Migraine - Introduction

Migraine is a wretched, disabling brain disorder that affects 1 in 10 men and 1 in 5 women – around 6 million people in the UK in all.

More than twice as many women as men suffer from migraine because of the involvement of hormonal factors [Corbis].

Migraines strike unexpectedly, disrupting lives. Many long-planned family celebrations have been ruined when one of the main participants ends up spending the whole day in a darkened room with a throbbing headache and nausea. In fact, about 25 million working days are lost to migraine every year.

Many people never visit their doctors for help with migraines, preferring to use over-the-counter painkillers and anti-inflammatory medicines such as aspirin and ibuprofen. For those who do consult a doctor, the first suggestion might be to make some lifestyle changes. This is because migraine attacks can be sparked off by stress, caffeine, exercise, or changes in eating or sleeping patterns. Recognising personal triggers and avoiding them wherever possible is a good start to dealing with migraine.

People who still have one or two migraines a month will generally turn to medication. In addition to painkillers and anti-inflammatory medicines, doctors can prescribe products specifically designed to deal with migraine – primarily the ergots and triptans. For people who have more frequent or particularly severe migraine attacks, there are also preventive treatments. Many of these, such as beta blockers (used to treat high blood pressure), antidepressants and anti-epilepsy drugs, were developed for completely different uses.

Dogs, cats, and rodents can provide invaluable models in which to study migraine mechanisms and to test potential new treatments. The larger animal species are sometimes needed because their brain size and structure is occasionally better suited to a particular study than that of rats or mice.

Causes of migraine
Migraine is one of the oldest disorders known to man. The Babylonians described migraine in 3000 BC; in 150 AD the Roman physician Galen coined the term hemicrania to describe the one-sided nature of migraine. Over the following centuries the word “hemicrania” gradually evolved into “migraine”. Despite recognising the condition for so long, we have only recently begun to understand what causes migraine and to use this information to develop specific treatments.

Migraines can be triggered by foods such as chocolate, wine, coffee and cheese, amongst others.

Trigeminovascular theory
The most popular explanation for migraine, which has been developed over many years by studying animal models of migraine, is called the trigeminovascular theory. This theory blames environmental triggers such as bright lighting for sparking off a sequence of events in the brain stem - the bit that joins the spine to the rest of the brain. Some of these events are responsible for the aura, sensitivity to light and sound, and the feelings of nausea. The headache itself is the result of the large trigeminal nerve being activated to send out chemical messengers that cause blood vessels in the brain to expand. This expansion stretches and squeezes nearby pain receptors, parts of cells that send pain messages to the brain.

Thanks are due to the following organisations and people: GlaxoSmithKline; The Migraine Trust; Professor Peter Goadsby, Wellcome Trust Senior Fellow, University College London; Dr Andrew Dowson, Director of the King's Headache Service London; and Professor Pat Humphrey, Executive Vice President, Theravance.

Treatment & needs