A migraine is not just "a bad headache." It's a chronic neurological condition that affects 1.3 billion people worldwide. The pain can be severe enough to make everyday life impossible.
With so many people suffering, there are plenty of companies trying to solve this. When I was working in the industry, multiple pharma companies were pouring resources into migraine treatments. I have no idea what breakthroughs have come out since then.
What Exactly Is a Migraine?
Migraine is characterized by throbbing headaches that worsen with movement. It's not just headache — it comes with photophobia (fear of light), phonophobia (fear of sound), nausea, and sometimes vomiting. It's a chronic neurological condition.
In plain terms:
- Pounding with your pulse — throbbing pain that beats with your heart
- One-sided — usually hits one side of your head
- Daily life stops — you're stuck lying down
- Movement makes it worse — even walking amps up the pain
- Nausea, light sensitivity, sound sensitivity — they come as a package deal
How Common Are Migraines?
| Category | Figure | Note |
|---|---|---|
| Global prevalence | ~1.3 billion | About 17% of world population |
| Disability ranking | 2nd | Per 2017 Global Burden of Disease study |
| Peak age group | 15-49 | Highest years lived with disability |
| Korean prevalence | ~17% | Roughly 1 in 5 adults |
One in five adults. More common than you'd think.
Types of Migraine
There are two main categories.
Episodic Migraine — Fewer Than 15 Days per Month
Lasts 4 to 72 hours, with worsening from routine activity, nausea/vomiting, and photophobia/phonophobia — at least one of these must be present. This is the "milder" type.
Chronic Migraine — 15+ Days per Month for Over 3 Months
More than half of those days (at least 8) must show migraine features. Headaches that respond to triptans or ergots also count toward the migraine day tally. Diagnosis criteria are more complex, and treatment is harder.
| Category | Episodic Migraine | Chronic Migraine |
|---|---|---|
| Frequency | < 15 days/month | 15+ days/month |
| Duration | 4-72 hours | 3+ months |
| Diagnostic criteria | Relatively simple | Complex |
| Treatment difficulty | Moderate | High |
Migraine Progresses in 4 Stages
- Prodrome — 1-2 days before the migraine. Mood changes, fatigue, stiff neck, food cravings, frequent yawning.
- Aura — Right before the migraine. Flashing lights or zigzag lines in your vision, sensory changes, speech difficulties. Lasts about 20-30 minutes.
- Headache phase — The main event. Throbbing, one-sided, nausea, light/sound sensitivity. This stage is absolute hell.
- Postdrome — After the headache fades. Fatigue, poor concentration, mood changes. Feels like post-battle exhaustion.
Migraine Causes — It's Not Just One Thing
The exact cause isn't fully understood. Multiple factors interact.
Genetic factors — 60-80% of migraine patients have a family history. My mother suffered from migraines too.
Neurological factors — Neurotransmitter imbalances, constriction and dilation of brain blood vessels, neuroinflammation. Recent research has identified CGRP (calcitonin gene-related peptide) as a key player in migraines, and drugs targeting it are now available.
Environmental factors — Stress (the most common), sleep pattern changes, hormonal changes, weather (barometric pressure, humidity), food (alcohol, caffeine, MSG), intense light/sound/smells.
Lifestyle factors — Irregular meals, lack of exercise, poor posture, prolonged smartphone/computer use. I'm guilty of most of these, so I can't really talk.
How Migraines Are Diagnosed
Primarily symptom-based, using the International Classification of Headache Disorders 3rd edition (ICHD-3).
Three key criteria:
- Headache lasts 4-72 hours
- At least 2 of: unilateral, pulsating, moderate-to-severe intensity, worsened by movement
- At least 1 of: nausea/vomiting or photophobia/phonophobia
If needed, imaging like CT or MRI can rule out other conditions. Keeping a headache diary also helps identify patterns.
Migraine Treatment
When a Migraine Hits (Acute Treatment)
OTC painkillers — Acetaminophen (Tylenol), ibuprofen (Advil/Taksen). Most effective when taken early.
Triptans — Migraine-specific drugs. They constrict blood vessels to relieve the headache. Injectable forms exist for severe vomiting.
CGRP antagonists — A newer class of drugs that address the shortcomings of triptans.
Preventing Migraines (Preventive Treatment)
Oral medications — Beta-blockers, antidepressants, anticonvulsants, calcium channel blockers, CGRP antagonists.
Injection therapy — Botulinum toxin (Botox), CGRP antagonist injections.
Non-drug treatments — Neuromodulation, biofeedback, cognitive behavioral therapy.
What You Can Do in Daily Life
Regular sleep, meals, and exercise. Stress management. Identify and avoid your personal triggers. Keep a headache diary.
When a migraine starts — take medication immediately, rest in a dark, quiet room, and drink plenty of water. If symptoms are severe or changing, see a healthcare provider.
Wrapping Up
Migraine is a complex neurological condition, not a simple headache. But treatment has come a long way. New drugs like CGRP antagonists are changing the landscape.
If you're suffering from migraines, seeing a specialist is a good idea. Though I've never actually seen one myself. That's probably why I'm still struggling.
In the next article, I cover my personal migraine experience. See you at My Life with Migraines.
This article is for general informational purposes and is not medical advice. If you have migraine symptoms, please consult a healthcare provider.