Migraine, more than a headache: a neurodisease

I suffer from migraines, along with 12% of the world's population.

Beyond the severe and unrelenting headache pain, migraine is accompanied by a range of striking symptoms that border on the bizarre:

• visual hallucinations

• imaginary smells (phantosmia)

• sensitivity to light, sound, and smell

• speech disturbances

• vomiting

• loss of appetite

• muscle weakness

• fainting

• irritability

• lethargy

Episodes can last from a few hours to days. Many of these symptoms are debilitating to migraine sufferers, who frequently report missing work as well as family and social events due to this disease. According to the Global Burden of Disease Study (2013), migraine is listed as the “sixth highest cause worldwide of years lost due to disability.”

I was first diagnosed with a migraine headache when I was 12 years old. The symptoms I experienced during this initial episode of migraine included double vision, vomiting, and extreme lethargy, with almost continuous yawning. After blood tests, a neurologic exam, and scans ruled out scarier diagnoses, my pediatrician settled on migraine and prescribed Cafergot (ergotamine) to abort the headache. I took it promptly when back home and went to bed in the late afternoon. My memory is still vivid of waking up to darkness, in the wee morning hours, with a feeling of euphoria as both pain and visual disturbance had vanished.

As a writer with an interest in the burgeoning field of neuroscience, I grew curious about the medical view of migraine historically and globally.

Years ago, medical science attributed migraine pain to vascular changes in the brain. Early treatments such as ergot-containing drugs targeted dilated blood vessels in the brain. Today, researchers in the field plainly state: Migraine is a neurodisease.

Leading migraine experts, David Bordick, MD, PhD, and David Borsook, MD, call for worldwide acceptance of this view: “Migraine has genetic, environmental, and likely epigenetic causes. No matter what the etiology, if we accept that migraine is a disease of the brain, we transform our current clinical construct about the disease and treatment approaches to patients.”

Further reading

Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Aug 22;386(9995):743–800.

Steiner TJ, Stovner LJ, Birbeck GL. Migraine: the seventh disabler. The Journal of Headache and Pain. 2013;14(1):1. doi:10.1186/1129-2377-14–1.

Borsook D, Dodick DW. Taking the headache out of migraine. Neurology. Clinical Practice, August 2015.