Migraine – Course, natural history and prognosis

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, medication use, and impact on…

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 differences between…

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…

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 to…

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, the interaction of these factors…

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…

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…

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…

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…

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…

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 attack, or…

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…

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…