Migraine: Multiple Processes, Complex Pathophysiology

Migraine is a common, hereditary neurovascular headache disorder affecting many individuals. It often begins in childhood, increasing from a few times yearly to weekly in adulthood, especially in females. Migraine attacks may start with warning signs and aura, which involve the hypothalamus, brainstem, and cortex. The headache itself is typically throbbing and worsens with increased intracranial pressure. Patients often experience nausea, vomiting, and heightened sensitivity to light, sound, and smell. Some may also have allodynia and muscle tenderness. These symptoms indicate multiple neuronal systems are functioning abnormally. The migraine brain shows structural and functional changes due to genetic factors. Research identifies several gene variants linked to glutamate neurotransmission and synaptic plasticity. These discoveries suggest a basis for the extreme sensitivity and recurrent headaches seen in migraine. The trigeminovascular pathway activation explains why pain is usually localized to the head. Clinical relevance: Understanding migraine's complex processes may lead to improved treatment strategies for patients.