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[[File:Migraine-art.jpg|left|thumb|320px|Source: [https://www.flickr.com/photos/tudedude/14019222689 Migraine by Tudor Barker]]]<br style="clear:both"> '''Migraines''' commonly occur in people with [[ME/CFS]]. In a 2011 study by Ravindran, et al, migraine headaches were found in 84%, and [[tension-type headache]]s in 81% of a cohort of [[chronic fatigue syndrome]] patients.<ref name="Ravindran2011" /> This compared to 5% and 45%, respectively, in a cohort of healthy controls.<ref name="Ravindran2011" /> ==Symptoms== <ref name="NHS-overall" /> ==Phases== Migraine phases: ;Prodromal (pre-headache) stage :changes in mood, energy levels, behaviour and appetite that can occur several hours or days before an attack ;Aura phase (if present) :visual problems are very common, e.g. flashes of light (scintillations) or blind spots (scotoma),Β aura symptoms last for 5 to 60 minutes ;Headache phase :usually a moderate or severe pulsating or throbbing pain on one side of the head, often accompanied by [[nausea]], [[vomiting]] or [[photophobia|extreme light sensitivity]] and extreme sensitivity to loud sounds, which last from 4 hours to 3 days ;Postdromal or resolution stage :the severe headache and other symptoms gradually fade, but there may be [[fatigue|tiredness]] for few days after<ref name="NHS-symptoms">{{Cite web|url=https://www.nhs.uk/conditions/migraine/symptoms/ | title = Migraine - Symptoms | last = | first = | authorlink = | date = | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-15}}</ref><ref name="Khan2021"/><ref name="NHS-overall" /> [[File:Migraine-phases.jpg|left|thumb|600px|Migraine phases.<br />Source: [https://www.sciencedirect.com/science/article/pii/S0753332221003425 Khan et. al. (2021). Biomedicine & Pharmacotherapy, 139, 111557.]<ref name="Khan2021"/>]]<br style="clear:both"> ==Types == ===Migraine without aura=== '''Migraine without aura''' is defined by the following diagnostic criteria outlined in ''The International Classification Of Headache Disorders, 3rd edition'': ====Migraine without aura diagnostic criteria==== <ol style="list-style-type:upper-alpha"><li> At least '''five''' headache attacks that</li> <li> Last 4β72 hours without successful treatment</li> <li> Headaches have at least '''two''' of the following four characteristics:</li> <ol><li> unilateral location;</li> <li> pulsating quality;</li> <li> moderate to severe pain intensity; and</li> <li> aggravation by or causing avoidance of routine physical activity.</li></ol> <li> During the headaches at least '''one''' of the following:</li> <ol><li> [[nausea]] and/or vomiting</li> <li> [[photophobia]] and phonophobia (avoidance of loud noises)</li></ol> <li> Not better accounted for by another ICHD-3 diagnosis.</li> </ol> :Migraines without aura may also be called '''common migraine'' or '''hemicrania simplex'''.<ref name="ICHD-3">{{Cite journal | last = Headache Classification Committee of the International Headache Society | date = 2018 | title = The International Classification of Headache Disorders|edition=3rd | url =https://doi.org/10.1177/0333102417738202|journal=Cephalalgia|language=en|volume=38|issue=1|pages=1β211|doi=10.1177/0333102417738202|issn=0333-1024}}</ref> ===Migraine with aura=== ====Migraine with aura diagnostic criteria==== :Visual, sensory and central nervous system symptom in beginning shortly before a migraine headache are known as an '''aura''', although migraine with aura without migraine headaches are also recognized. <ol style="list-style-type:upper-alpha"><li> At least '''two''' migraine attacks fulfilling criteria B and C</li> <li>'''One''' or more of the following fully reversible aura symptoms</li> <ol><li> visual </li> <li> sensory </li> <li> speech and/or language </li> <li> motor </li> <li> brainstem </li> <li> retinal </li></ol> <li> At least '''three''' of the following characteristics:</li> <ol><li> at least '''one''' aura symptom spreads gradually over five minutes or longer</li> <li> '''two''' or more aura symptoms occur in succession</li> <li> each individual aura symptom lasts 5 to 60 minutes </li> <li> at least one aura symptom is '''unilateral''' (one sided)</li> <li> at least one aura symptom is '''positive''' </li> <li> the aura is accompanied, or followed within 60 minutes, by headache</li></ol> <li> Not better accounted for by another ICHD-3 diagnosis.