Index for
slide deck
Introduction
![Migraine - Course, natural history and prognosis](https://neurotorium.org/wp-content/uploads/Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_Slide1-1024x576.png)
Migraine - Course, natural history and prognosis
![Diagnosis and segmentation in migraine](https://neurotorium.org/wp-content/uploads/OpdateretAud19_2022_Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_MDA-HS_mno-Slide-2-1024x576.png)
Diagnosis and segmentation in migraine
The American Migraine Prevalence and Prevention (AMPP) study was started in 2004, and involved posting questionnaires to 120,000 households in the US.[Silberstein et al., 2007; AMF website] The questionnaire included questions about headache frequency, severity, medicatio…
![Episodic and chronic migraine](https://neurotorium.org/wp-content/uploads/Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_Slide3_Reviewed-1024x576.png)
Episodic and chronic migraine
Migraine is a complex spectrum disorder, the clinical and pathological features of which may evolve over time – neuroimaging studies of people with migraine suggest that chronic migraine is associated with progressive brain dysfunction.[Aurora & Brin, 2017] The difference…
A migraine attack
![A migraine attack](https://neurotorium.org/wp-content/uploads/Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_Slide4-1024x576.png)
A migraine attack
![Proposed phases of a migraine attack](https://neurotorium.org/wp-content/uploads/OpdateretAud19_2022_Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_MDA-HS_mno-Slide-5-1024x576.png)
Proposed phases of a migraine attack
Migraine attacks can be broken down into four phases: prodrome, aura, headache, and postdrome, as shown on the slide.[Dodick, 2018; IHS, 2018] The exact timing of each phase is highly variable; the headache phase of a migraine can range from 4–72 hours in adults, and 2–48…
![Bothersome migraine symptoms and unmet treatment needs](https://neurotorium.org/wp-content/uploads/FINAL-Update-Aug29-Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_MDA-HS_mno_slide6-1024x576.png)
Bothersome migraine symptoms and unmet treatment needs
In the Migraine in America Symptoms and Treatment (MAST) study, all 15,133 participants were invited to participate in a 6-month follow-up study.[Munjal et al., 2020] In total, 50% (7,518/15,133) completed the 6-month follow-up study, of whom 80.4% (6,045/7518) continued …
Migraine triggers
![Migraine triggers](https://neurotorium.org/wp-content/uploads/Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_Slide7-1024x576.png)
Migraine triggers
![Migraine triggers](https://neurotorium.org/wp-content/uploads/Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_Slide8-1024x576.png)
Migraine triggers
Various migraine triggers have been identified, including emotional, physical, dietary, and environmental factors.[Migraine Trust; Park et al., 2016; Pavlovic et al., 2014; Sarchielli, 2006]
Whilst many potential trigger factors for migraine attacks have been identified, …
![Triggers of a migraine attack in a large-scale study](https://neurotorium.org/wp-content/uploads/Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_Slide9-1024x576.png)
Triggers of a migraine attack in a large-scale study
In this survey, 1,207 people with migraine were asked to rate triggers on a 0–3 scale (0, never; 1, occasional, 1–33%; 2, frequent, 34–66%; 3, very frequent, 66–100%).[Kelman, 2007] As shown on the slide, stress and hormones (women) were the most common triggers reported …
![Stress as a migraine trigger](https://neurotorium.org/wp-content/uploads/Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_Slide10-1024x576.png)
Stress as a migraine trigger
Stress is an important migraine trigger.[Kajal et al., 2017] Several different patterns of stress leading to a migraine attack have been described in the literature:[Spierings et al., 2014; Spierings et al., 1997]
- stress in the afternoon, leading to a headache in the eve…
![Alcohol as a migraine trigger](https://neurotorium.org/wp-content/uploads/FINAL-Update-Aug29-Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_MDA-HS_mno_slide11-1024x576.png)
Alcohol as a migraine trigger
Alcohol is identified as a headache trigger in roughly a third of people with migraine, and many mechanisms have been hypothesised to underly this connection.[Panconesi, 2008; Panconesi, 2016; Onderwater et al., 2019] Why some people with migraine do not experience alcoho…
![Is chocolate a trigger or not?](https://neurotorium.org/wp-content/uploads/Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_Slide12-1024x576.png)
Is chocolate a trigger or not?
Among the difficulties of studying the link between chocolate and migraine is the variation in chocolate that is sold to consumers; the fat content of marketed chocolate can vary between 33–37 grams per 100, and the carbohydrate content can vary between 52–60 grams per 10…
![Monitoring potential trigger factors](https://neurotorium.org/wp-content/uploads/FINAL-Update-Aug29-Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_MDA-HS_mno_slide13-1024x576.png)
Monitoring potential trigger factors
As outlined on the slide, diaries are a powerful tool for identifying potential trigger factors.[Migraine Trust] Once triggers are identified, it is possible to consider changes to avoid those triggers.[Migraine Trust; Kelman, 2007] However, depending on the nature of the…
![Distinguishing triggers from premonitory symptoms](https://neurotorium.org/wp-content/uploads/FINAL-Update-Aug29-Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_MDA-HS_mno_slide14-1024x576.png)
Distinguishing triggers from premonitory symptoms
Consider a person who regularly eats chocolate during the period between migraine attacks.[Lipton et al., 2014] Following this chocolate consumption, the individual experiences a migraine attack.[Lipton et al., 2014] Chocolate might be a triggering factor for the migraine…
![The usefulness of triggers for migraine prevention](https://neurotorium.org/wp-content/uploads/Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_Slide15-1024x576.png)
The usefulness of triggers for migraine prevention
Dealing with trigger factors for migraine requires an element of common sense.[Hoffmann & Recober, 2013] Avoidance of specific avoidable trigger factors may make sense for an individual – e.g., if red wine has been identified by that person as a reliable trigger.[Hoffmann…
![Migraine triggers and preventive medication](https://neurotorium.org/wp-content/uploads/Migraine-4-Course-natural-history-and-prognosis-20-Feb-22NT_Slide16-1024x576.png)
Migraine triggers and preventive medication
This study asked people with migraine to use a smartphone diary program to log details of trigger factors and headache characteristics over a three-month period.[Park et al., 2016] Of the 113 people recruited into the study, 62 (55%) kept the smartphone diary for at least…