The Burden in Your Brain: Understanding Migraine and Headache Disorders
Salman Al Jerdi, MD
Assistant Professor of Neurology
Director, Neurology Clerkship, WCMQ
Consultant, Vascular and General Neurology, HMC
Headache disorders are among the most common neurological conditions worldwide and a leading reason for seeking medical care. Approximately 40% of the global population is affected by headaches, making them one of the top causes of disability.¹˒² Headaches can be classified as either primary, where the headache itself is the central pathological concern, or secondary, where an underlying cause such as infection, vascular abnormality, or structural lesion is identified. Primary headaches are far more prevalent, with tension-type headache and migraine being the most commonly reported.
Migraine is a neurological condition typically characterized by moderate-to-severe pulsatile headaches lasting from 4 to 72 hours. These are often unilateral, aggravated by routine physical activity, and associated with symptoms such as nausea, photophobia, or phonophobia.¹ About one-quarter of individuals with migraine experience a preceding aura—transient focal neurological symptoms that commonly present as visual flickering, zigzag lines, or blind spots.³ Various triggers can precipitate migraine attacks, including irregular or insufficient sleep, missed meals, specific foods, stress, and hormonal fluctuations.
Diagnosis of headache disorders, including migraine, is almost entirely clinical. It relies on a comprehensive patient history and detailed physical and neurological examination. While laboratory tests play no significant role in diagnosing primary headaches, neuroimaging and other investigations, such as lumbar puncture, may be warranted to rule out secondary causes, especially in patients with red flag symptoms.
The treatment of migraine and other headache disorders is multifaceted and often requires a long-term strategy that integrates both pharmacologic and non-pharmacologic interventions. Pharmacologic treatment is generally divided into abortive and prophylactic therapies. Abortive therapy aims to stop an ongoing headache, while prophylactic therapy focuses on reducing the frequency, severity, and duration of future attacks.
Prophylactic management begins with lifestyle modifications and trigger avoidance. Daily supplementation with magnesium or riboflavin may offer some benefit, while prescription medications—such as beta-blockers, calcium channel blockers, and certain antiepileptics—are frequently used in more persistent cases. In recent years, botulinum toxin (Botox) injections and calcitonin gene-related peptide (CGRP) inhibitors have expanded preventive options, particularly for patients with chronic or refractory migraine.⁴
Abortive therapies include oral, intranasal, or parenteral medications such as triptans, ergots, NSAIDs, and antiemetics, aimed at halting the progression of an acute migraine episode. Emerging technologies, including neuromodulation devices and wearable or implantable stimulators, are under active investigation for their potential to abort or reduce the impact of various headache types.
In summary, headache disorders—particularly migraine—represent a significant burden on individuals and healthcare systems alike. Though often underdiagnosed or undertreated, they are manageable with a personalized, multidisciplinary approach that incorporates lifestyle strategies, acute and preventive medications, and, when appropriate, newer biologic or device-based therapies. Early recognition and proactive treatment are key to improving quality of life and long-term outcomes for patients living with recurrent headaches.
References:
- GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–1222. doi:10.1016/S0140-6736(20)30925-9
- Stovner LJ, Hagen K, Linde M, Steiner TJ. The global prevalence of headache: An update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain. 2022;23(1):34. doi:10.1186/s10194-022-01320-2
- Charles A. The pathophysiology of migraine: Implications for clinical management. Lancet Neurol. 2018;17(2):174–182. doi:10.1016/S1474-4422(17)30435-0
- Dodick DW, Lipton RB, Ailani J, et al. Efficacy and safety of fremanezumab for the preventive treatment of chronic migraine: A randomized, double-blind, placebo-controlled phase 3 trial. JAMA. 2018;319(19):1999–2008. doi:10.1001/jama.2018.4858