients with headache | journal = The Journal of Headache and Pain | volume = 18 | issue = 1 | pages = 107 | date = October 2017 | pmid = 29067618 | pmc = 5655397 | doi = 10.1186/s10194-017-0806-2 | doi-access = free | title-link = doi }} Low levels of the neurotransmitter serotonin, also known as 5-hydroxytryptamine (5-HT), are also believed to be involved.{{cite journal |vauthors=Hamel E |date=November 2007 |title=Serotonin and migraine: biology and clinical implications |journal=Cephalalgia |volume=27 |issue=11 |pages=1293–300 |doi=10.1111/j.1468-2982.2007.01476.x |pmid=17970989 |s2cid=26543041 |doi-access=free}}

Calcitonin gene-related peptides (CGRPs) have been found to play a role in the pathogenesis of the pain associated with migraine, as levels of it become elevated during an attack.

The diagnosis of a migraine is based on signs and symptoms. Neuroimaging tests are not necessary to diagnose migraine, but may be used to find other causes of headaches in those whose examination and history do not confirm a migraine diagnosis.

• {{cite journal | vauthors = Lewis DW, Dorbad D | title = The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations | journal = Headache | volume = 40 | issue = 8 | pages = 629–32 | date = September 2000 | pmid = 10971658 | doi = 10.1046/j.1526-4610.2000.040008629.x | s2cid = 14443890 }}
• {{cite journal | vauthors = Silberstein SD | title = Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 55 | issue = 6 | pages = 754–62 | date = September 2000 | pmid = 10993991 | doi = 10.1212/WNL.55.6.754 | doi-access = free | title-link = doi }}
• {{cite journal | author = Medical Advisory Secretariat | title = Neuroimaging for the evaluation of chronic headaches: an evidence-based analysis | journal = Ontario Health Technology Assessment Series | volume = 10 | issue = 26 | pages = 1–57 | year = 2010 | pmid = 23074404 | pmc = 3377587 }} It is believed that a substantial number of people with the condition remain undiagnosed.

The diagnosis of migraine without aura, according to the International Headache Society, can be made according the "5, 4, 3, 2, 1 criteria", which is as follows:

• Five or more attacks – for migraine with aura, two attacks are sufficient for diagnosis.
• Four hours to three days in duration
• Two or more of the following:
• Unilateral (affecting one side of the head)
• Pulsating
• Moderate or severe pain intensity
• Worsened by or causing avoidance of routine physical activity
• One or more of the following:
• Nausea and/or vomiting
• Sensitivity to both light (photophobia) and sound (phonophobia)

If someone experiences two of the following: photophobia, nausea, or inability to work or study for a day, the diagnosis is more likely.{{cite journal | vauthors = Cousins G, Hijazze S, Van de Laar FA, Fahey T | title = Diagnostic accuracy of the ID Migraine: a systematic review and meta-analysis | journal = Headache | volume = 51 | issue = 7 | pages = 1140–8 | date = Jul–Aug 2011 | pmid = 21649653 | doi = 10.1111/j.1526-4610.2011.01916.x | s2cid = 205684294 }} In those with four out of five of the following: pulsating headache, duration of 4–72 hours, pain on one side of the head, nausea, or symptoms that interfere with the person's life, the probability that this is a migraine attack is 92%. In those with fewer than three of these symptoms, the probability is 17%.

{{Main|ICHD classification and diagnosis of migraine}}

Migraine was first comprehensively classified in 1988.{{cite book| vauthors = Olesen J, Goadsby PJ | chapter = The Migraines: Introduction | veditors = Olesen J |title=The Headaches|year=2006|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5400-2|pages=232–233| chapter-url=https://books.google.com/books?id=F5VMlANd9iYC&pg=PA232|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20170313073938/https://books.google.com/books?id=F5VMlANd9iYC&pg=PA238|archive-date=13 March 2017}}

The International Headache Society updated their classification of headaches in 2004. A third version was published in 2018.{{cite journal | vauthors = | title = Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition | journal = Cephalalgia | volume = 38 | issue = 1 | pages = 1–211 | date = January 2018 | pmid = 29368949 | doi = 10.1177/0333102417738202 | doi-access = free | title-link = doi }} According to this classification, migraine is a primary headache disorder along with tension-type headaches and cluster headaches, among others.{{cite journal | vauthors = Nappi G | title = Introduction to the new International Classification of Headache Disorders | journal = The Journal of Headache and Pain | volume = 6 | issue = 4 | pages = 203–4 | date = September 2005 | pmid = 16362664 | pmc = 3452009 | doi = 10.1007/s10194-005-0185-y }}

Migraine is divided into six subclasses (some of which include further subdivisions):{{Cite journal |date=January 2018 |title=Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition |url=http://journals.sagepub.com/doi/10.1177/0333102417738202 |journal=Cephalalgia |volume=38 |issue=1 |pages=1–211 |doi=10.1177/0333102417738202 |pmid=29368949 |issn=0333-1024}}

