Migraine: What is it and how is it diagnosed

Migraine is caused by changes in brain processing signals, especially pain signals. It is thought as a network disorder with multiple cogs and factors working together to result in migraine.

Key features include:

• Increased sensitivity of pain pathways

• Altered signaling involving brain chemicals such as CGRP

• Changes in how the brain responds to normal sensory input

Migraine is not caused by brain damage, stress alone, or weak coping skills.

Yes.

Many people with migraine will have family members who also have migraine and headache disorders.

• Having a first-degree relative with migraine increases risk

• Genetics influence how sensitive the brain is to migraine triggers

• Inheritance is complex and involves many genes — there is no single “migraine gene”

The difference between episodic and chronic migraine is based on how often migraine occurs. It is important to distinguish between the two since treatment options differ between episodic and chronic migraine.

Episodic migraine

• Headache on fewer than 15 days per month

• Migraine attacks may be occasional or frequent

Chronic migraine

• Headache on 15 or more days per month, for at least 3 months

• At least 8 of those days are migraine days

• Headaches may feel less distinct over time

• Daily or near-daily symptoms are common

Yes.

Migraine can change over time, and factors that increase the risk of migraine becoming chronic include:

• Frequent inappropriately treated migraine attacks

• Overuse of acute pain medications

• Poorly controlled migraine triggers

• High stress or major life changes

• Lack of preventive treatment

Early and appropriate treatment can reduce the risk of progression, and for this reason the International Headache Society's position statement is to offer effective preventive treatment to eligible patients early.

Migraine triggers vary between individuals and may include:

• Irregular sleep

• Skipped meals

• Hormonal changes

• Stress (or stress let-down)

• Weather changes

• Sensory overload

Triggers do not cause migraine on their own — they interact with an already sensitive brain.

Neck pain is a common symptom during the migraine prodrome. For most people, it typically suggests that they are already in a migraine attack.

A phase after headache pain resolves, marked by:

• Fatigue or exhaustion

• Brain fog or slowed thinking

• Low mood or irritability

• Residual head or neck discomfort

This can last hours to a full day or longer.

• Rest and hydration

• Gentle activity

• Sleep

• Avoid overusing pain medication

Currently, most plans use step therapy with pre-authorization criteria.

Each insurance plan is different.

A headache diary helps identify patterns, triggers, and how well treatments work. It’s also valuable when talking with your clinician about preventive therapy. 

• Trial of at least two oral preventive medications

• Each at a therapeutic dose for ~3 months (varies by insurance)

• Documentation of migraine frequency and impact

Coverage varies by insurer.

Not always. Once stable, care can usually transition to your family doctor and they should continue any relevant renewals.

Yes.

Once you are taking a CGRP antagonist:

• No routine bloodwork or monitoring is required

• GP renewal is safe and appropriate

• Renewal is easier now with less paper-work and support programs are available to help family doctors with renewals.

If migraine worsens, side effects occur, pregnancy is planned, or treatment changes are needed. 

Yes.

With the right acute and preventive strategy, most people experience fewer attacks, less disability, and better daily function.