<ref name="ICHD-3" /></li></ol> The recognized types of migraine with aura are: *Typical aura with headache *Typical aura without headache *Migraine with brainstem aura *Hemiplegic migraine, including familial hemiplegic migraine (FHM) type 1, type 2, type 3 and with other loci * Sporadic hemiplegic migraine (SHM) * Retinal migraine Migraines without aura may also be called '''Classic or classical migraine''', '''ophthalmic, hemiparaesthetic, hemiplegic or aphasic migraine''', or '''complicated migraine'''.<ref name="ICHD-3" /> ===Chronic migraine === <ref name="ICHD-3" /> ===Silent migraine === Migraine symptoms that do not result in a headache are known as silent migraines, e.g. migraine aura symptoms without head pain.migraine aura without headache, also known as silent migraine β where an aura or other migraine symptoms are experienced, but a headache does not develop.<ref name="NHS-overall">{{Cite web|url=https://www.nhs.uk/conditions/migraine/ | title = Migraine | last = | first = | authorlink = | date = | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-15}}</ref> ===Abdominal migraine === <ref name="ICHD-3" /> ==Triggers == [[File:Migraine_triggers.jpg|left|600px|Migraine triggers.<br />Source: [https://www.sciencedirect.com/science/article/pii/S0753332221003425 Biomedicine & Pharmacotherapy, 139, 111557]<ref name="Khan2021"/>]]<br style="clear:both"> Common migraine triggers include: * Food and drinks, e.g., chocolate, alcohol, aged cheese, [[gluten sensitivity|gluten]] * Lifestyle patterns, e.g. [[stress]], weather changes, or fasting * Genetics * Physiological and biochemical factors, e.g. insulin or oestrogen [[hormone]] levels, increased [[oxidative stress]]<ref name="Khan2021"/><ref name="NHS-overall" /> ==Migraines in ME/CFS== Migraines is one of several illnesses or conditions common in people with [[ME/CFS]].<ref name="ammes">{{Cite web|url=https://ammes.org/overlapping-conditions/ | title = Overlapping Conditions β American ME and CFS Society|website=ammes.org|language=en-US|access-date=2018-08-12}}</ref><ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17= Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012 | isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref><br> The [[Canadian Consensus Criteria]] recognizes migraines in the [[:Category:Neurological signs and symptoms|possible neurological symptoms]] of [[ME/CFS]], and the [[International Consensus Criteria]] recognizes [[headache]] conditions including [[migraine]] and [[tension-type headache]] in the diagnostic criteria for [[myalgic encephalomyelitis]].<ref name="ICC2011primer" /> ==Possible causes== ==Potential treatments== Migraine treatment consists of: *Abortive treatments, that aim to stop a migraine attack or reduce the symptoms *Prevention, which aims to reduce how often migraines occur and their intensity === Migraine attack treatments === *General [[analgesic|pain medications]], including [[acetaminophen]] and [[Nonsteroidal anti-inflammatory drug|nonsteroidal anti-inflammatories]] (NSAID), for mild to moderate migraines. Different types of medications are sometimes combined, for example acetaminophen and [[naproxen]].<ref name="Khan2021">{{Cite journal | last = Khan | first = Johra | last2 = Asoom | first2 = Lubna Ibrahim Al | last3 = Sunni | first3 = Ahmad Al | last4 = Rafique | first4 = Nazish | last5 = Latif | first5 = Rabia | last6 = Saif | first6 = Seham Al | last7 = Almandil | first7 = Noor B. | last8 = Almohazey | first8 = Dana | last9 = AbdulAzeez | first9 = Sayed | date = 2021-07-01 | title = Genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine|url=https://www.sciencedirect.com/science/article/pii/S0753332221003425|journal=Biomedicine & Pharmacotherapy|language=en|volume=139|pages=111557|doi=10.1016/j.biopha.2021.111557|issn=0753-3322}}</ref> *[[:Category:Triptans|Triptans]] for moderate or severe migraine e.g. [[sumatriptan]] (Imitrex): 13 out of 14 newly diagnosed migraine subjects responded to sumatriptan in one [[Chronic fatigue syndrome|CFS]] patient cohort<ref name="Ravindran2011" /> or [[zomitriptan]] (Zomig)<ref name="drugscom">{{Cite web|url=https://www.drugs.com/health-guide/migraine.html | title = Migraine Guide: Causes, Symptoms and Treatment Options|website=Drugs.com|language=en|access-date=2021-10-12}}</ref> *Small molecule [[:Category:CGRP antagonists|CGRP antagonists]], known as [[:Category:Gepants|gepants]], which are the newest group of migraine drugs<ref name="Negro2019">{{Cite journal | last = Negro | first = Andrea | authorlink = | last2 = Martelletti | first2 = Paolo | authorlink2 = | date = Jun 2019 | title = Gepants for the treatment of migraine|url=https://pubmed.ncbi.nlm.nih.gov/31081399/|journal=Expert Opinion on Investigational Drugs|volume=28|issue=6 | pages = 555β567|doi=10.1080/13543784.2019.1618830|issn=1744-7658|pmc=|pmid=31081399|access-date=|quote=|via=}}</ref> *There is some limited evidence for [[transcranial magnetic stimulation]] (TMS) in migraines with aura, this is a non-invasive brain based treatment<ref name="NHStreat">{{Cite web|url=https://www.nhs.uk/conditions/migraine/treatment/ | title = Migraine - Treatment | last = | first = | authorlink = | date = | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-15}}</ref> === Migraine prevention === *[[Migraine elimination diet]]s, which rely on identifying particular foods, drinks or additives that trigger migraines, for example avoiding food or drinks containing [[nitrates]] or [[tyramine]]<ref name="Khan2021" /><ref name="NHS" /> *CGRP antagonists, particularly [[Calcitonin gene-related peptide monoclonal antibody|CGRP monoclonal antibodies]] but possibly some gepants<ref name="Negro2019" /> *Drugs developed for other uses that are known to reduce migraines, including propranolol, [[amitriptyline]] (Elavil), [[topiramate]] (Topamax) or botulinum toxin type A (Botox injections)<ref name="Negro2019" /><ref name="NHS" /> *Acupuncture<ref name="NHS">{{Cite web|url=https://www.nhs.uk/conditions/migraine/prevention/ | title = Migraine - Prevention | last = | first = | authorlink = | date = 2017-10-23 | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-12}}</ref> *[[Daith piercing]], a type of ear piercings not routinely recommended<ref name="Cascio2017">{{Cite journal | last = Cascio Rizzo | first = Angelo | last2 = Paolucci | first2 = Matteo | last3 = Altavilla | first3 = Riccardo | last4 = Brunelli | first4 = Nicoletta | last5 = Assenza | first5 = Federica | last6 = Altamura | first6 = Claudia | last7 = Vernieri | first7 = Fabrizio | date = 2017 | title=Daith Piercing in a Case of Chronic Migraine: A Possible Vagal Modulation|journal=Frontiers in Neurology|language=English|volume=8|pages=|doi=10.3389/fneur.2017.00624|issn=1664-2295|pmc=5711775|pmid=29230190|via=}}</ref> * Natural or alternative dietary supplements including [[magnesium]], [[feverfew]], the B vitamin [[riboflavin]], [[CoQ10]], and others.<ref name="Sun2011">{{Cite journal | last = Sun-Edelstein | first = Christina | authorlink = | last2 = Mauskop | first2 = Alexander | authorlink2 = | date = Mar 2011 | title = Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments: March 2011|url=https://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2011.01846.x|journal=Headache: The Journal of Head and Face Pain|language=en|volume=51|issue=3 | pages = 469β483|doi=10.1111/j.1526-4610.2011.01846.x|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref name="Barmherzig2021">{{Cite journal | last = Barmherzig | first = Rebecca | last2 = Rajapakse | first2 = Thilinie | date = 2021-05-10 | title = Nutraceuticals and Behavioral Therapy for Headache|url=https://doi.org/10.1007/s11910-021-01120-3|journal=Current Neurology and Neuroscience Reports|language=en|volume=21|issue=7|pages=33|doi=10.1007/s11910-021-01120-3|issn=1534-6293}}</ref><ref name="Sun2009">{{Cite journal | last = Sun-Edelstein | first = Christina | authorlink = | last2 = Mauskop | first2 = Alexander | authorlink2 = | date = Jun 2009 | title = Foods and Supplements in the Management of Migraine Headaches|url=https://journals.lww.com/clinicalpain/Abstract/2009/06000/Foods_and_Supplements_in_the_Management_of.15.aspx|journal=The Clinical Journal of Pain|language=en-US|volume=25|issue=5 | pages = 446β452|doi=10.1097/AJP.0b013e31819a6f65|issn=0749-8047|pmc=|pmid=|access-date=|quote=|via=}}</ref> [[Butterbur]] is not recommended due to liver toxicity.