• Migraine without aura, or "common migraine", involves migraine headaches that are not accompanied by aura.
• Migraine with aura, or "classic migraine", usually involves migraine headaches accompanied by aura. Less commonly, aura can occur without a headache, or with a nonmigraine headache. Two other varieties are familial hemiplegic migraine and sporadic hemiplegic migraine, in which a person has migraine with aura and with accompanying motor weakness. If a close relative has had the same condition, it is called "familial", otherwise it is called "sporadic". Another variety is basilar-type migraine, where a headache and aura are accompanied by difficulty speaking, world spinning, ringing in ears, or a number of other brainstem-related symptoms, but not motor weakness. This type was initially believed to be due to spasms of the basilar artery, the artery that supplies the brainstem. Now that this mechanism is not believed to be primary, the symptomatic term migraine with brainstem aura (MBA) is preferred. Retinal migraine (which is distinct from visual or optical migraine) involves migraine headaches accompanied by visual disturbances or even temporary blindness in one eye.
• Childhood periodic syndromes that are commonly precursors of migraine include cyclical vomiting (occasional intense periods of vomiting), abdominal migraine (abdominal pain, usually accompanied by nausea), and benign paroxysmal vertigo of childhood (occasional attacks of vertigo).
• Complications of migraine describe migraine headaches and/or auras that are unusually long or unusually frequent, or associated with a seizure or brain lesion.
• Probable migraine describes conditions that have some characteristics of migraine, but where there is not enough evidence to diagnose it as migraine with certainty (in the presence of concurrent medication overuse).
• Chronic migraine is a complication of migraine, and is a headache that fulfills diagnostic criteria for migraine headache and occurs for a greater time interval. Specifically, greater or equal to 15 days/month for longer than 3 months.{{cite journal | vauthors = Negro A, Rocchietti-March M, Fiorillo M, Martelletti P | title = Chronic migraine: current concepts and ongoing treatments | journal = European Review for Medical and Pharmacological Sciences | volume = 15 | issue = 12 | pages = 1401–20 | date = December 2011 | pmid = 22288302 }}

The diagnosis of abdominal migraine is controversial.{{cite book| vauthors = Davidoff RA |title=Migraine : manifestations, pathogenesis, and management|year=2002|publisher=Oxford Univ. Press|location=Oxford [u.a.]|isbn=9780195137057|page=81|url=https://books.google.com/books?id=PAdn6xC3KlAC&pg=PA81|edition=2|url-status=live|archive-url=https://web.archive.org/web/20161222063436/https://books.google.com/books?id=PAdn6xC3KlAC&pg=PA81|archive-date=22 December 2016}} Some evidence indicates that recurrent episodes of abdominal pain in the absence of a headache may be a type of migraine{{cite journal | vauthors = Russell G, Abu-Arafeh I, Symon DN | title = Abdominal migraine: evidence for existence and treatment options | journal = Paediatric Drugs | volume = 4 | issue = 1 | pages = 1–8 | year = 2002 | pmid = 11817981 | doi = 10.2165/00128072-200204010-00001 | s2cid = 12289726 }} or are at least a precursor to migraine attacks. These episodes of pain may or may not follow a migraine-like prodrome and typically last minutes to hours. They often occur in those with either a personal or family history of typical migraine. Other syndromes that are believed to be precursors include cyclical vomiting syndrome and benign paroxysmal vertigo of childhood.

Other conditions that can cause similar symptoms to a migraine headache include temporal arteritis, cluster headaches, acute glaucoma, meningitis and subarachnoid hemorrhage. Temporal arteritis typically occurs in people over 50 years old and presents with tenderness over the temple, cluster headache presents with one-sided nose stuffiness, tears and severe pain around the orbits, acute glaucoma is associated with vision problems, meningitis with fevers, and subarachnoid hemorrhage with a very fast onset. Tension headaches typically occur on both sides, are not pounding, and are less disabling.

Those with stable headaches that meet criteria for migraine should not receive neuroimaging to look for other intracranial disease.{{cite journal | vauthors = Lewis DW, Dorbad D | title = The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations | journal = Headache | volume = 40 | issue = 8 | pages = 629–32 | date = September 2000 | pmid = 10971658 | doi = 10.1046/j.1526-4610.2000.040008629.x | s2cid = 14443890 }}{{cite journal | vauthors = Silberstein SD | title = Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 55 | issue = 6 | pages = 754–62 | date = September 2000 | pmid = 10993991 | doi = 10.1212/WNL.55.6.754 | doi-access = free | title-link = doi }}{{cite journal | author = Medical Advisory Secretariat | title = Neuroimaging for the evaluation of chronic headaches: an evidence-based analysis | journal = Ontario Health Technology Assessment Series | volume = 10 | issue = 26 | pages = 1–57 | year = 2010 | pmid = 23074404 | pmc = 3377587 }} This requires that other concerning findings such as papilledema (swelling of the optic disc) are not present. People with migraine are not at an increased risk of having another cause for severe headaches.{{Citation needed|date=November 2023}}

{{Main|Management of migraine}}

Management of migraine includes prevention of migraine attacks and rescue treatment. There are three main aspects of treatment: trigger avoidance, acute (abortive), and preventive (prophylactic) control.{{Cite journal | vauthors = Chawla J, Lutsep HL |date=2023-06-13 |title=Migraine Headache Treatment & Management |url=https://emedicine.medscape.com/article/1142556-treatment?form=fpf |journal=Medscape |access-date=2024-05-03}}

