Migraine: A Disabling Neurological Disease
Migraine is a prevalent and often debilitating neurological disorder that extends beyond mere headaches. Affecting millions of individuals globally, it ranks as the leading cause of disability among adults under 50.
Migraine is characterized by a multitude of symptoms encompassing neurological, sensory, autonomic, vestibular, cognitive, and gastrointestinal manifestations, rendering it a “whole body phenomenon.” The diagnosis requires a minimum of five attacks, each lasting between 4 and 72 hours and accompanied by at least two of the following symptoms: unilateral location, pulsating quality, moderate or severe intensity, and aggravation due to or avoidance of physical activity.
Acute Treatment Options
A range of acute treatments is available for migraine, including gepants and ditans, which are newer classes of medication. Gepants, such as rimegepant (Nurtec ODT) and ubrogepant (Ubrelvy), offer advantages in tolerability, with lower rates of nausea and somnolence. Lasmiditan (Reyvow) is another option for patients who cannot tolerate triptans due to contraindications.
Non-Pharmacological Interventions
Beyond pharmacological treatments, non-pharmacological options for migraine management exist. Acupuncture, cognitive behavioral therapy, biofeedback, relaxation training, and mindfulness-based stress reduction have demonstrated efficacy in reducing headache frequency and severity.
Personalized Treatment
Personalized treatment is paramount in migraine management. Factors such as headache features, comorbidities, medication interactions, and patient preferences should be considered. Shared decision-making between healthcare providers and patients is essential to determine the most appropriate treatment plan.
Migraine is a complex and multifaceted condition that requires a comprehensive understanding for effective management. Advances in acute, preventive, and cognitive behavioral therapies offer hope for improved outcomes and enhanced quality of life for those affected by this debilitating disease.
