Migraine

The biological factors influencing migraine

Migraine

Migraine is a debilitating and painful neurological disorder.¹ It is characterised by recurrent, moderate to severe pulsating headaches, that typically are aggravated by physical activity, and accompanied by nausea and/or photophobia (sensitivity to light) and phonophobia (sensitivity to sound).²

 

Episodic migraine (4 to 15 headache days per month) can progress to chronic migraine (15 or more days per month).² Studies have shown that those with chronic migraine demonstrate a higher individual and societal burden and have greater impaired quality of life compared to those with episodic migraine.³

 

The frequent use of acute or symptomatic medication for migraine can also lead to an increased number of migraine attacks, or the worsening of existing ones, in a person who already has a migraine disorder.⁴

 

 

Genetics

Migraine has a large genetic component. Certain genescan make people more sensitive to changes in theirenvironment and other such triggers that can bring onan attack.⁵

It is estimated that genetics can account for up to 60% of the reasons people get migraine.⁵

Biological sex

Although migraine can affect both men and women, women are up to three times more likely to experience them than men⁶

 

Migraine also affects women differently⁷

 

  • Longer attack duration in women than men⁷
  • More comorbidities in women than men (average, 11 in women and 5 in men) and more psychiatric comorbidities (e.g., anxiety and depression)⁷
  • In general, the characteristic symptoms accompanying migraine (e.g., nausea, vomiting and sensitivity to light) are more frequent among women than men⁷

Although there is general agreement that migraine is different in men and women, the reason why is still not completely understood⁸

 

  • Biological factors – hormone fluctuations may impact parts of the brain involved in migraine development.⁸ They may also raise the production of calcitonin generelated peptide (CGRP), a protein involved in the transmission of pain⁸
  • Brain structure and function – sex-related differences in brain function and structure may also play a role, with women having a greater number of irregular brain connections and a lower resilience to the loss of function of certain brain networks⁸

Migraine and hormones

About 60% of women, with migraine note an increased number of attacks in association with their menstrual cycle.⁷

In contrast, results from studies suggest that up to 80% of women, who have migraine without sensory disturbances* experience improvement inmigraine during pregnancy, particularly during the secondand third trimesters.⁷

Age

  • Migraine often begins in childhood – around puberty – with a few attacks per year.⁹
  • It may progress into chronic migraine (defined as at least 15 days with headache per month) between the ages of 22 and 55 years.¹⁰
  • After the age of around 55, the attacks tend to become less frequent, milder or disappear altogether.¹¹
  • Hormones as a trigger peak in women in the 30- to 49-year-old age group.¹¹

Comorbid conditions, lifestyle factors and medicine overuse headache (MoH)

  • Obesity, depression and sleep disorders are all considered risk factors for the worsening of migraine¹²⁻¹³
  • Lifestyle factors such as caffeine overuse, stressful life events and low physical activity can also contributeto disease progression, from episodic to chronic migraine¹²⁻¹⁵
  • Healthcare professionals aspire to not just relieve current pain and disability, but to avoid migraine progression
  • Reducing attack frequency, avoiding medication overuse, appropriately using preventive drugs and behaviouraltherapies, and encouraging a healthy lifestyle can all be useful tools in the fight against migraine¹²

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Infographic: The biological factors influencing migraine (PDF, 6 MB)

This infographic was created by H. Lundbeck A/S and it is not intended to be used in a promotional context. This infographic is for educational purposes only.
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* Migraine can happen with or without ‘aura’. ‘Aura’ is described as sensory disturbances that happen shortly before a migraine attack. These disturbances range from seeing sparks, bright dots and zig zags, to tingling on one side of the body or an inability to speak clearly.¹⁶

1. The Migraine Trust. What is migraine? 2020. Available at: https://migrainetrust.org/understand-migraine/what-is-migraine/#page-section-1. Last accessed: February 2022.

2. Headache Classification Committee ofthe International Headache Society (IHS). The International Classification of Headache Disorders, 3rd Edition. Cephalalgia. 2018;38(1):1–211.

3. Katsarava Z, et al. Defining the Differences Between Episodic Migraineand Chronic Migraine. Curr Pain Headache Rep. 2012;16(1):86–92.

4. The International Classification of Headache Disorders (ICHD-3). Available at: https://ichd-3.org/8- headache-attributed-to-a-substance-or-itswithdrawal/8-2-medication-overuse-headache-moh/. Last accessed: February 2022.

5. The Migraine Trust. Genetics and migraine. Available at: https:// migrainetrust.org/understand-migraine/genetics-and-migraine/. Last accessed: February 2022.

6. Vetvik K and MacGregor E. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017;16(1):76–87.

7. Allais G, et al. Gender-relateddifferences in migraine. Neurol Sci. 2020;41(Suppl 2):429–436.

8. Al-Hassany L, et al. Giving Researchers a Headache – Sex and Gender Differences in Migraine. Front Neurol. 2020;11:549038.

9. National MigraineCentre. Migraine in pregnancy. Available at: https://www.nationalmigrainecentre.org.uk/migraine-and-headaches/migraine-and-headachefactsheets/migraine-in-pregnancy/. Last accessed: February 2022.

10. AmericanMigraine Foundation. Understanding migraine with aura. Available at: https://americanmigrainefoundation.org/resource-library/ understanding-migraine-aura/. Last accessed: February 2022.

11. Human HealthProject. Do Migraines Decrease As We Age? Available at: https://humanhealthproject.org/do-migraines-decrease-as-weage/. Last accessed: February 2022.

12. Bigal M and Lipton R. Modifiable Risk Factors for MigraineProgression. Headache. 2006;46(9):1334–1343.

13. Buse D, et al. Migraine Progression: A Systematic Review. Headache. 2019;59(3):306–338.

14. Lippi G, et al. Physical exercise and migraine: for or against? Ann TranslMed. 2018;6(10):181.

15. Diener HC, et al. Medication-overuse headache: risk factors, pathophysiology and management. Nat Rev Neurol. 2016;12(10):575–583.

16. Migraine Ireland. Migraine and Women. Available at: https://migraine.ie/migraineand-women/. Last accessed: February 2022.

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