Modern approaches to migraine management emphasize personalized care that considers individual patient needs. Lifestyle modifications, such as managing triggers and addressing comorbidities, form the foundation of treatment. Behavioral techniques and supplements like magnesium and riboflavin can serve as supportive options for some individuals.Jenkins, B. Migraine management. Australian Prescriber. 2020; 43(5):148–151. https://doi.org/10.18773/austprescr.2020.047 Behavioral techniques that have been utilized in the treatment of migraines include Cognitive Behavioral Therapy (CBT), relaxation training, biofeedback, Acceptance and Commitment Therapy (ACT), as well as mindfulness-based therapies. A 2024 systematic literature review and meta analysis found evidence that treatments such as CBT, relaxation training, ACT, and mindfulness-based therapies can reduce migraine frequency both on their own and in combination with other treatment options.{{cite report | vauthors = Treadwell JR, Tsou AY, Rouse B, Ivlev I, Fricke J, Buse D, Powers SW, Minen M, Szperka CL, Mull NK | title = Behavioral Interventions for Migraine Prevention | date = 2024 | pmid = 39471258 | doi = 10.23970/ahrqepccer270 | publisher = Agency for Healthcare Research and Quality (AHRQ) }} In addition, it was found that relaxation therapy aided in the lessening of migraine frequency when compared to education by itself. Similarly for children and adolescents, CBT and biofeedback strategies have shown effective in a decrease of frequency and intensity of migraines. These techniques often include relaxation methods and promotion of long-term management without medication side effects which is emphasized for younger individuals. Acute treatments, including NSAIDs and triptans, are most effective when administered early in an attack, while preventive medications are recommended for those experiencing frequent or severe migraines. Proven preventive options include beta blockers, topiramate, and CGRP inhibitors like erenumab and galcanezumab, which have demonstrated significant efficacy in clinical studies.{{cite journal | vauthors = Mohanty D, Lippmann S | title = CGRP Inhibitors for Migraine | journal = Innovations in Clinical Neuroscience | volume = 17 | issue = 4–6 | pages = 39–40 | date = April 2020 | pmid = 32802591 | pmc = 7413335 | doi = }} The European Consensus Statement provides a framework for diagnosis and management, emphasizing the importance of accurate assessment, patient education, and consistent adherence to prescribed treatments. Innovative therapies of oral medications used to treat migraine symptoms, such as gepants and ditans, are emerging as alternatives for patients who cannot use traditional options.{{cite journal | vauthors = Eigenbrodt AK, Ashina H, Khan S, Diener HC, Mitsikostas DD, Sinclair AJ, Pozo-Rosich P, Martelletti P, Ducros A, Lantéri-Minet M, Braschinsky M, Del Rio MS, Daniel O, Özge A, Mammadbayli A, Arons M, Skorobogatykh K, Romanenko V, Terwindt GM, Paemeleire K, Sacco S, Reuter U, Lampl C, Schytz HW, Katsarava Z, Steiner TJ, Ashina M | title = Diagnosis and management of migraine in ten steps | journal = Nature Reviews. Neurology | volume = 17 | issue = 8 | pages = 501–514 | date = August 2021 | pmid = 34145431 | pmc = 8321897 | doi = 10.1038/s41582-021-00509-5 }}

A 2024 systematic review and network meta analysis compared the effectiveness of medications for acute migraine attacks in adults. It found that triptans were the most effective class of drugs followed by non-steroidal anti-inflammatories. Gepants were less effective than non-steroidal anti-inflammatory drugs.{{Cite journal |last=Karlsson |first=William K. |last2=Ostinelli |first2=Edoardo G. |last3=Zhuang |first3=Zixuan A. |last4=Kokoti |first4=Lili |last5=Christensen |first5=Rune H. |last6=Al-Khazali |first6=Haidar M. |last7=Deligianni |first7=Christina I. |last8=Tomlinson |first8=Anneka |last9=Ashina |first9=Håkan |last10=Torre |first10=Elena Ruiz de la |last11=Diener |first11=Hans-Christoph |last12=Cipriani |first12=Andrea |last13=Ashina |first13=Messoud |date=2024-09-18 |title=Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis |url=https://www.bmj.com/content/386/bmj-2024-080107 |journal=BMJ |language=en |volume=386 |pages=e080107 |doi=10.1136/bmj-2024-080107 |issn=1756-1833 |pmid=39293828|pmc=11409395 }}{{Cite journal |date=4 March 2025 |title=Which drugs are best for migraine attacks? |url=https://evidence.nihr.ac.uk/alert/which-drugs-are-best-for-migraine-attacks/ |journal=NIHR Evidence}}

Calcitonin gene-related peptide (CGRP) is a neuropeptide implicated in the pathophysiology of migraines. It is predominantly found in the trigeminal ganglion and central nervous system pathways associated with migraine mechanisms.{{cite journal | vauthors = Wattiez AS, Sowers LP, Russo AF | title = Calcitonin gene-related peptide (CGRP): role in migraine pathophysiology and therapeutic targeting | journal = Expert Opinion on Therapeutic Targets | volume = 24 | issue = 2 | pages = 91–100 | date = February 2020 | pmid = 32003253 | pmc = 7050542 | doi = 10.1080/14728222.2020.1724285 }} During migraine attacks, elevated levels of CGRP are detected, leading to vasodilation of cerebral and dural blood vessels and the release of inflammatory mediators from mast cells. These actions contribute to the transmission of nociceptive signals, culminating in migraine pain. Targeting CGRP has emerged as a promising therapeutic strategy for migraine management. Several CGRP inhibitors have been developed and approved for clinical use, categorized into monoclonal antibodies and small-molecule receptor antagonists (gepants).