<ref name="NCCIH">{{Cite web|url=https://www.nccih.nih.gov/health/providers/digest/dietary-supplements-for-headaches-science | title = Dietary Supplements for Headaches: What the Science Says | last = | first = | authorlink = | date = | website = [[National Center for Complementary and Integrative Health]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-13}}</ref> *Migraines with aura may be reduce with [[transcranial magnetic stimulation]], although evidence for this is limited <ref name="NHStreat" /> ==Notable studies== *2011, Migraine headaches in [[chronic fatigue syndrome]] (CFS): comparison of two prospective cross-sectional studies.<ref name="Ravindran2011">{{Cite journal | last = Ravindran | first = Murugan K | last2 = Zheng | first2 = Yin | last3 = Timbol | first3 = Christian | last4 = Merck | first4 = Samantha J | last5 = Baraniuk | first5 = James N | authorlink5 = James Baraniuk | date = 5 Mar 2011 | title = Migraine headaches in Chronic Fatigue Syndrome (CFS): Comparison of two prospective cross-sectional studies|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058027/|journal=BMC Neurology|language=en|volume=11|issue=1|pages=|doi=10.1186/1471-2377-11-30|issn=1471-2377|pmc=|pmid=21375763|via=}}</ref> *2013, Migraine in [[Gulf War Illness|gulf war illness]] and [[chronic fatigue syndrome]]: Prevalence, potential mechanisms, and evaluation.<ref name="Rayhan">{{Cite journal | last = Rayhan | first = Rakib U. | last2 = Ravindran | first2 = Murugan K. | last3 = Baraniuk | first3 = James N.| date = 2013 | title = Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation | url =https://www.ncbi.nlm.nih.gov/pubmed/23898301|journal=Frontiers in Physiology|volume=4|pages=181|doi=10.3389/fphys.2013.00181|issn=1664-042X|pmid=23898301|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721020/ (Full Text)] *2016, Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the [[American Gut Project]] Cohort<ref>{{Cite journal | last = Gonzalez | first = Antonio | last2 = Hyde | first2 = Embriette | last3 = Sangwan | first3 = Naseer | last4 = Gilbert | first4 = Jack A. | last5 = Virre | first5 = Erik | last6 = Knight | first6 = Rob | date = Oct 18, 2016 | title = Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the American Gut Project Cohort|url=https://msystems.asm.org/content/msys/1/5/e00105-16.full.pdf | journal=American Society for Microbiology|volume=1|issue=5|pages=|via=}}</ref> [https://msystems.asm.org/content/msys/1/5/e00105-16.full.pdf (Full Text)] ==News and articles== *Oct 18, 2016, [https://www.theguardian.com/science/2016/oct/18/migraines-could-be-caused-by-gut-bacteria-nitrates-food-trigger-study-suggests Migraines could be caused by gut bacteria, study suggests]<ref>{{Cite web|url=http://www.theguardian.com/science/2016/oct/18/migraines-could-be-caused-by-gut-bacteria-nitrates-food-trigger-study-suggests | title = Migraines could be caused by gut bacteria, study suggests | last = Devlin | first = Hannah | date = 2016-10-18 | website = the Guardian|language=en|access-date=2018-08-11}}</ref> *May 19, 2018, [https://www.healthrising.org/blog/2018/05/19/migraine-drug-explosion-fibromyalgia-chronic-fatigue/ The Migraine Drug Explosion Begins: Could Fibromyalgia and ME/CFS Benefit?]<ref>{{Cite news | url=https://www.healthrising.org/blog/2018/05/19/migraine-drug-explosion-fibromyalgia-chronic-fatigue/ | title = The Migraine Drug Explosion Begins: Could Fibromyalgia and ME/CFS Benefit? - Health Rising | last = Johnson | first =Cort | date = 2018-05-19|work=Health Rising|access-date=2018-08-11|archive-url=|archive-date=|url-status=|language=en-US}}</ref> ==Learn more == *[https://www.nhs.uk/conditions/migraine/treatment/ Migraine treatment] - National Health Service *[https://www.nccih.nih.gov/health/providers/digest/dietary-supplements-for-headaches-science Dietary Supplements for Headaches: What the Science Says] - National Center for Complementary and Integrative Health == See also == * [[Headache]] * [[Magnesium]] * [[Analgesic]] (pain killer) ==References== {{reflist}} [[Category:Diagnoses]] [[Category:Neurological diseases and disorders]] [[Category:Potential comorbidities]] [[Category:Signs and symptoms]] [[Category:Pain signs and symptoms]] [[Category:Neurological signs and symptoms]]
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