Migraine Without Aura
Disease Details
Family Health Simplified
- Description
- Migraine without aura is a type of migraine characterized by moderate to severe headache, usually on one side of the head, accompanied by nausea, vomiting, and sensitivity to light and sound, but without the sensory disturbances that precede migraine with aura.
- Type
- Migraine without aura is a type of primary headache disorder commonly known as "common migraine." The type of genetic transmission for migraine without aura is generally considered to be multifactorial, involving multiple genes and environmental factors, rather than following a clear Mendelian inheritance pattern. Researchers have identified several genetic loci that may contribute to susceptibility, but no single gene has been definitively pinpointed as the cause.
- Signs And Symptoms
-
Migraine typically presents with self-limited, recurrent severe headache associated with autonomic symptoms. About 15–30% of people living with migraine experience episodes with aura, and they also frequently experience episodes without aura. The severity of the pain, duration of the headache, and frequency of attacks are variable. A migraine attack lasting longer than 72 hours is termed status migrainosus. There are four possible phases to a migraine attack, although not all the phases are necessarily experienced:
The prodrome, which occurs hours or days before the headache
The aura, which immediately precedes the headache
The pain phase, also known as headache phase
The postdrome, the effects experienced following the end of a migraine attackMigraine is associated with major depression, bipolar disorder, anxiety disorders, and obsessive–compulsive disorder. These psychiatric disorders are approximately 2–5 times more common in people without aura, and 3–10 times more common in people with aura. - Prognosis
- "Migraine exists on a continuum of different attack frequencies and associated levels of disability." For those with occasional, episodic migraine, a "proper combination of drugs for prevention and treatment of migraine attacks" can limit the disease's impact on patients' personal and professional lives. But fewer than half of people with migraine seek medical care and more than half go undiagnosed and undertreated. "Responsive prevention and treatment of migraine is incredibly important" because evidence shows "an increased sensitivity after each successive attack, eventually leading to chronic daily migraine in some individuals." Repeated migraine results in "reorganization of brain circuitry," causing "profound functional as well as structural changes in the brain." "One of the most important problems in clinical migraine is the progression from an intermittent, self-limited inconvenience to a life-changing disorder of chronic pain, sensory amplification, and autonomic and affective disruption. This progression, sometimes termed chronification in the migraine literature, is common, affecting 3% of migraineurs in a given year, such that 8% of migraineurs have chronic migraine in any given year." Brain imagery reveals that the electrophysiological changes seen during an attack become permanent in people with chronic migraine; "thus, from an electrophysiological point of view, chronic migraine indeed resembles a never-ending migraine attack." Severe migraine ranks in the highest category of disability, according to the World Health Organization, which uses objective metrics to determine disability burden for the authoritative annual Global Burden of Disease report. The report classifies severe migraine alongside severe depression, active psychosis, quadriplegia, and terminal-stage cancer.Migraine with aura appears to be a risk factor for ischemic stroke doubling the risk. Being a young adult, being female, using hormonal birth control, and smoking further increases this risk. There also appears to be an association with cervical artery dissection. Migraine without aura does not appear to be a factor. The relationship with heart problems is inconclusive with a single study supporting an association. Migraine does not appear to increase the risk of death from stroke or heart disease. Preventative therapy of migraines in those with migraine with aura may prevent associated strokes. People with migraine, particularly women, may develop higher than average numbers of white matter brain lesions of unclear significance.
- Onset
- The onset of a migraine without aura typically includes a gradual build-up of headache intensity, often starting as a dull ache that develops into a throbbing or pulsating pain. This type of migraine does not present with the sensory disturbances known as auras, which precede the headache phase in migraines with aura.
- Prevalence
- Prevalence: Migraine without aura affects approximately 10% of the global population. It is more common in women than in men, with a female-to-male ratio of about 3:1.
- Epidemiology
- Migraine is common, with around 33% of women and 18% of men affected at some point in their lifetime. Onset can be at any age, but prevalence rises sharply around puberty, and remains high until declining after age 50. Before puberty, boys and girls are equally impacted, with around 5% of children experiencing migraines. From puberty onwards, women experience migraines at greater rates than men. From age 30 to 50, up to 4 times as many women experience migraines as men.Worldwide, migraine affects nearly 15% or approximately one billion people. In the United States, about 6% of men and 18% of women experience a migraine attack in a given year, with a lifetime risk of about 18% and 43% respectively. In Europe, migraines affect 12–28% of people at some point in their lives with about 6–15% of adult men and 14–35% of adult women getting at least one yearly. Rates of migraine are slightly lower in Asia and Africa than in Western countries. Chronic migraine occurs in approximately 1.4 to 2.2% of the population.In women, migraine without aura are more common than migraine with aura; however in men the two types occur with similar frequency.During perimenopause symptoms often get worse before decreasing in severity. While symptoms resolve in about two-thirds of the elderly, in 3–10% they persist.
