Migraine is a disease that spares no civilization , there are testimonies from the beginnings of written history. Which was a handicap for Caesar, Kant or Freud, but also a daily reality in the lives of millions of anonymous people.
In the second century CE, Arete described heterocrania causing “ unseemly and excruciating symptoms, nausea; vomiting of bilious matter; the collapse of the patient ” and describes the latter as a patient plunged into a great torpor of anguish (Sacks et al. 1999).
The term heterocrania was used for centuries before the designation "hemicrania" prevailed, referring to a unilateral evil. Gradually, the term “megrim” supplanted hemicrania, then evolved into “migraine”, a term that we still use today.
Not just a headache
It is noted through the evolution of this nomenclature, that the emphasis is particularly placed on headaches. However, the term migraine does not take into account the complexity of this pathology . Headache is a symptom that is not necessary for its diagnosis. Indeed, the migraine complex encompasses all kinds of distinct syndromes that involve both the central, peripheral and autonomic nervous system.
During a migraine attack, the whole brain seems to go into a state of transient hyperexcitability. Headache is the most common symptom of common migraine, around which gathers a whole range of other symptoms such as nausea, vomiting, abdominal pain, or mood changes...
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Epidemiology of migraine: precise diagnostic criteria
The development of diagnostic criteria for migraine by the International Headache Society (IHS) (ICHD-3 2018) has made it possible to define this condition more precisely, which is subdivided into two main clinical forms: migraine without aura , where the clinical is dominated by headache attacks with specific characteristics, and migraine with typical aura .
The other clinical forms of migraine are less frequent and often require additional imaging examinations. These are migraine with brainstem aura (or basilar migraine), hemiplegic migraine, retinal migraine, and chronic migraine.
The complications of migraine also constitute very varied clinical pictures: persistent aura without infarction, migraine infarction, or even epilepsy (Ducros 2006). The complexity of migraine diagnosis lies above all in the exclusion of more serious pathologies that can reproduce similar signs. The importance of an in-depth clinical examination is therefore essential and first and foremost requires a study of the patient's behavior.
During an attack, the migraine patient seeks calm, darkness, a lying position. Some headaches such as intracranial hypertension are, for example, aggravated by lying down, while others, on the contrary, appear in an upright position and are relieved in decubitus, as is the case for hypotension of the cerebrospinal fluid (Géraud 2015) .
In the case of vascular pain of the face , the patient is restless and rest does nothing to alleviate his pain (May et al. 2018). These observations and an evolution by crisis, make it possible to direct the practitioner on a diagnosis of migraine. Thereafter, the clinical examination must be deepened by a neurological assessment and particularly by an examination of the fundus , looking for hemorrhage or papilledema (Géraud 2015; Lanteri-Minet et al. 2013) .
The search for oculomotor paralysis, loss of sensitivity or balance makes it possible to refine the examination. Finally, the diagnosis of migraine is made by progressive exclusion of other primary or secondary headache pathologies.
In case of doubt, a cerebral scanner and a lumbar puncture will make it possible to exclude a vascular or infectious origin.
2nd most disabling pathology in the world
In France, the rate of migraine sufferers has been evaluated at between 8 and 11% of the population if we consider “strict” migraine , that is to say corresponding precisely to all the criteria for migraine, but if the Migraine is considered “probable” , which meets all but one of the criteria, the prevalence can reach up to 20% (Stovner et al. 2007; Lanteri-Minet et al. 2013). This places headaches in second place in the world for the most debilitating pathologies of all sexes combined (Davoine 2016). This prevalence seems stable over time, but varies according to geographical origins.
The prevalence is highest in Europe and North America , followed by Africa and South America, and lastly Asia (Géraud 2015). These differences can be explained culturally and by genetic factors. Within the same population, female predominance for migraine is always found. In adulthood, the ratio by sex is 1 affected male for 3 females (Lanteri-Minet et al. 2013). However, this female predominance does not appear until after puberty, suggesting an important role for hormones (Todd, Lagman-Bartolome, and Lay 2018).
The variability of migraine prevalence is also reflected in its increase in the first part of life , with a maximum of migraine patients between 30 and 50 years old (Géraud 2015). This also explains the significant socio-economic impact of migraine, because it mainly affects the active population. The direct and indirect expenses linked to absenteeism for migraine represent a public health cost of more than 40 billion euros on a European scale in 2010 (Gustavsson et al. 2011).
In addition to the economic cost due to professional absence, the impact on the quality of life is also considerable. In 2016, an analysis evaluating the impact on quality of life of 328 pathologies ranked migraine second (Vos et al. 2017).
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Davoine, Dr ELISE. 2016. “Migraine: from general recommendations to practical management”. SWISS MEDICAL REVIEW , 5. Ducros, A. 2006. “Migraine”. EMC - Neurology 3 (1): 1‑15. https://doi.org/10.1016/S0246-0378(06)39459-6. Geraud, Gilles. 2015. Headaches in 30 lessons . Elsevier Masson. Ebreges. Gustavsson, Anders, Mikael Svensson, Frank Jacobi, Christer Allgulander, Jordi Alonso, Ettore Beghi, Richard Dodel, et al. 2011. “Cost of Disorders of the Brain in Europe 2010”. European Neuropsychopharmacology 21 (10): 718-79. https://doi.org/10.1016/j.euroneuro.2011.08.008. ICHD-3. 2018. “Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd Edition.” Cephalalgia 38 (1): 1‑211. https://doi.org/10.1177/0333102417738202. Lanteri-Minet, M., D. Valade, G. Géraud, C. Lucas, and A. Donnet. 2013. “Diagnostic and therapeutic management of migraine in adults and children”. Neurological Review 169(1): 14‑29. https://doi.org/10.1016/j.neurol.2012.07.022. May, Arne, Todd J. Schwedt, Delphine Magis, Patricia Pozo-Rosich, Stefan Evers, and Shuu-Jiun Wang. 2018. “Cluster Headache.” NatureReviews. Disease Primers 4: 18006. https://doi.org/10.1038/nrdp.2018.6. Sacks, Oliver. 1999. Migraine . Edition of the Threshold. Paperback. New York: Vintage. Stovner, Lj, K. Hagen, R. Jensen, Z. Katsarava, Rb Lipton, Ai Scher, Tj Steiner, and J.-A. Zwart. 2007. “The Global Burden of Headache: A Documentation of Headache Prevalence and Disability Worldwide.” Cephalalgia: An International Journal of Headache 27 (3): 193-210. https://doi.org/10.1111/j.1468-2982.2007.01288.x. Todd, Candice, Ana Marissa Lagman-Bartolome, and Christine Lay. 2018. “Women and Migraine: The Role of Hormones.” Current Neurology and Neuroscience Reports 18(7):42. https://doi.org/10.1007/s11910-018-0845-3. Vos, Theo, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M. Abbas, Foad Abd-Allah, Rizwan Suliankatchi Abdulkader, et al. 2017. “Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 328 Diseases and Injuries for 195 Countries, 1990–2016: A Systematic Analysis for the Global Burden of Disease Study 2016.” The Lancet 390 (10100): 1211-59. https://doi.org/10.1016/S0140-6736(17)32154-2.
