MIGRAINE

WHAT IS MIGRAINE?

 

Migraine is a common, but under diagnosed and undertreated malady. Estimates of the American Migraine Study suggest that 23 million persons older than 12 years of age have migraine headaches, with a 17.6% prevalence in females and 5.7% in males.

 The majority of migraineurs who seek medical attention consult primary care physicians. Therefore, it is important for the generalist to be conversant with the diagnosis, prevention and treatment of migraine. It is useful to conceptualize the patient with migraine as having an inherited susceptibility to headache. 

A so-called “migrainous threshold” likely exists in migraineurs, which consists of balanced excitatory and inhibitory neural circuits.

 This balance may be perturbed by a wide variety of exogenous and endogenous factors, which can lower the migrainous threshold, resulting in migraine. The variability of these migraine “triggers” in different patients, and even in individuals, supports the concept of a multi-faceted substrate

for the occurrence of migraine. 

The primacy of trigger identification in the prevention of migraine will be discussed. An in-depth analysis of current thoughts on the pathophysiology of migraine is beyond the scope of this article; however, suffice it to say that the previous concept of migraine being a primary vascular phenomenon is untenable. The importance of serotonergic circuitry in the brainstem in the pathogenesis of migraine is now clear. Its perturbation can lead to not only intracranial and extracranial vasoconstriction and dilation, but also activation of pain receptors of the so-called trigemino vascular system.