Key Concepts

• Migraine is more than a headache: it is intensely painful and has distinct phases.
• The disorder used to be considered a vascular one, but recent research reveals it to be neurological, related to a wave of nerve cell activity that sweeps across the brain.
• The root of migraine may reside in brain stem malfunctioning.
• Although debate swirls about the precise cause of migraine, discoveries are already permitting the development of new treatments

For the more than 300 million people who suffer migraines, the excruciating, pulsating pain that characterizes these debilitating headaches needs no description. For those who do not, the closest analogous experience might be severe altitude sickness: nausea, acute sensitivity to light, and searing, bed-confining headache. “That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing,” wrote Joan Didion in the 1979 essay “In Bed” from her collection The White Album.

Historical records suggest the condition has been with us for at least 7,000 years, yet it continues to be one of the most misunderstood, poorly recognized and inadequately treated medical disorders. Indeed, many people seek no medical care for their agonies, most likely believing that doctors can do little to help or will be downright skeptical and hostile toward them. Didion wrote “In Bed” almost three decades ago, but some physicians remain as dismissive today as they were then: “For I had no brain tumor, no eyestrain, no high blood pressure, nothing wrong with me at all: I simply had migraine headaches, and migraine headaches were, as everyone who did not have them knew, imaginary.”

   
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