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Headache

Migraine

Migraine · G43

Migraine is a neurological disorder characterized by recurrent moderate-to-severe throbbing headaches lasting 4-72 hours, accompanied by nausea, vomiting, and sensitivity to light and sound.

2026-03-26

At a Glance

Migraine is a recurrent throbbing headache typically affecting one side of the head. It is accompanied by nausea, vomiting, and hypersensitivity to light and sound, with attacks lasting 4-72 hours. Approximately 12-15% of the global population is affected, with women three times more likely than men. Overactivation of perivascular nerves around the meningeal vessels leading to release of pain mediators is the primary mechanism. Stress, sleep changes, and hormonal fluctuations are common triggers. Acute medications, preventive medications, and neuromodulation can reduce attack frequency and severity.

Definition and Overview

Migraine is a recurrent neurological disorder characterized by moderate-to-severe throbbing headache. According to the International Headache Society classification, unilateral pulsating headache lasting 4-72 hours is the hallmark, accompanied by nausea, vomiting, and hypersensitivity to light and sound [3].

The 2019 Global Burden of Disease Study estimates approximately 1.1 billion people worldwide suffer from migraine [1]. It ranks as the second leading cause of disability among neurological disorders. Prevalence in Korea is approximately 6-17%, most common in women aged 30-40 [1].

Epidemiology

The 1-year global migraine prevalence is approximately 12-15% [5]. Women (17-18%) have approximately 3 times higher prevalence than men (6-8%). This sex difference becomes pronounced after puberty, with estrogen fluctuations as the primary cause [5].

Migraine prevalence peaks between ages 25-55, overlapping with peak productive years, creating significant socioeconomic burden. WHO classifies migraine among the most disabling conditions [1].

Causes

The core mechanism involves overactivation of perivascular nerves around the meningeal (dural) vessels [4]. When these nerves are stimulated, pain-inducing substances are released, notably calcitonin gene-related peptide (CGRP), which causes vasodilation and neurogenic inflammation [4].

Pain signals are transmitted to the brain's sensory centers and perceived as headache [2]. Migraine patients' brains show heightened sensitivity to sensory stimuli even between attacks [2].

Some patients experience visual aura (flashing lights, zigzag patterns) before headache onset, caused by cortical spreading depression - a wave of neuronal electrical activity changes [2].

Repeated migraine attacks progressively sensitize the brain's pain processing circuits, potentially leading to allodynia - pain from normally non-painful stimuli like face washing or hair brushing [2].

Symptoms

Unilateral (sometimes bilateral) throbbing pulsatile pain, moderate to severe intensity, worsened by routine physical activity such as walking or climbing stairs [3].

Nausea, vomiting commonly accompany the headache. Hypersensitivity to bright light and loud noise occurs, with some patients also sensitive to odors [3].

Premonitory symptoms including fatigue, irritability, food cravings, and neck stiffness may appear 1-2 days before the headache.

Diagnosis

ICHD-3 diagnostic criteria for migraine [3]:

  • At least 5 attacks meeting the following criteria
  • Headache lasting 4-72 hours (untreated or unsuccessfully treated)
  • At least 2 of: unilateral, pulsating, moderate-to-severe intensity, aggravated by routine physical activity
  • During headache, at least 1 of: nausea and/or vomiting, photophobia and phonophobia
  • Not better accounted for by another diagnosis

Migraine is primarily diagnosed through history and neurological examination. Brain imaging may be performed when necessary to rule out other causes.

Classification

Migraine without aura accounts for approximately 70-75% of cases [3]. Migraine with aura accounts for 25-30%, with visual, sensory, or speech symptoms lasting 5-60 minutes before or during headache.

Chronic migraine is defined as headache on 15 or more days per month for more than 3 months, with at least 8 days meeting migraine criteria. Approximately 2.5-3% of episodic migraine patients progress to chronic migraine annually, with analgesic overuse as a major risk factor [5].

