Migraine Headaches

Summary

Migraine headaches are a type of headache believed to be caused by irritation of trigeminal sensory afferents that innervate the meninges of the brain. This leads to the release of vasodilatory neuropeptides, including Substance P and CGRP. The resulting vasodilation and leakage of fluid can cause inflammation, leading to the pain characteristic of a migraine headache. Clinically, migraine headaches are unilateral, affecting one side of the head with a dull throbbing or pulsating quality. This headache may be associated with nausea and vomiting, aversion to light and sound, as well as distinct visual disturbances called auras. Migraine headaches usually last around one day, and can be treated with NSAIDs and triptans to stop the pain. In the case of preventative medications, beta-blockers are often used, as well as TCAs and anticonvulsants like topiramate and valproate.

Key Points

• Migraine Headaches
  • Pathophysiology
    • Due to irritation of CN V (trigeminal) sensory afferents innervating the meninges
      • Leads to the release of vasoactive neuropeptides, such as substance P and calcitonin gene-related peptide (CGRP)
      • Resultant vasodilation and leakage results in brain inflammation
  • Location
    • Unilateral
  • Presentation
    • Affects all genders and ages; more common in young women
      • Contrast vs. cluster headaches, which primarily affect males
    • Pulsating/throbbing pain
      • Key feature of migraine; fairly distinct vs. tension or cluster headache, which cause steady pain
    • Nausea/Vomiting
    • Photophobia and Phonophobia
    • May cause visual disturbances (aura)
  • Duration
    • Usually lasts around one day
  • Treatment
    • NSAIDs
    • Triptans (sumatriptan)
  • Prophylaxis
    • Lifestyle changes (sleep, exercise, diet)
    • Beta-Blockers
    • TCAs (amitriptyline)
    • Anticonvulsants (Topiramate, Valproate)
    • Botulinum toxin
    • Anti-CGRP monoclonal antibodies
    • SNRIs (duloxetine)