“Throbbing, pulsating pain.” “Like a drill boring into your head.” “As though your head is gripped by a vise.” “Stabbing pain hammering through your brain.” There is no shortage of metaphors used to describe the horrific, incapacitating pain of migraines. But try as we might, can any of them truly convey what it feels like to be at the mercy of such pain? In many ways, migraines reveal our shortcomings: with language that fails to accurately describe pain, with empathy when we continue to dismiss migraines as “just really bad headaches”, with medicine as we struggle to find reliable treatments and preventatives, and with biology as we fail to understand the complete pathology of this condition. In this episode, we do our best to explore these shortcomings by deep diving into what we do know about the biology and history of migraines. Why do some people get migraines and others don’t? How do certain medications work? What the heck is going on with aura? Have migraines always been around? How have people dealt with them or perceived them historically? What’s on the horizon for migraines in the future? As always, we’ve got lots of questions and lots of answers for you, so tune in today!
| History | Biology |
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| Rose, F. Clifford. “The history of migraine from Mesopotamian to Medieval times.” Cephalalgia 15.15_suppl (1995): 1-3. | Pietrobon, D. and Moskowitz, M.A., 2013. Pathophysiology of migraine. Annual review of physiology, 75, pp.365-391. |
| Ashina, M., Hansen, J.M., Do, T.P., Melo-Carrillo, A., Burstein, R. and Moskowitz, M.A., 2019. Migraine and the trigeminovascular system—40 years and counting. The Lancet Neurology, 18(8), pp.795-804. | |
| Eigenbrodt, A.K., Ashina, H., Khan, S., Diener, H.C., Mitsikostas, D.D., Sinclair, A.J., Pozo-Rosich, P., Martelletti, P., Ducros, A., Lantéri-Minet, M. and Braschinsky, M., 2021. Diagnosis and management of migraine in ten steps. Nature Reviews Neurology, 17(8), pp.501-514. | |
| Breslau, N., Schultz, L.R., Stewart, W.F., Lipton, R.B., Lucia, V.C. and Welch, K.M.A., 2000. Headache and major depression: is the association specific to migraine?. Neurology, 54(2), pp.308-308. | |
| Goadsby, P.J., Lipton, R.B. and Ferrari, M.D., 2002. Migraine—current understanding and treatment. New England journal of medicine, 346(4), pp.257-270. | |
| Ashina, M., Katsarava, Z., Do, T.P., Buse, D.C., Pozo-Rosich, P., Özge, A., Krymchantowski, A.V., Lebedeva, E.R., Ravishankar, K., Yu, S. and Sacco, S., 2021. Migraine: epidemiology and systems of care. The Lancet, 397(10283), pp.1485-1495. | |
| Ashina, M., Terwindt, G.M., Al-Karagholi, M.A.M., De Boer, I., Lee, M.J., Hay, D.L., Schulte, L.H., Hadjikhani, N., Sinclair, A.J., Ashina, H. and Schwedt, T.J., 2021. Migraine: disease characterisation, biomarkers, and precision medicine. The Lancet, 397(10283), pp.1496-1504. | |
| Ashina, M., Buse, D.C., Ashina, H., Pozo-Rosich, P., Peres, M.F., Lee, M.J., Terwindt, G.M., Singh, R.H., Tassorelli, C., Do, T.P. and Mitsikostas, D.D., 2021. Migraine: integrated approaches to clinical management and emerging treatments. The Lancet, 397(10283), pp.1505-1518. | |
| Pietrobon, D. and Striessnig, J., 2003. Neurobiology of migraine. Nature Reviews Neuroscience, 4(5), pp.386-398. | |
| Azmy, D.J. and Qualia, C.M., 2020. Review of abdominal migraine in children. Gastroenterology & Hepatology, 16(12), p.632. | |
| Andreou, A.P. and Edvinsson, L., 2019. Mechanisms of migraine as a chronic evolutive condition. The journal of headache and pain, 20(1), pp.1-17. | |
| Stovner, L.J., Nichols, E., Steiner, T.J., Abd-Allah, F., Abdelalim, A., Al-Raddadi, R.M., Ansha, M.G., Barac, A., Bensenor, I.M., Doan, L.P. and Edessa, D., 2018. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 17(11), pp.954-976. | |
| Global Health Metrics. Migraine – Level 4 cause. Global Burden of Disease 2019. IHME https://www.healthdata.org/results/gbd_summaries/2019/migraine-level-4-cause | |
| Ailani, J., Lipton, R.B., Goadsby, P.J., Guo, H., Miceli, R., Severt, L., Finnegan, M. and Trugman, J.M., 2021. Atogepant for the preventive treatment of migraine. New England Journal of Medicine, 385(8), pp.695-706. | |
| Buse, D.C., Fanning, K.M., Reed, M.L., Murray, S., Dumas, P.K., Adams, A.M. and Lipton, R.B., 2019. Life with migraine: effects on relationships, career, and finances from the chronic migraine epidemiology and outcomes (CaMEO) study. Headache: The Journal of Head and Face Pain, 59(8), pp.1286-1299. |
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