- Intractability
- Migraine without aura can vary in its response to treatment. While many individuals find relief through medications and lifestyle changes, others may experience intractable migraines, which are resistant to standard treatments. Intractable or refractory migraines are challenging to manage and often require specialized treatment approaches.
- Disease Severity
- The severity of migraine without aura can vary widely among individuals. It often presents as moderate to severe, throbbing headaches typically on one side of the head, and can be accompanied by nausea, vomiting, and sensitivity to light and sound. The intensity and impact on daily life can make it a significant condition for those affected.
- Healthcare Professionals
- Disease Ontology ID - DOID:12783
- Pathophysiology
- Migraine is believed to be primarily a neurological disorder, while others believe it to be a neurovascular disorder with blood vessels playing the key role, although evidence does not support this completely. Others believe both are likely important. One theory is related to increased excitability of the cerebral cortex and abnormal control of pain neurons in the trigeminal nucleus of the brainstem.Sensitization of trigeminal pathways is a key pathophysiological phenomenon in migraine. It is debatable whether sensitization starts in the periphery or in the brain.
- Carrier Status
- Migraine without aura does not have a carrier status since it is not a condition caused by a single genetic mutation that can be "carried." Instead, it is a neurological condition influenced by a combination of genetic and environmental factors.
- Mechanism
-
Migraines without aura are primarily caused by a combination of genetic, environmental, and neurological factors. The exact mechanism is not fully understood, but it involves complex interactions between the brain and surrounding tissues.
**Mechanism:**
- **Neurovascular Theory:** Suggests that migraines involve the trigeminovascular system, where activation of the trigeminal nerve leads to the release of neuropeptides like calcitonin gene-related peptide (CGRP). This causes vasodilation and inflammation of cerebral blood vessels.
- **Cortical Spreading Depression (CSD):** Though more commonly linked to migraines with aura, some researchers suggest CSD might also play a role in migraines without aura by causing changes in brain excitability and triggering the trigeminal system.
**Molecular Mechanisms:**
- **CGRP (Calcitonin Gene-Related Peptide):** This neuropeptide is a potent vasodilator and is elevated during migraine attacks. It is key in transmitting pain signals during a migraine.
- **Serotonin (5-HT):** Altered levels of serotonin are implicated in migraines. Low levels may cause blood vessels to dilate and contribute to pain and inflammation.
- **Ion Channels:** Mutations affecting ion channels (e.g., sodium, potassium, and calcium channels) can influence neuronal excitability, which may lead to the initiation of a migraine attack.
- **Genetic Factors:** Genes such as CACNA1A, ATP1A2, and SCN1A have been associated with susceptibility to migraines. These genes typically encode proteins involved in ion transport and neuronal function.
Understanding these mechanisms helps in developing targeted treatments to alleviate or prevent migraine attacks. - Treatment
-
Treatment for migraine without aura typically involves a combination of medication and lifestyle changes. Acute treatments to relieve symptoms include:
1. Over-the-counter pain relievers: Such as ibuprofen, aspirin, or acetaminophen.
2. Triptans: Prescription medications like sumatriptan and rizatriptan.
3. Anti-nausea drugs: If nausea is a significant symptom.
Preventive treatments for reducing the frequency of migraine attacks include:
1. Beta-blockers: Such as propranolol.
2. Antidepressants: Like amitriptyline.
3. Anticonvulsants: Such as topiramate and valproate.
4. CGRP inhibitors: Such as erenumab and fremanezumab.
Lifestyle changes include:
1. Regular sleep schedule.
2. Proper hydration.
3. Consistent meal times.
4. Stress management techniques.
Consult a healthcare professional for a personalized treatment plan. - Compassionate Use Treatment
-
Compassionate use treatments and off-label or experimental treatments for migraine without aura involve medications and therapies not typically approved exclusively for migraines but may be prescribed when standard treatments fail. Some of these include:
1. **Monoclonal Antibodies:** Drugs like erenumab, fremanezumab, and galcanezumab, initially developed for other conditions, are explored for chronic and refractory migraines.
2. **Anti-Seizure Medications:** Medications like topiramate and valproate, primarily used for epilepsy, are sometimes prescribed off-label for migraine prevention.
3. **Antidepressants:** Certain antidepressants, especially tricyclics like amitriptyline and SNRIs like venlafaxine, can be effective in reducing migraine frequency.
4. **Botox Injections:** Initially approved for cosmetic purposes, onabotulinumtoxinA (Botox) is used for chronic migraines.
5. **CGRP Inhibitors:** Though many are now approved for migraines, some CGRP inhibitors were initially explored for other uses.
6. **Ketamine:** Known primarily as an anesthetic and pain management drug, ketamine is researched for its potential in treating severe refractory migraines.
7. **Neuromodulation Devices:** Devices like transcranial magnetic stimulation (TMS) and vagus nerve stimulators are being studied for their effects on migraine patterns.