Monoclonal Antibodies:

• Erenumab (Aimovig): A monoclonal antibody that inhibits the CGRP receptor, administered via monthly subcutaneous injections.{{cite journal | vauthors = Mohanty D, Lippmann S | title = CGRP Inhibitors for Migraine | journal = Innovations in Clinical Neuroscience | volume = 17 | issue = 4–6 | pages = 39–40 | date = April 2020 | pmid = 32802591 | pmc = 7413335 }}
• Fremanezumab (Ajovy): Targets the CGRP ligand, available as monthly or quarterly subcutaneous injections.
• Galcanezumab (Emgality): Binds to the CGRP ligand, administered monthly via subcutaneous injection.
• Eptinezumab (Vyepti): Targets the CGRP ligand, administered quarterly through intravenous infusion.

Gepants (Small-Molecule CGRP Receptor Antagonists):

• Ubrogepant (Ubrelvy): An oral medication approved for the acute treatment of migraines.
• Rimegepant (Nurtec ODT): Approved for both acute and preventive treatment of migraines, available as an orally disintegrating tablet.
• Atogepant (Qulipta): An oral medication approved for the preventive treatment of migraines.
• Zavegepant (Zavzpret): A nasal spray approved for the acute treatment of migraines.

{{cleanup|reason=incoherent amalgamation of sentences cut and pasted verbatim from sources|date=January 2025}}

"Migraine exists on a continuum of different attack frequencies and associated levels of disability."{{cite journal | vauthors = Silberstein SD, Lee L, Gandhi K, Fitzgerald T, Bell J, Cohen JM | title = Health care Resource Utilization and Migraine Disability Along the Migraine Continuum Among Patients Treated for Migraine | journal = Headache | volume = 58 | issue = 10 | pages = 1579–1592 | date = November 2018 | pmid = 30375650 | doi = 10.1111/head.13421 | s2cid = 53114546 }} For those with occasional, episodic migraine, a "proper combination of drugs for prevention and treatment of migraine attacks" can limit the disease's impact on patients' personal and professional lives.{{cite web | url = https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page | title = Migraine Information Page: Prognosis | archive-url = https://web.archive.org/web/20200610010837/https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page | archive-date=10 June 2020 | work = National Institute for Neurological Disorders and Stroke (NINDS) | publisher = National Institutes of Health (US) }} But fewer than half of people with migraine seek medical care and more than half go undiagnosed and undertreated.{{cite web|title=Key facts and figures about migraine|year=2017|url=https://www.migrainetrust.org/about-migraine/migraine-what-is-it/facts-figures/|archive-url=https://web.archive.org/web/20170312001659/https://www.migrainetrust.org/about-migraine/migraine-what-is-it/facts-figures/|archive-date=12 March 2017|website=The Migraine Trust|access-date=13 June 2021|url-status=live}} "Responsive prevention and treatment of migraine is incredibly important" because evidence shows "an increased sensitivity after each successive attack, eventually leading to chronic daily migraine in some individuals." Repeated migraine results in "reorganization of brain circuitry", causing "profound functional as well as structural changes in the brain."{{cite journal | vauthors = Brennan KC, Pietrobon D | title = A Systems Neuroscience Approach to Migraine | journal = Neuron | volume = 97 | issue = 5 | pages = 1004–1021 | date = March 2018 | pmid = 29518355 | pmc = 6402597 | doi = 10.1016/j.neuron.2018.01.029 }} "One of the most important problems in clinical migraine is the progression from an intermittent, self-limited inconvenience to a life-changing disorder of chronic pain, sensory amplification, and autonomic and affective disruption. This progression, sometimes termed chronification in the migraine literature, is common, affecting 3% of migraineurs in a given year, such that 8% of migraineurs have chronic migraine in any given year." Brain imagery reveals that the electrophysiological changes seen during an attack become permanent in people with chronic migraine; "thus, from an electrophysiological point of view, chronic migraine indeed resembles a never-ending migraine attack." Severe migraine ranks in the highest category of disability, according to the World Health Organization, which uses objective metrics to determine disability burden for the authoritative annual Global Burden of Disease report. The report classifies severe migraine alongside severe depression, active psychosis, quadriplegia, and terminal-stage cancer.{{cite web | publisher = World Health Organization | date = 2008 | quote = Disability classes for the ''Global Burden of Disease study (table 8) | url = https://apps.who.int/iris/bitstream/handle/10665/43942/9789241563710_eng.pdf | title = The Global Burden of Disease: 2004 Update | archive-url = https://web.archive.org/web/20210613232410/https://apps.who.int/iris/bitstream/handle/10665/43942/9789241563710_eng.pdf | archive-date = 13 June 2021 | page = 33}}

