Allodynia, dizziness, vomiting, and cognitive impairment are possible additional defining symptoms. The aggravation of headaches while engaging in physical activity is an additional characteristic.

Aura, a premonitory phase of sensory disruption that is thought to be induced by cortical spreading depression at the outset of a migraine episode, can affect up to one-third of migraine sufferers. Although migraine is mainly thought of as a headache problem, it is actually more appropriate to think of migraine as a spectrum disease rather than a single clinical entity due to its widely variable clinical presentation.

The burden of sickness can vary from chronic illness to episodic discrete bouts, which might occur as little as a few times in a lifetime.

SIGNS AND SYMPTOMS

A severe headache that is self-limited, recurrent, and accompanied by autonomic symptoms is the usual presentation of migraine. Between 15 and 30 percent of migraine sufferers have aura-producing episodes and they also regularly have aura-free episodes. There is variation in the headache's duration, intensity, and frequency of bouts. Status migrainous refers to a migraine attack that lasts more than 72 hours. A migraine attack can occur in four different phases, albeit not every phase is felt at the same time:

1. The prodrome, which manifests itself days or hours before a headache.
2. The aura comes on suddenly before the headache
3. The headache phase (sometimes called the discomfort phase)
4. The aftereffects of a migraine attack are known as the postdrome.

Major depressive disorder, bipolar disorder, anxiety disorders, and obsessive-compulsive disorder are all linked to migraines. In those without aura, these psychiatric problems are roughly 2.5–5 times more common; in those with aura, they are 3–10 times more common.

Prodrome phase

About 60% of migraine sufferers experience prodromal or premonitory symptoms, which can start two hours to two days before pain or aura begins. Numerous phenomena can be associated with these symptoms, such as a change in mood, irritability, despair or euphoria, exhaustion, cravings for particular foods, stiff neck muscles, constipation or diarrhoea, and sensitivity to noises or scents. People who have migraine without aura or migraine with aura may experience this. Neuroimaging suggests that prodromal symptoms in migraine originate in the limbic system and hypothalamus.

Aura phase

Aura is a pre-or during-headache transient focused neurological phenomenon. Aura typically lasts less than 60 minutes and manifests gradually over a period of time, usually spanning 5 to 60 minutes. There are many other types of symptoms that many people suffer, including visual, sensory, and motor ones. The most common type of effects are visual ones, which can happen in as many as 99% of cases and over 50% of them don't have any accompanying sensory or motor effects. Persistent aura is the term for a state in which any symptom lasts longer than sixty minutes.

Pain Phase

Traditionally, the headache is pounding, unilateral, and ranges in intensity from moderate to severe. It often develops gradually and is made worse by exertion when a migraine attack occurs. The relationship between physical activity and migraine is complicated, though, and some researchers have shown that although regular exercise might prevent migraine symptoms, it can also make attacks less frequent. The pain is not pulsating in time with the pulse. However, in over 40% of instances, the pain may be bilateral, affecting both sides of the head, and it is frequently accompanied with neck pain. Those with migraine without aura are especially prone to experiencing bilateral discomfort. Less frequently, pain may mostly affect the top or rear of the head. In adults, the pain often lasts between four and seventy-six hours; in young children, it often lasts less than an hour. Attacks can occur anywhere from a few times in a lifetime to multiple times a week, with an average of roughly one per month.

Silent Migraine

Auras can sometimes appear without accompanying headaches. This is referred to as a normal aura without headache in modern classification, as an acephalgic migraine in earlier classifications, or simply as a silent migraine. Nonetheless, incapacitating symptoms such as visual disruption, loss of vision in half of the eyes, changes in colour perception, and other sensory issues like light, sound, and odour sensitivity can still be caused by silent migraine. It often lasts no more than 60 minutes, although it can last anywhere from 15 to 30 minutes. It can also occur repeatedly or just once.

Postdrome

The group of symptoms that appear after an intense headache has subsided is known as the migraine postdrome. Many describe pain where the migraine was felt, and some report having trouble thinking for a few days following the headache's resolution. Along with head discomfort, weakness, gastrointestinal issues, mood swings, and cognitive impairments, the person may feel exhausted or "hung over". According to a summary, "Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise."

CAUSES

• Genetics: Twin studies show that migraine risk is influenced by genes in 34% to 51% of cases. When it comes to migraines with aura versus migraines without, there is a greater hereditary correlation. A slight to moderate increase in risk is caused by several distinct gene variations. It is uncommon for migraines to be caused by single-gene abnormalities. Familial hemiplegic migraine is a kind of aura-producing migraine that is inherited in an autosomal dominant manner. Research has demonstrated the involvement of four genes in familial hemiplegic migraine. These three genes have anything to do with ion transport. The axonal protein PRRT2, connected to the exocytosis complex, is the fourth. CADASIL syndrome, also known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, is another genetic condition linked to migraine. Angiotensin-converting enzyme polymorphisms have been found in one meta-analysis to have a protective effect against migraine. Migraines have been associated with the cation channel-coding gene TRPM8.
• TriggersTriggers may cause migraines; some indicate that this is the case in a minority of cases, while others report that it is the case in the majority. A wide range of items, including food, alcohol, weariness, and weather, have been classified as triggers; however, it is unclear how strong and significant these associations are. The majority of migraineurs say they have triggers. A trigger may cause symptoms to appear up to 24 hours later.

Physiological aspects

Stress, hunger, and exhaustion are frequently mentioned triggers (all three of these equally contribute to tension headaches). Fifty to eighty percent of respondents have identified psychological stress as a contributing factor. Additionally, maltreatment and post-traumatic stress disorder have been linked to migraines. Periods are a prime time for migraine attacks to happen. Aside from these factors, other hormonal factors include menarche, using oral contraceptives, pregnancy, perimenopause, and menopause. In cases with migraine without aura, these hormonal factors appear to be more significant. Usually, migraine attacks don't happen after menopause or in the second and third trimesters of pregnancy.

Dietary aspects

12% to 60% of individuals say that certain foods are triggers. Numerous findings have indicated that tyramine, which is found naturally in chocolate, alcoholic beverages, most cheeses, processed meats, and other foods, might cause migraine symptoms in certain people. Although monosodium glutamate (MSG) has been linked to migraines, a systematic study found no evidence of a direct link between MSG and headaches. It would seem premature to conclude that headaches are caused by MSG found in food.

Environmental aspects

According to a 2009 analysis, "migraineurs worldwide consistently report similar environmental triggers," even though there was not enough research to prove that environmental factors cause migraines. The review focused on putative triggers in both indoor and outdoor environments.

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