Consultation with a healthcare provider is essential before using any off-label or experimental treatments to ensure safety and appropriateness. - Lifestyle Recommendations
-
For managing migraines without aura, consider the following lifestyle recommendations:
1. **Regular Sleep Schedule**: Maintain consistent sleep patterns by going to bed and waking up at the same times daily.
2. **Healthy Diet**: Eat balanced meals at regular intervals and avoid known food triggers such as caffeine, alcohol, and processed foods.
3. **Hydration**: Drink plenty of water throughout the day to stay hydrated.
4. **Regular Exercise**: Engage in moderate physical activity regularly, like walking or swimming, to reduce stress and improve overall health.
5. **Stress Management**: Practice relaxation techniques such as deep breathing, meditation, or yoga to manage stress levels.
6. **Avoid Skipping Meals**: Eating regularly can help prevent drops in blood sugar that may trigger migraines.
7. **Proper Posture**: Maintain good posture, especially while working at a desk, to avoid muscle tension that can lead to headaches.
8. **Monitor Triggers**: Keep a diary to identify and avoid personal migraine triggers, such as certain foods, smells, or environmental changes.
9. **Limit Screen Time**: Take breaks when using screens to reduce eye strain and avoid potential triggers.
Implementing these lifestyle changes may help reduce the frequency and severity of migraines without aura. - Medication
- Preventive migraine medications are considered effective if they reduce the frequency or severity of the migraine attacks by at least 50%. Due to few medications being approved specifically for the preventative treatment of migraine headaches; many medications such as beta-blockers, anticonvulsive agents such as topiramate or sodium valproate, antidepressants such as amitriptyline and calcium channel blockers such as flunarizine are used off label for the preventative treatment of migraine headaches. Guidelines are fairly consistent in rating the anticonvulsants topiramate and divalproex/sodium valproate, and the beta blockers propranolol and metoprolol as having the highest level of evidence for first-line use for migraine prophylaxis in adults. Propranolol and topiramate have the best evidence in children; however, evidence only supports short-term benefit as of 2020.The beta blocker timolol is also effective for migraine prevention and in reducing migraine attack frequency and severity. While beta blockers are often used for first-line treatment, other antihypertensives also have a proven efficiency in migraine prevention, namely the calcium channel blocker verapamil and the angiotensin receptor blocker candesartan.Tentative evidence also supports the use of magnesium supplementation. Increasing dietary intake may be better. Recommendations regarding effectiveness varied for the anticonvulsants gabapentin and pregabalin. Frovatriptan is effective for prevention of menstrual migraine.The antidepressants amitriptyline and venlafaxine are probably also effective. Angiotensin inhibition by either an angiotensin-converting enzyme inhibitor or angiotensin II receptor antagonist may reduce attacks.Medications in the anti-calcitonin gene-related peptide, including eptinezumab, erenumab, fremanezumab, and galcanezumab, appear to decrease the frequency of migraines by one to two per month.
- Repurposable Drugs
-
Repurposable drugs for treating migraines without aura include:
1. **Amitriptyline**: Originally used as an antidepressant, amitriptyline can help prevent migraines.
2. **Topiramate**: Primarily an anticonvulsant, topiramate can reduce the frequency of migraines.
3. **Propranolol**: Commonly used for hypertension and heart conditions, propranolol is effective in migraine prevention.
4. **Candesartan**: An antihypertensive drug that has shown efficacy in reducing migraine frequency.
5. **Flunarizine**: A calcium channel blocker typically used for vertigo, it can be repurposed for migraine prevention.
These repurposable drugs may provide effective migraine management, though individual responses may vary. Consult a healthcare provider for personalized treatment. - Metabolites
- The term "nan" could be a typographical error or abbreviation, but it doesn't clearly relate to metabolites. Do you want information specifically on metabolites associated with migraine without aura?
- Nutraceuticals
-
For migraines without aura, nutraceuticals commonly recommended include:
- **Magnesium:** Often used to prevent migraines, with a typical dose of 400-600 mg per day.
- **Riboflavin (Vitamin B2):** Recommended dosage is around 400 mg per day, potentially reducing the frequency and severity of migraines.
- **Coenzyme Q10 (CoQ10):** Common doses range from 100 to 400 mg per day to help reduce migraine frequency.
- **Feverfew:** An herbal supplement that can help in preventing migraines, with varied dosages typically starting around 50-150 mg of extract per day.
These supplements are considered generally safe but should be discussed with a healthcare provider to ensure they are appropriate and to determine optimal dosing. - Peptides
- In the context of migraine without aura, peptides such as Calcitonin Gene-Related Peptide (CGRP) play a significant role. CGRP is a neuropeptide that is involved in the pathophysiology of migraines by promoting inflammation and vasodilation within the brain. CGRP receptor antagonists and monoclonal antibodies targeting CGRP or its receptor are treatments that have been developed to help prevent and treat migraine attacks. These therapies work by blocking the activity of CGRP, thereby reducing the frequency and severity of migraines.