Migraine with aura appears to be a risk factor for ischemic stroke{{cite journal | vauthors = Schürks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T | title = Migraine and cardiovascular disease: systematic review and meta-analysis | journal = BMJ | volume = 339 | pages = b3914 | date = October 2009 | pmid = 19861375 | pmc = 2768778 | doi = 10.1136/bmj.b3914 }} doubling the risk.{{cite journal | vauthors = Kurth T, Chabriat H, Bousser MG | title = Migraine and stroke: a complex association with clinical implications | journal = The Lancet. Neurology | volume = 11 | issue = 1 | pages = 92–100 | date = January 2012 | pmid = 22172624 | doi = 10.1016/S1474-4422(11)70266-6 | s2cid = 31939284 }} Being a young adult, being female, using hormonal birth control, and smoking further increases this risk. There also appears to be an association with cervical artery dissection.{{cite journal | vauthors = Rist PM, Diener HC, Kurth T, Schürks M | title = Migraine, migraine aura, and cervical artery dissection: a systematic review and meta-analysis | journal = Cephalalgia | volume = 31 | issue = 8 | pages = 886–96 | date = June 2011 | pmid = 21511950 | pmc = 3303220 | doi = 10.1177/0333102411401634 }} Migraine without aura does not appear to be a factor.{{cite journal | vauthors = Kurth T | title = The association of migraine with ischemic stroke | journal = Current Neurology and Neuroscience Reports | volume = 10 | issue = 2 | pages = 133–9 | date = March 2010 | pmid = 20425238 | doi = 10.1007/s11910-010-0098-2 | s2cid = 27227332 }} The relationship with heart problems is inconclusive with a single study supporting an association. Migraine does not appear to increase the risk of death from stroke or heart disease.{{cite journal|vauthors=Schürks M, Rist PM, Shapiro RE, Kurth T|date=September 2011|title=Migraine and mortality: a systematic review and meta-analysis|journal=Cephalalgia|volume=31|issue=12|pages=1301–14|doi=10.1177/0333102411415879|pmc=3175288|pmid=21803936}} Preventative therapy of migraine in those with migraine with aura may prevent associated strokes.{{cite journal | vauthors = Weinberger J | title = Stroke and migraine | journal = Current Cardiology Reports | volume = 9 | issue = 1 | pages = 13–9 | date = March 2007 | pmid = 17362679 | doi = 10.1007/s11886-007-0004-y | s2cid = 46681674 }} People with migraine, particularly women, may develop higher than average numbers of white matter brain lesions of unclear significance.{{cite journal | vauthors = Hougaard A, Amin FM, Ashina M | title = Migraine and structural abnormalities in the brain | journal = Current Opinion in Neurology | volume = 27 | issue = 3 | pages = 309–14 | date = June 2014 | pmid = 24751961 | doi = 10.1097/wco.0000000000000086 }}

File:Chalmer 2023.jpg

Migraine is common, with around 33% of women and 18% of men affected at some point in their lifetime.{{cite journal | vauthors = Ferrari MD, Goadsby PJ, Burstein R, Kurth T, Ayata C, Charles A, Ashina M, van den Maagdenberg AM, Dodick DW | title = Migraine | journal = Nature Reviews. Disease Primers | volume = 8 | issue = 1 | pages = 2 | date = January 2022 | pmid = 35027572 | doi = 10.1038/s41572-021-00328-4 | s2cid = 245883895 }} Onset can be at any age, but prevalence rises sharply around puberty, and remains high until declining after age 50. Before puberty, boys and girls are equally impacted, with around 5% of children experiencing migraine attacks. From puberty onwards, women experience migraine attacks at greater rates than men. From age 30 to 50, up to 4 times as many women experience migraine attacks as men., this is most pronounced in migraine without aura.{{cite journal | vauthors = Chalmer MA, Kogelman LJ, Callesen I, Christensen CG, Techlo TR, Møller PL, Davidsson OB, Olofsson IA, Schwinn M, Mikkelsen S, Dinh KM, Nielsen K, Topholm M, Erikstrup C, Ostrowski SR, Pedersen OB, Hjalgrim H, Banasik K, Burgdorf KS, Nyegaard M, Olesen J, Hansen TF | title = Sex differences in clinical characteristics of migraine and its burden: a population-based study | journal = European Journal of Neurology | volume = 30 | issue = 6 | pages = 1774–1784 | date = June 2023 | pmid = 36905094 | doi = 10.1111/ene.15778 }}

Worldwide, migraine affects nearly 15% or approximately one billion people. In the United States, about 6% of men and 18% of women experience a migraine attack in a given year, with a lifetime risk of about 18% and 43% respectively. In Europe, migraine affects 12–28% of people at some point in their lives with about 6–15% of adult men and 14–35% of adult women getting at least one attack yearly.{{cite journal |vauthors=Stovner LJ, Zwart JA, Hagen K, Terwindt GM, Pascual J |date=April 2006 |title=Epidemiology of headache in Europe |journal=European Journal of Neurology |volume=13 |issue=4 |pages=333–45 |doi=10.1111/j.1468-1331.2006.01184.x |pmid=16643310 |s2cid=7490176 |doi-access=free}} Rates of migraine are slightly lower in Asia and Africa than in Western countries.{{cite journal | vauthors = Wang SJ | title = Epidemiology of migraine and other types of headache in Asia | journal = Current Neurology and Neuroscience Reports | volume = 3 | issue = 2 | pages = 104–8 | date = March 2003 | pmid = 12583837 | doi = 10.1007/s11910-003-0060-7 | s2cid = 24939546 }} Chronic migraine occurs in approximately 1.4–2.2% of the population.{{cite journal | vauthors = Natoli JL, Manack A, Dean B, Butler Q, Turkel CC, Stovner L, Lipton RB | title = Global prevalence of chronic migraine: a systematic review | journal = Cephalalgia | volume = 30 | issue = 5 | pages = 599–609 | date = May 2010 | pmid = 19614702 | doi = 10.1111/j.1468-2982.2009.01941.x | s2cid = 5328642 }}