Triggers

Major triggers include stress (approximately 70%), insufficient or excessive sleep (approximately 50%), menstrual cycle (approximately 60% of women), weather changes (approximately 40%), specific foods (approximately 25%), and strong light, noise, or odors [5].

Triggers vary among individuals. Keeping a headache diary to identify personal triggers is the first step in migraine management.

Course and Complications

Migraine is generally not life-threatening but significantly reduces quality of life. Without appropriate treatment, attack frequency may gradually increase and progress to chronic migraine [5].

Taking analgesics more than 10 days per month can paradoxically worsen headache through medication overuse headache. Migraine with aura has been associated with a slightly increased stroke risk, requiring accurate diagnosis and management [2].

Lifestyle Guide

Regular sleep is crucial - maintain consistent sleep and wake times, avoiding significant changes even on weekends.

Eat regular meals and avoid dehydration. Small amounts of caffeine may help relieve headache, but excessive intake or abrupt cessation can trigger attacks.

Keep a headache diary to identify personal triggers and avoid them. Regular aerobic exercise (3-5 times per week, 30+ minutes) helps prevent migraine.

Frequently Asked Questions

Migraine is a recurrent moderate-to-severe throbbing headache. Unlike simple headaches, it is accompanied by nausea, vomiting, and hypersensitivity to light and sound, with pain primarily on one side of the head. It is a neurological disorder caused by a combination of genetic predisposition and environmental factors, and proper diagnosis and treatment can significantly improve quality of life.

Migraine typically causes throbbing pain on one side of the head that worsens with movement and is accompanied by nausea and sensitivity to light and sound. Regular tension-type headaches cause bilateral pressing pain with fewer associated symptoms. If headaches are recurrent or interfere with daily life, consult a specialist for an accurate diagnosis.

The perivascular nerves around the meningeal vessels become overactivated, releasing pain-inducing substances that cause inflammation and vasodilation, resulting in headache. In genetically predisposed individuals, triggers such as stress, sleep changes, hormonal fluctuations, and certain foods can provoke attacks. Identifying your personal triggers can greatly help reduce attacks.

Migraine itself does not indicate structural brain damage. It is a functional condition where the brain overreacts to normal stimuli. However, in rare cases, migraine with visual symptoms (aura) may be associated with stroke risk, so getting an accurate diagnosis provides peace of mind.

Yes, genetic factors play a significant role. Having a first-degree relative with migraine increases the risk 2-4 fold. Multiple genes are involved rather than a single gene, so if you have a family history, paying extra attention to trigger management is recommended.

While a complete cure is difficult, proper treatment can significantly reduce attack frequency and severity. Options include acute medications for attacks, preventive medications to reduce frequency, and recently developed targeted therapies. Consult with a specialist to develop the best treatment strategy for your needs.

Rest in a quiet, dark environment. If you have prescribed acute medication, taking it as early as possible when the headache begins improves effectiveness. However, using over-the-counter analgesics more than 10 days per month can paradoxically worsen headaches, so always follow the prescribed frequency.

References

  1. [1] GBD 2019 Diseases and Injuries Collaborators (2020). "Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019." The Lancet, 396: 1204-1222. DOI PubMed
  2. [2] Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S (2017). "Pathophysiology of migraine: a disorder of sensory processing." Physiological Reviews, 97: 553-622. DOI PubMed
  3. [3] Headache Classification Committee of the International Headache Society (2018). "The International Classification of Headache Disorders, 3rd edition." Cephalalgia, 38: 1-211. DOI PubMed
  4. [4] Ashina M, Hansen JM, Do TP, Melo-Carrillo A, Burstein R, Moskowitz MA (2019). "Migraine and the trigeminovascular system—40 years and counting." The Lancet Neurology, 18: 795-804. DOI PubMed
  5. [5] Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF (2007). "Migraine prevalence, disease burden, and the need for preventive therapy." Neurology, 68: 343-349. DOI PubMed

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