Migraine.

ABSTRACT

This chapter presents an overview of migraine epidemiology and mechanisms. Migraine is a common and disabling neurologic disorder characterized by episodic attacks of severe head pain and other symptoms, including interference with activity, nausea, and sensitivity to light and sound. A number of risk factors for migraine onset and progression have been identified, including the presence of comorbid disorders and overuse of acute headache medications. Though the pathophysiology of migraine is complex and incompletely understood, advances in genetics research and clinical trials methodology offer promise for better understanding the underlying pathophysiologic mechanisms. These advances presently center on genomewide studies, development of antibodies targeting calcitonin gene-related peptide, and understanding the psychologic mechanisms that underlie the efficacy of some interventions. Studies of both pharmacologic and behavioral interventions for migraine and its common comorbidities also offer promise for understanding the neuroepidemiologic mechanisms of migraine. Clinical trials relevant to these mechanisms are reviewed, and methodologic considerations for future trials are discussed.