During perimenopause symptoms often get worse before decreasing in severity.{{cite journal | vauthors = Nappi RE, Sances G, Detaddei S, Ornati A, Chiovato L, Polatti F | title = Hormonal management of migraine at menopause | journal = Menopause International | volume = 15 | issue = 2 | pages = 82–6 | date = June 2009 | pmid = 19465675 | doi = 10.1258/mi.2009.009022 | s2cid = 23204921 }} While symptoms resolve in about two-thirds of the elderly, in 3–10% they persist.{{cite book| vauthors = Dodick DW, Capobianco DJ | chapter = Chapter 14: Headaches | chapter-url=https://books.google.com/books?id=c1tL8C9ryMQC&pg=PA197 | veditors = Sirven JI, Malamut BL |title=Clinical neurology of the older adult |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|year=2008|isbn=9780781769471|edition=2nd |location=Philadelphia|page=197 |archive-url=https://web.archive.org/web/20170312231334/https://books.google.com/books?id=c1tL8C9ryMQC&pg=PA197|archive-date=12 March 2017|url-status=live}}

Image:Cruikshank - The Head Ache.png

An early description consistent with migraine is contained in the Ebers Papyrus, written around 1500 BCE in ancient Egypt.{{cite book| vauthors = Miller N |title=Walsh and Hoyt's clinical neuro-ophthalmology.|year=2005|publisher=Lippincott Williams & Wilkins|location=Philadelphia, Pa.|isbn=9780781748117|page=1275|url=https://books.google.com/books?id=9RA2ZOPRuhgC&pg=PA1275|edition=6|url-status=live|archive-url=https://web.archive.org/web/20170312232704/https://books.google.com/books?id=9RA2ZOPRuhgC&pg=PA1275|archive-date=12 March 2017}}

The word migraine is from the Greek ἡμικρᾱνίᾱ (hēmikrāníā), 'pain in half of the head',{{cite web | vauthors = Liddell HG, Scott R |title=ἡμικρανία |work=A Greek-English Lexicon |url=https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dh%28mikrani%2Fa |url-status=live |archive-url=https://web.archive.org/web/20131108145951/http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dh%28mikrani%2Fa |archive-date=8 November 2013 }} on Perseus from ἡμι- (hēmi-), 'half' and κρᾱνίον (krāníon), 'skull'.{{cite book | vauthors = Anderson K, Anderson LE, Glanze WD |title=Mosby's Medical, Nursing & Allied Health Dictionary |year=1994 |publisher=Mosby |isbn=978-0-8151-6111-0 |page=998 |edition=4|title-link=Mosby's Medical, Nursing & Allied Health Dictionary }}

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In 200 BCE, writings from the Hippocratic school of medicine described the visual aura that can precede the headache and a partial relief occurring through vomiting.{{cite book| vauthors = Borsook D |title=The migraine brain : imaging, structure, and function|year=2012|publisher=Oxford University Press|location=New York|isbn=9780199754564|pages=3–11|url=https://books.google.com/books?id=5GVVJS_fCAkC&pg=PA3|url-status=live|archive-url=https://web.archive.org/web/20170313014706/https://books.google.com/books?id=5GVVJS_fCAkC&pg=PA3|archive-date=13 March 2017}}

A second-century description by Aretaeus of Cappadocia divided headaches into three types: cephalalgia, cephalea, and heterocrania.{{cite book|vauthors=Waldman SD|title=Pain management|year=2011|publisher=Elsevier/Saunders|location=Philadelphia, PA|isbn=9781437736038|pages=2122–2124|url=https://books.google.com/books?id=O6AojTbeXoEC&pg=PT2122|edition=2|access-date=24 September 2016|archive-date=23 August 2023|archive-url=https://web.archive.org/web/20230823052214/https://books.google.com/books?id=O6AojTbeXoEC&pg=PT2122|url-status=live}} Galen of Pergamon used the term hemicrania (half-head), from which the word migraine was eventually derived. He also proposed that the pain arose from the meninges and blood vessels of the head. Migraine was first divided into the two now used types – migraine with aura (migraine ophthalmique) and migraine without aura (migraine vulgaire) in 1887 by Louis Hyacinthe Thomas, a French librarian. The mystical visions of Hildegard von Bingen, which she described as "reflections of the living light", are consistent with the visual aura experienced during migraine attacks.{{cite web |title= Sex(ism), Drugs, and Migraines |date= 15 January 2019 |url= https://www.sciencehistory.org/distillations/podcast/sexism-drugs-and-migraines |website= Distillations |publisher= Science History Institute |access-date= 6 February 2020 |archive-date= 14 March 2021 |archive-url= https://web.archive.org/web/20210314045616/https://www.sciencehistory.org/distillations/podcast/sexism-drugs-and-migraines |url-status= live }}

Image:Trepanated skull of a woman-P4140363-black.jpg skull, from the Neolithic. The perimeter of the hole in the skull is rounded off by ingrowth of new bony tissue, indicating that the person survived the operation.]]

