Migraine is a common neurological disorder characterized by recurrent moderate to severe headaches, often accompanied by autonomic nervous symptoms. This condition not only affects the quality of life of patients but can also severely disrupt daily activities and work performance. According to statistics, approximately 15% of the global population suffers from migraines, with a significantly higher incidence in women compared to men, suggesting a possible association with hormonal changes. This article will comprehensively analyze this common yet often underestimated neurological issue, covering its causes, symptoms, diagnosis, treatment, and prevention strategies.
Modern medicine has classified migraine as a "neurovascular disease" within chronic conditions, with its pathological mechanisms involving abnormal interactions between neuronal activity in the brain and the vascular system. Patients often describe the headache as unilateral, accompanied by pulsating pain, which may worsen with physical activity. Notably, about 30% of patients experience aura symptoms before the headache, such as visual disturbances or limb numbness; the diagnostic criteria and treatment for "migraine with aura" differ slightly from those without aura. Understanding these core features aids in early identification and timely intervention.
The mechanism of migraine onset involves a complex interaction between genetic susceptibility and environmental triggers. Genetic studies show that if one parent has a history of migraines, the risk for the child increases by 50%, and if both parents are affected, the risk may rise to 75%. In terms of physiological mechanisms, abnormal cortical inhibition leads to sensitization, coupled with activation of the trigeminal vascular system, triggering the release of inflammatory mediators. This process may cause dilation of the scalp and intracranial blood vessels, generating pain signals.
Triggers vary from person to person, but common ones include hormonal changes (such as menstrual cycles and oral contraceptive use), specific food components (such as tyramine and nitrates), sleep rhythm disturbances (excessive sleep or insomnia), changes in weather pressure, and excessive sensory stimuli (bright lights, noise). Research indicates that prolonged elevation of the stress hormone cortisol lowers the pain threshold in the brain, creating a vicious cycle: pain → stress → more severe pain.
Migraine attacks typically occur in four stages: prodrome, aura, headache, and postdrome. About 75% of patients experience prodromal symptoms 24-48 hours before the headache, such as mood swings, frequent urination, or cravings for specific foods. The aura phase may manifest as visual flickering, unilateral limb numbness, or speech disturbances; these neurological symptoms usually last 10-60 minutes but do not exceed one hour.
It is noteworthy that about 25% of patients have "migraine with aura," whose neuroimaging examinations are usually normal, but fMRI of the brain shows specific metabolic abnormalities in certain brain regions during attacks. Some patients may also experience autonomic symptoms such as nausea, vomiting, and differences in pupil size, with the severity of these symptoms positively correlated with the frequency of attacks.
Diagnosing migraine primarily relies on collecting medical history and analyzing symptoms; currently, there are no specific laboratory tests available to confirm the diagnosis. The International Classification of Headache Disorders, third edition (ICHD-3), defines the diagnostic criteria as: at least five attacks that meet specific criteria, while excluding other secondary headache causes. Doctors will ask detailed questions about headache characteristics, including pain intensity, duration, accompanying symptoms, and possible triggers.
Differential diagnosis must rule out acute conditions such as intracranial bleeding, brain tumors, and glaucoma, which may require head MRI or lumbar puncture examinations. During the assessment, doctors will use a headache diary to record the frequency and severity of attacks, helping to confirm the diagnosis. 50% of patients are misdiagnosed as having tension-type headaches during their initial visit, making accurate symptom description crucial.
The goal of acute treatment is to quickly block the worsening of pain, with first-line medications including triptans and ergot alkaloids. Triptans work by selectively activating 5-HT1B/1D receptors, constricting dilated blood vessels and inhibiting inflammatory responses. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are most effective when used early in an attack, but long-term use requires caution due to gastrointestinal side effects.
For patients experiencing more than four attacks per month or poor response to acute medications, preventive medication should be considered. Common medications include beta-blockers (such as propranolol), anticonvulsants (such as valproate), and emerging CGRP antibody injections. In terms of non-pharmacological treatments, neuromodulation therapies (such as vagus nerve stimulation) and biofeedback training have shown a 60-70% symptom relief rate in specific populations.
Prevention strategies should combine lifestyle adjustments with medical interventions. Regular sleep cycles (7-8 hours daily) can reduce the risk of attacks by 40%, while regular exercise (such as 150 minutes of aerobic exercise per week) has been proven to further decrease the frequency of attacks. In terms of diet, avoiding processed meats containing nitrates, excessive caffeine, and foods high in tyramine, such as aged cheeses, can reduce trigger risks.
Stress management is a key preventive measure; mindfulness meditation and cognitive behavioral therapy (CBT) can reduce stress indices by 25-30%. For preventive medication, if attacks occur more than 8 days per month or if pain lasts more than 4 hours in a single day, daily medication should be considered. New CGRP inhibitors can reduce attack frequency by up to 50%, but potential side effects such as platelet dysfunction should be noted.
When headache patterns change, such as sudden intensification or accompanied by neurological symptoms (such as unilateral limb weakness or speech disturbances), immediate medical attention should be sought to rule out central nervous system emergencies. If attacks occur more than four times a month, or if a single attack lasts more than 72 hours, referral to a neurologist for specialized evaluation is necessary. The following situations require professional diagnosis:
Early diagnosis can effectively prevent complications, such as medication overuse headache (MOH). When patients experience more than 15 days of attacks per year and continuously use painkillers for more than 10 days, they may fall into a vicious cycle of medication dependence and worsening headaches, requiring adjustment of treatment strategies by a physician.
Regular follow-up is particularly important for patients with chronic migraines; tracking triggers through a headache diary, combined with adjustments to preventive medications, can reduce annual attack frequency by up to 70%. When "red flag symptoms" such as headache following head trauma or new headaches accompanied by a history of immunosuppression appear, immediate neuroimaging should be performed.
At the onset of an attack, cold compresses (such as applying an ice pack to the painful side of the head or neck) or gentle massage around the temples can help alleviate symptoms. Resting in a quiet, dimly lit environment and staying hydrated, especially when dehydration may trigger headaches, is particularly important.
What daily dietary habits may trigger migraines?Certain foods and beverages are known to trigger migraines, including processed meats containing nitrates, aged cheeses high in tyramine, artificial additives like nitrates, and high-caffeine drinks. Some individuals may be sensitive to chocolate, citrus fruits, or alcoholic beverages, and it is recommended to track personal triggers through a "food diary."
Why do doctors recommend using preventive medications only when migraines occur frequently?Preventive medications (such as beta-blockers or anticonvulsants) may have side effects affecting liver and kidney function, so they are usually recommended for patients experiencing more than four attacks per month that severely impact daily life. Physicians will assess the risks and benefits of long-term use based on age, comorbidities, and drug interactions.
Can regular exercise reduce the frequency of migraine attacks?Moderate aerobic exercise (such as brisk walking or swimming) can regulate serotonin levels and may reduce the frequency of attacks over the long term. However, excessive exercise should be avoided, as vigorous activity may become a trigger. It is recommended to start with light exercise three times a week for 20-30 minutes each session and adjust under the guidance of a physician.
What evidence supports stress management in the treatment of migraines?Psychological stress is one of the main triggers for migraines; cognitive behavioral therapy (CBT) and mindfulness meditation have been shown to reduce the frequency of attacks. By employing stress management techniques (such as deep breathing and time planning), the autonomic nervous system can be regulated, reducing the vicious cycle of headaches triggered by neuroinflammatory responses.
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