Most of us have had a strong, bothersome headache at some point—and often got rid of it with simple painkillers. For many people, though, things are harder: they have frequent or severe headaches, or both. One of the most common forms of headache is migraine, a major health issue that affects a large share of the global population, often during the most productive years of life, from childhood into the mid‑fifties. According to the Hellenic Migraine and Headache Patient Association, more than 1,000,000 people in Greece are estimated to live with migraine; among women the figure is around 18–20%. Unfortunately, lack of awareness and information still leads to migraine and other headache disorders being underestimated, so that millions of people worldwide suffer, often daily, without a proper diagnosis or appropriate care.
Symptoms
Migraine is often mistaken for an ordinary headache. It is a chronic neurological disorder with many dimensions. It shows up as attacks of intense headache—from once to several times a month—lasting 4 to 72 hours, along with a wide range of symptoms such as nausea, vomiting and sensitivity to light, sound and smells. The pain is typically throbbing or pulsing and can affect any part of the head: one side and the area around the eye and temple, the top of the head, the back of the head, the neck or the whole head. For a diagnosis of migraine, pain does not have to be on one side only. The pain may always be in the same place or may switch sides during or between attacks. Given how intense and repeated the attacks can be, the impact on the person, their ability to function, their family and social life can be heavy and exhausting.
The stages of a migraine attack
Although each person’s experience is different, migraine attacks often follow a similar pattern, which has led to the description of five phases. The first phase—the prodrome—can start hours or even 1–2 days before the pain and may include mood changes, tiredness, sleepiness, yawning, sensitivity to light, sound or smells, neck or other pain, and increased or decreased appetite. So the start of an attack is not always the pain itself but a cluster of symptoms that the person may not even notice. The second phase, aura, involves various neurological symptoms affecting vision, speech, movement or sensation and usually appears just before the headache, lasting on average 15–20 minutes; it occurs in about 25–30% of people with migraine. It is linked to an electrophysiological phenomenon called cortical spreading depression. The third phase is the headache itself, which can be so severe that the person seeks a quiet, dark room for relief. Function drops sharply and concentration or normal activity becomes very difficult. Then come the postdrome (when the pain gradually or suddenly eases) and the recovery phase, which marks the end of the attack.
Genetic background and other factors
Research has increasingly focused on migraine, and in recent years a lot of work has gone into understanding the condition and finding effective treatments. Migraine is considered a primary headache disorder—it is not caused by a single identifiable cause (such as a head injury), and its mechanisms are not fully understood. Studies have, however, identified many genetic, environmental and neurological factors that appear to be linked to migraine. The condition has a strong genetic component: first-degree relatives of people with migraine have roughly three times the risk, though no single inheritance pattern has been established. Stress, weather changes, hormonal changes (especially around menstruation and pregnancy), too little or too much sleep, alcohol (especially wine), smoking, skipping meals and sudden caffeine withdrawal are recognised as common triggers. The link between migraine and mental health is also important: people with migraine have higher rates of depression, anxiety and bipolar spectrum disorders. All of this underscores the need for timely diagnosis and effective treatment.
Treatment
Treatment of migraine generally has two parts: acute treatment (during an attack) and preventive treatment with follow-up. Acute treatment aims to relieve pain during an attack and may involve several types of medication. Triptans are among the most widely used drugs with a specific role in migraine pain. Other options include simple analgesics (e.g. paracetamol) and non-steroidal anti-inflammatory drugs (e.g. ibuprofen, naproxen, aspirin and others). People with mild, infrequent migraine may get good relief from these; they are not always suitable for people with more severe or frequent attacks. In fact, frequent or high-dose use can lead to medication-overuse headache and a vicious cycle. Preventive treatment aims to reduce the frequency and intensity of attacks and may include lifestyle measures (balanced diet, exercise, adequate sleep, avoiding triggers) as well as medication such as certain antidepressants, calcium-channel blockers and beta-blockers. In addition, a newer form of preventive treatment specifically for migraine uses monoclonal antibodies targeting CGRP (calcitonin gene-related peptide). The first such antibody was approved in the United States in 2018 and is now used in many countries, offering hope to many people with migraine and their doctors.
Migraine is not “just a bad headache” that goes away with a painkiller; it is recognised as a complex neurological disorder. Despite the challenges of managing attacks, progress in research and in public awareness is leading to better treatments and to more understanding and support for those affected. The Hellenic Migraine and Headache Patient Association, founded in 2017 by a small group of patients, works to inform the public, patients, doctors and policymakers about all types of headache, to bring patients together and to offer mutual support. Seven years on, the association is a leading voice for people with migraine and other headache disorders in Greece and continues to work for better quality of life and access to care.
For more on lifestyle and wellbeing, see How to Support Your Mental Health Through Nutrition and Foods That May Keep You Awake at Night.
Happy Life Team
Bibliography:
- Migraine Headaches, Marco A. Pescador Ruschel; Orlando De Jesus, Statpearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK560787/
- Migraine Headache, Jasvinder Chawla, MD, MBA, https://emedicine.medscape.com/article/1142556-overview
- Cortical spreading depression—new insights and persistent questions, A Charles and KC Brennan, PubMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500297/
- Migraine and other headaches, Dr Michail Vikelis, published by the Hellenic Migraine and Headache Patient Association, Athens, 2021
