[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Migraine [Conditions](https://durgical.com/en/conditions/) · [Head and neck](https://durgical.com/en/anatomy/region/head-and-neck/) # Migraine Migraine is a common headache disorder with repeated attacks of throbbing, often one-sided pain, nausea and sensitivity to light and sound. Updated 2026-10-30 ## Structures involved Tap one to see what it is and open it in 3D. - [Trigeminal nerve (V)](https://durgical.com/en/anatomy/trigeminal-nerve/) - [Dura mater](https://durgical.com/en/anatomy/cranial-dura/) - [Visual cortex](https://durgical.com/en/anatomy/cuneus/) - [V1 ophthalmic](https://durgical.com/en/anatomy/ophthalmic-nerve/) - [Trigeminal ganglion](https://durgical.com/en/anatomy/trigeminal-ganglion/) - [Hypothalamus](https://durgical.com/en/anatomy/hypothalamus/) - [Midbrain](https://durgical.com/en/anatomy/midbrain/) - [Middle meningeal artery](https://durgical.com/en/anatomy/middle-meningeal-artery/) ## In biochemistry - [Serotonin (5-hydroxytryptamine)](https://durgical.com/en/biochemistry/molecules/serotonin/) ## In physiology - [Headache physiology](https://durgical.com/en/physiology/headache-physiology/) ## What it is A common primary headache disorder with recurrent attacks of usually one-sided, throbbing headache with nausea and sensitivity to light and sound, sometimes preceded by an aura. ## Who gets it One of the commonest neurological disorders and a major cause of disability in young and middle-aged adults. It is about three times more common in women and often starts around puberty. In a Colombian health-insurer cohort (2018–2022, 89,227 patients), recorded prevalence was 1.69–2.42 per 100 affiliates, lower than earlier Colombian studies, and 84.9% were women. ## Causes - Genetic predisposition (strong family history) - Familial hemiplegic migraine is a rare monogenic form ## Risk factors - Female sex and hormonal changes (menstruation) - Family history - Triggers: stress, poor sleep, skipped meals, alcohol, some foods - Overuse of acute headache medicines (medication-overuse headache) - Obesity ## Pathophysiology A hyperexcitable brain activates the trigeminovascular system, releasing neuropeptides such as CGRP that cause neurogenic inflammation of the meninges and sensitisation of pain pathways. Aura is linked to cortical spreading depression, a slow wave of neuronal depolarisation, often across the occipital cortex. ## Classification - Migraine without aura - Migraine with aura: visual, sensory or speech symptoms that develop gradually and reverse - Chronic migraine: headache on 15 or more days a month - Menstrual migraine - Rare types: hemiplegic, brainstem aura ## Symptoms and signs - Moderate–severe, often unilateral, pulsating headache lasting hours to a few days - Worse with routine physical activity - Nausea or vomiting - Photophobia and phonophobia - Aura: zigzag lines, scotoma or spreading tingling, usually lasting minutes - Prodrome (yawning, mood change) and postdrome (fatigue) ## Red flags - Thunderclap onset or «worst ever» headache - New headache after age 50 - Fever, neck stiffness or weight loss - Focal deficit, confusion or seizure - Change in pattern or progressive headache; worse on lying down or with coughing - Headache in pregnancy, immunosuppression or cancer ## Diagnosis **Clinical** Clinical diagnosis using International Classification of Headache Disorders (ICHD-3) criteria, with a normal neurological examination. A headache diary helps. **Tests** No routine tests; targeted tests only when another cause is suspected. **Imaging** Not needed in typical migraine with a normal examination. CT or MRI when red flags suggest a secondary headache. ## Differential diagnosis - Tension-type headache - Cluster headache - Medication-overuse headache - Subarachnoid haemorrhage or other secondary headache - Transient ischaemic attack or seizure (for aura) ## Goal of treatment Stop attacks quickly, reduce their frequency and disability, and avoid medication-overuse headache. ## Treatment **Acute** Acute treatment early in the attack: simple analgesics or NSAIDs, triptans, antiemetics; newer gepants or ditans in some settings. Opioids are avoided. **Medical** Prevention for frequent or disabling attacks: beta-blockers, some antiepileptics, tricyclic antidepressants, calcium channel blockers; CGRP-targeting antibodies or botulinum toxin for chronic migraine in specialist care. **Lifestyle** Regular sleep and meals, exercise, stress management, identifying triggers and limiting acute medicine use. ## Drugs for this condition - [Ibuprofen](https://durgical.com/en/pharmacology/ibuprofen/) - [Propranolol](https://durgical.com/en/pharmacology/propranolol/) - [Valproic acid](https://durgical.com/en/pharmacology/valproic-acid/) - [Topiramate](https://durgical.com/en/pharmacology/topiramate/) - [Ergotamine](https://durgical.com/en/pharmacology/ergotamine/) - [Amitriptyline](https://durgical.com/en/pharmacology/amitriptyline/) ## Complications - Medication-overuse headache - Chronic migraine - Status migrainosus (attack lasting over 72 hours) - Rarely migrainous infarction - Anxiety and depression ## Prognosis Often improves with age and, for many women, after menopause. Good acute and preventive care greatly reduces disability. ## Prevention - Trigger management and regular routines - Preventive medicines when attacks are frequent - Limiting acute medicines to a few days a month ## Test yourself Think of the answer, then tap the question to see it. ## Which features favour migraine over tension-type headache? Pulsating, often one-sided pain worsened by activity, with nausea and photophobia or phonophobia. ## What phenomenon is thought to underlie migraine aura? Cortical spreading depression, a slow wave of neuronal depolarisation across the cortex. ## What is a key risk of frequent use of acute migraine medicines? Medication-overuse headache. ## Which headache features need urgent investigation? Thunderclap onset, new headache after 50, fever or neck stiffness, focal deficit, seizure, or a progressive or changed pattern. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/migraine/) ## Related conditions - [Subarachnoid haemorrhage](https://durgical.com/en/conditions/subarachnoid-haemorrhage/) - [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/) - [Epilepsy and seizures](https://durgical.com/en/conditions/epilepsy-and-seizures/) - [Bacterial meningitis](https://durgical.com/en/conditions/bacterial-meningitis/) - [Tension-type headache](https://durgical.com/en/conditions/tension-type-headache/) - [Transient ischaemic attack](https://durgical.com/en/conditions/transient-ischaemic-attack/) - [Acute rhinosinusitis](https://durgical.com/en/conditions/acute-rhinosinusitis/) - [Benign paroxysmal positional vertigo (BPPV)](https://durgical.com/en/conditions/benign-paroxysmal-positional-vertigo/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Migraine Headache](https://www.ncbi.nlm.nih.gov/books/NBK560787/) (StatPearls (NCBI Bookshelf), 2024); [Epidemiological, clinical characterization and treatment patterns of migraine patients in a Colombian cohort from 2018 to 2022](https://europepmc.org/article/PMC/PMC11667797) (The journal of headache and pain, 2024) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/migraine/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/migraine/