What causes migraine?

Migraine is a type of headache, i.e., headache. It is classified as a primary headache, which is a headache that is not caused by a brain injury.

Although the cause of migraine is not completely known, the currently accepted pathophysiological theory is that of activation of the trigeminovascular system. In this theory, the neurons of the trigeminal system activate the vascular system of the meninges (membranes that cover and protect the brain), which is what causes the pain.

Migraine is the second most common type of headache, after tension headache. It is estimated to affect approximately 12% of the population, being more frequent in women and especially in young people.

The pain that characterizes migraine is usually hemicranial, throbbing, possibly accompanied by nausea and vomiting, and also often intolerance to light and sound. This pain usually improves with rest in the dark and, in episodes of severe pain, is very disabling. Migraine can last from a few hours to several days.

There are triggers of pain, among which, according to importance and in order of frequency, are the following:

  • Stress
  • Hormonal changes
  • Prolonged fasting
  • Changes in the weather

Are there different types of migraine?

The latest international classification of headaches differentiates multiple types of migraine. It classifies them according to triggering factors, the presence or absence of aura and according to chronological factors into acute and chronic.

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Migraine aura consists of a series of neurological symptoms, which can be very varied, preceding or accompanying the migraine attack. The most frequent type of aura is visual aura. This manifests mainly as luminous flashes, generally in the form of zigzags, or as blurred vision, which can affect one or both eyes. It can also be sensory, in the form of a tingling or prickling sensation in the fingers, mouth or tongue. Although these forms of aura are the most common, as mentioned above, it can have very different characteristics.

Finally, the duration of aura is usually 5 to 20 minutes and usually less than 60 minutes. If these symptoms are prolonged, especially in patients with hypercoagulability factors, smokers or those taking oral contraceptives, the patient should be seen in the emergency department on suspicion of a migraine infarction. This complication is infrequent but must be taken into account as it is a serious pathology that requires confirmation with imaging tests and hospital admission.

What are the causes?

As specified above, the cause of migraine is not completely determined. It occurs due to a combination of predisposing factors, especially of a genetic nature, and factors that trigger pain attacks.

Neurologists are used to seeing how there is a familial aggregation in migraine patients, although chance and genetic variability complicate the study so much that at present only 12 genetic locations associated with migraine are known.

The paradigm of migraine of genetic origin is Familial Hemiplegic Migraine, in which, in addition to pain, the patient loses strength in half of the body and can simulate a stroke. Transmission in these cases is from parents to children. It is rare, but it must be taken into account in order to choose the appropriate preventive treatment.

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What does the treatment of migraine with Botox consist of?

Treatment with botulinum toxin (Botox) consists of the application of this toxin diluted in saline at key points of the muscles of the skull and cervical spine. This treatment is indicated in patients with chronic migraine, in whom the different preventive treatments have been ineffective or are intolerant to them. This treatment should be administered periodically, either quarterly or biannually.

Is it possible to stop suffering from migraine?

The prognosis of migraine is highly variable. The control and even the eradication of migraine depends on the modulation that we can do on the triggering factors of the pain attacks. This can be achieved by modifying our diet, reducing its fat content or eliminating the foods that in each case cause the pain. In these cases it is the patient himself who must identify the foods that affect his migraine.

However, there are cases in which there are endogenous factors, of genetic origin, that we cannot modify, or hormonal factors that cause migraine to accompany us throughout our lives in a more or less frequent and intense way. When migraine is related to hormonal changes, it usually improves to a great extent after menopause.