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#migraineawareness2021
What is migraine?
Migraine is a neurologic disease that has been identified as the leading cause of years lived with disability in people under the age of 50 years. It directly affects more than 1 billion people worldwide and the prevalence peaks between the ages of 35 and 39 years. It merits emphasis that migraine is more common in women, with a female-to-male ratio of 3:1.
The two most common types of migraine are: migraine without aura and migraine with aura. Furthermore, a minority of people with migraine develop chronic migraine, in which attacks become highly frequent.
Migraine without aura is characterized by recurrent headache attacks with a range of accompanying symptoms, such as nausea, light sensitivity, and sound sensitivity. A typical migraine attack lasts 4 to 72 hours.
In about one-third of people with migraine, headache is sometimes or always preceded or accompanied by transient neurologic disturbances that last 5 to 60 minutes and are referred to as migraine aura.
Most often aura symptoms comprise visual disturbances (such as fortification spectra) followed by hemisensory paraesthesia. The latter is typically characterized by the feeling of pins/needles and/or numbness that spreads gradually in the face or arm. Less common aura symptoms include aphasic speech disturbance, brainstem symptoms (such as dysarthria or vertigo), motor weakness (in hemiplegic migraine) and retinal symptoms (for example, repeated monocular visual disturbances).
Although the pathogenesis of migraine is incompletely understood, it is considered to involve the trigeminal nerve and its axonal projections to the intracranial vasculature (termed the trigeminovascular system). Nociceptive signals from the trigeminovascular system are relayed to areas in the brain that yield the perception of migraine pain.
The physiological substrate of migraine aura is widely thought to be cortical spreading depression (or CSD), a self-propagating wave of depolarization across the cerebral cortex that disrupts ionic gradients and is followed by cerebral hypoperfusion. CSD tends to start over the occipital lobe where the visual cortex is located. This explains why visual aura is so common.
A point, that merits emphasis, is the considerable global disease burden attributed to migraine. Concerted efforts are needed to implement and improve migraine care that is supported by informed health-care policies. Keep in mind, the unpredictable and disabling nature of migraine attacks has substantial negative effects not only on people, who are directly affected, but also on their families, colleagues, and society.


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