Trepanation, the deliberate drilling of holes into a skull, was practiced as early as 7,000 BCE. While sometimes people survived, many would have died from the procedure due to infection.{{cite book| vauthors = Margaret C, Simon M |title=Human osteology : in archaeology and forensic science|year=2002|publisher=Cambridge University Press|location=Cambridge [etc.]|isbn=9780521691468|page=345|url=https://books.google.com/books?id=-UqAnk-n7wgC&pg=PA345|edition=Repr.|url-status=live|archive-url=https://web.archive.org/web/20130617062401/http://books.google.com/books?id=-UqAnk-n7wgC|archive-date=17 June 2013}} It was believed to work via "letting evil spirits escape".{{cite book| vauthors = Colen C |title=Neurosurgery|year=2008|publisher=Colen Publishing|isbn=9781935345039|page=1|url=https://books.google.com/books?id=zHg53Gw0JrAC&pg=PA1}} William Harvey recommended trepanation as a treatment for migraine in the 17th century.{{cite book| vauthors = Daniel BT |title=Migraine|year=2010|publisher=AuthorHouse|location=Bloomington, IN|isbn=9781449069629|page=101|url=https://books.google.com/books?id=YSoSECeCudIC&pg=PA101|url-status=live|archive-url=https://web.archive.org/web/20170313073818/https://books.google.com/books?id=YSoSECeCudIC&pg=PA101|archive-date=13 March 2017}} The association between trepanation and headaches in ancient history may simply be a myth or unfounded speculation that originated several centuries later. In 1913, the world-famous American physician William Osler misinterpreted the French anthropologist and physician Paul Broca's words about a set of children's skulls from the Neolithic age that he found during the 1870s. These skulls presented no evident signs of fractures that could justify this complex surgery for mere medical reasons. Trepanation was probably born of superstitions, to remove "confined demons" inside the head, or to create healing or fortune talismans with the bone fragments removed from the skulls of the patients. However, Osler wanted to make Broca's theory more palatable to his modern audiences, and explained that trepanation procedures were used for mild conditions such as "infantile convulsions headache and various cerebral diseases believed to be caused by confined demons."{{cite book |vauthors=Butticè C |url=https://www.abc-clio.com/products/a6280c/ |title=What you need to know about headaches |date=April 2022 |publisher=Greenwood Publishing Group |isbn=978-1-4408-7531-1 |location=Santa Barbara, California |pages=29–30 |oclc=1259297708 |access-date=2 November 2022 |archive-date=28 November 2022 |archive-url=https://web.archive.org/web/20221128083152/https://www.abc-clio.com/products/a6280c/ |url-status=live }}

While many treatments for migraine have been attempted, it was not until 1868 that use of a substance which eventually turned out to be effective began. This substance was the fungus ergot from which ergotamine was isolated in 1918{{cite journal | vauthors = Tfelt-Hansen PC, Koehler PJ | title = One hundred years of migraine research: major clinical and scientific observations from 1910 to 2010 | journal = Headache | volume = 51 | issue = 5 | pages = 752–78 | date = May 2011 | pmid = 21521208 | doi = 10.1111/j.1526-4610.2011.01892.x | s2cid = 31940152 }} and first used to treat migraine in 1925.{{cite journal | url=https://journals.sagepub.com/doi/10.1111/j.1468-2982.2008.01578.x | doi=10.1111/j.1468-2982.2008.01578.x | title=History of the Use of Ergotamine and Dihydroergotamine in Migraine from 1906 and Onward | date=2008 | journal=Cephalalgia | volume=28 | issue=8 | pages=877–886 | pmid=18460007 | vauthors = Tfelt-Hansen P, Koehler P }} Methysergide was developed in 1959 and the first triptan, sumatriptan, was developed in 1988. During the 20th century with better study-design, effective preventive measures were found and confirmed.

Migraine is a significant source of both medical costs and lost productivity. It has been estimated that migraine is the most costly neurological disorder in the European Community, costing more than €27 billion per year.{{cite journal | vauthors = Stovner LJ, Andrée C | title = Impact of headache in Europe: a review for the Eurolight project | journal = The Journal of Headache and Pain | volume = 9 | issue = 3 | pages = 139–46 | date = June 2008 | pmid = 18418547 | pmc = 2386850 | doi = 10.1007/s10194-008-0038-6 }} In the United States, direct costs have been estimated at $17 billion, while indirect costs – such as missed or decreased ability to work – is estimated at $15 billion.{{cite journal | vauthors = Mennini FS, Gitto L, Martelletti P | title = Improving care through health economics analyses: cost of illness and headache | journal = The Journal of Headache and Pain | volume = 9 | issue = 4 | pages = 199–206 | date = August 2008 | pmid = 18604472 | pmc = 3451939 | doi = 10.1007/s10194-008-0051-9 }} Nearly a tenth of the direct cost is due to the cost of triptans. In those who do attend work during a migraine attack, effectiveness is decreased by around a third. Negative impacts also frequently occur for a person's family.

