This article will help you understand "migraine"

Author: Jia Lingyun, Chief Physician, Xuanwu Hospital, Capital Medical University

Reviewer: Chief Physician of Huayang Capital Medical University Xuanwu Hospital

Have you ever experienced this? I was usually in good health, but when I stayed up late or worked too hard, I would get a migraine, nausea, and fatigue. I would feel better after taking medicine, but the headache became a regular problem, and it would come from time to time.

You may be wondering if this phenomenon is what is commonly known as a migraine? What causes it?

1. The difference between migraine and common headache

Many people have difficulty distinguishing between common headaches and migraines. In fact, there are obvious differences between the two types of headaches.

Migraine is a common primary vascular headache. It is not just a unilateral headache, but also a headache characterized by paroxysmal moderate to severe, throbbing pain, sometimes unilateral pain, sometimes bilateral pain. The pain feels like throbbing in the temple area. The headache lasts for a long time, lasting 4 to 72 hours, and nausea, vomiting, and even photophobia and phonophobia may occur. If you continue to move at this time, the symptoms will be more obvious. According to the frequency of headache attacks, migraine can be divided into paroxysmal migraine and chronic migraine. The former is intermittent, while the latter is continuous. In the case of drug abuse, migraine will worsen, and paroxysmal migraine can be transformed into chronic migraine.

Figure 1 Copyright image, no permission to reprint

Common headaches are mostly occasional headaches caused by stimulation or physical discomfort. If you take medicine and rest well, there will basically be no big problem. Of course, if the headache recurs, it is relieved after taking medicine, but the headache starts again after the effect of the medicine wears off, you still need to go to the hospital for treatment.

2. Is migraine caused by vascular abnormalities?

So far, there is no clear conclusion on what causes migraine. It is generally believed that migraine is a complex neurological disease caused by the combined effects of genetics, environment and other factors. The pathogenesis is complex, involving blood vessels, nerves, inflammatory mediators, brain structure, functional abnormalities and genetic inheritance. The generally recognized mechanism is that the pain-sensitive tissues in the skull and the surrounding nerve fibers and trigeminal nerves work together to produce migraine.

The vascular structure of migraine patients is generally normal, and migraine does not mean that there are irreversible lesions in the cerebral blood vessels on the painful side, such as stenosis or occlusion. In other words, migraine does not necessarily mean that vascular lesions have occurred, but may be the result of multiple brain tissue and nerve effects. However, it is clear that migraine attacks are closely related to the trigeminovascular reflex.

Because the cause of migraine is relatively complex, it is difficult to determine the cause through conventional diagnosis, and professional examinations are needed to confirm the diagnosis. Currently, there are two main examination methods, namely transcranial Doppler ultrasound bubble test and cerebral artery ultrasound examination. Some migraines, especially migraines without aura, may be related to abnormal right-to-left shunts in the heart. The transcranial Doppler ultrasound bubble test is an effective means of diagnosing right-to-left shunts in the heart.

In addition, migraine is closely related to the intracranial nerves and blood vessels. Cerebral artery ultrasound examination can reflect the intracranial condition on the instrument through the effect of ultrasound, making it easier for doctors to judge the condition of the intracranial nerves and blood vessels more intuitively.

Figure 2 Copyright image, no permission to reprint

Treatment of migraine

Usually, the treatment of migraine is still mainly based on drug therapy. In the past, acute treatment drugs were more commonly used, but the range of options is limited, and these drugs have different degrees of adverse reactions.

In recent years, there have been new breakthroughs in drug development, and highly effective, safe and specific drugs have continued to emerge, such as 5-hydroxytryptamine 1F receptor agonists, calcitonin gene-related peptide receptor antagonists, anti-calcitonin gene-related peptide monoclonal antibodies, etc., which have pointed out a new direction for the prevention and treatment of migraine.

In addition, the latest neuromodulatory treatment (including psychological and behavioral intervention, neuromodulatory drugs, neuromodulatory devices and traditional Chinese medicine) is gradually being accepted by doctors and patients due to its reliable efficacy, good safety and availability. This method complements traditional analgesics, 5-hydroxytryptamine 1F receptor agonists and other drug treatments, and has gradually become the main measure for the prevention and treatment of migraine.

At present, the diagnosis and treatment of migraine are relatively complete. Therefore, if corresponding symptoms appear, it is necessary to conduct professional examinations and treatment in time to get rid of the pain caused by the disease as soon as possible.

References

[1] An Zhanjun, Xu Lixia, Shi Baoquan, et al. Neuroregulatory mechanisms of migraine and related treatment progress[J]. Journal of Practical Cardiovascular Diseases, 2022, 30(11): 120-125.

[2] Yang Xinyi, Zhang Jing, Li Nanyang, et al. New progress in the prevention and treatment of migraine drugs[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2020, 25(12): 1429-1435.

[3] Ye Shenqiong, Wang Xiangming, Zhang Yuehui. Research progress on the pathogenesis of migraine[J]. Medical Review, 2020, 26(6): 1086-1091.