Transcranial magnetic stimulation shows promise,{{cite journal | vauthors = Magis D, Jensen R, Schoenen J | title = Neurostimulation therapies for primary headache disorders: present and future | journal = Current Opinion in Neurology | volume = 25 | issue = 3 | pages = 269–76 | date = June 2012 | pmid = 22543428 | doi = 10.1097/WCO.0b013e3283532023 }} as does transcutaneous supraorbital nerve stimulation.{{cite journal | vauthors = Jürgens TP, Leone M | title = Pearls and pitfalls: neurostimulation in headache | journal = Cephalalgia | volume = 33 | issue = 8 | pages = 512–25 | date = June 2013 | pmid = 23671249 | doi = 10.1177/0333102413483933 | s2cid = 42537455 }} There is preliminary evidence that a ketogenic diet may help prevent episodic and long-term migraine.{{cite journal | vauthors = Barbanti P, Fofi L, Aurilia C, Egeo G, Caprio M | title = Ketogenic diet in migraine: rationale, findings and perspectives | journal = Neurological Sciences | volume = 38 | issue = Suppl 1 | pages = 111–115 | date = May 2017 | pmid = 28527061 | doi = 10.1007/s10072-017-2889-6 | type = Review | s2cid = 3805337 }}{{cite journal | vauthors = Gross EC, Klement RJ, Schoenen J, D'Agostino DP, Fischer D | title = Potential Protective Mechanisms of Ketone Bodies in Migraine Prevention | journal = Nutrients | volume = 11 | issue = 4 | pages = 811 | date = April 2019 | pmid = 30974836 | pmc = 6520671 | doi = 10.3390/nu11040811 | doi-access = free | title-link = doi }}

Statistical data indicates that women may be more prone to having migraine, showing migraine incidence three times higher among women than men.{{cite journal | vauthors = Artero-Morales M, González-Rodríguez S, Ferrer-Montiel A | title = TRP Channels as Potential Targets for Sex-Related Differences in Migraine Pain | journal = Frontiers in Molecular Biosciences | volume = 5 | pages = 73 |year = 2018 | pmid = 30155469 | pmc = 6102492 | doi = 10.3389/fmolb.2018.00073 | doi-access = free | title-link = doi }}{{cite journal | vauthors = Stewart WF, Lipton RB, Celentano DD, Reed ML | title = Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors | journal = JAMA | volume = 267 | issue = 1 | pages = 64–69 | date = January 1992 | pmid = 1727198 | doi = 10.1001/jama.1992.03480010072027 }} The Society for Women's Health Research has also mentioned hormonal influences, mainly estrogen, as having a considerable role in provoking migraine pain. Studies and research related to the sex dependencies of migraine are still ongoing, and conclusions have yet to be achieved.{{cite web|date=28 August 2018|title=Speeding Progress in Migraine Requires Unraveling Sex Differences|url=https://swhr.org/speeding-progress-in-migraine-requires-unraveling-sex-differences/|access-date=17 March 2021|publisher=Society for Women's Health Research|archive-date=18 June 2020|archive-url=https://web.archive.org/web/20200618070625/https://swhr.org/speeding-progress-in-migraine-requires-unraveling-sex-differences/|url-status=live}}

{{Clear}}

• Cluster headache
• Tension headache
• Trigeminal neuralgia

{{Reflist}}

{{refbegin}}

• {{cite journal | vauthors = Ashina M | title = Migraine | journal = The New England Journal of Medicine | volume = 383 | issue = 19 | pages = 1866–1876 | date = November 2020 | pmid = 33211930 | doi = 10.1056/nejmra1915327 | s2cid = 227078662 | veditors = Ropper AH }}
• {{cite journal | vauthors = Oskoui M, Pringsheim T, Billinghurst L, Potrebic S, Gersz EM, Gloss D, Holler-Managan Y, Leininger E, Licking N, Mack K, Powers SW, Sowell M, Victorio MC, Yonker M, Zanitsch H, Hershey AD | title = Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society | journal = Neurology | volume = 93 | issue = 11 | pages = 500–509 | date = September 2019 | pmid = 31413170 | pmc = 6746206 | doi = 10.1212/WNL.0000000000008105 }}
• {{cite journal | vauthors = Oskoui M, Pringsheim T, Holler-Managan Y, Potrebic S, Billinghurst L, Gloss D, Hershey AD, Licking N, Sowell M, Victorio MC, Gersz EM, Leininger E, Zanitsch H, Yonker M, Mack K | title = Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society | journal = Neurology | volume = 93 | issue = 11 | pages = 487–499 | date = September 2019 | pmid = 31413171 | doi = 10.1212/WNL.0000000000008095| s2cid = 199662718 | doi-access = free | title-link = doi }}

{{refend}}

{{offline|med}}

{{external media | width = 210px | headerimage= | audio1 = [https://www.sciencehistory.org/distillations/podcast/sexism-drugs-and-migraines Sex(ism), Drugs, and Migraines], Distillations Podcast, Science History Institute, 15 January 2019}}

{{Medical condition classification and resources

|DiseasesDB = 8207

|DiseasesDB_mult = {{DiseasesDB2|31876}} {{DiseasesDB2|4693}}

|ICD11 = {{ICD11|8A80}}

|ICD10 = {{ICD10|G43}}

|ICD9 = {{ICD9|346}}

|OMIM = 157300

|MedlinePlus = 000709

|eMedicineSubj = neuro

|eMedicineTopic = 218

|eMedicine_mult = {{eMedicine2|neuro|517}} {{eMedicine2|emerg|230}} {{eMedicine2|neuro|529}}

| MeshID = D008881

|}}

{{Diseases of the nervous system}}

{{Headache}}

{{Antimigraine preparations}}

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Category:Wikipedia medicine articles ready to translate (full)

Category:Wikipedia neurology articles ready to translate

Category:Ailments of unknown cause