Although some people may present without migraineurs symptoms, the International Headache Society defines migraine without aura as five or more bouts of headache lasting four to 72 hours that have gone untreated or have been unsuccessfully treated, plus any two of the following: (a) moderate to severe intensity, (b) throbbing or pulsing, (c) aggravated by movement, and (d) unilateral, plus any of the following: (i) nausea or vomiting (ii) photophobia/phonophobia. It is a diagnosis of exclusion and history taking is pertinent, with the patient meeting the specified criteria per referenceable regional guidelines. These next-generation sequencing-based studies have accelerated the discovery of single locus mutations and mendelian inheritance patterns in the genes of people with some rare forms of inherited migraine variants such as familial migraine and hemiplegic migraine, particularly genes like SCN1A, CACNA1A, and ATP1A2, Furthermore, the diagnosis of migraine is made after excluding other causes of recurring headache such as a space-occupying lesion and intracranial aneurysm. The exact cause of migraine is unknown, but it is thought to be caused by a complex cascade of neurovascular disorders in the cranial nerve pain pathway, particularly the involvement of trigeminovascular neurons, issues with hypersensitivity of gated channels, and abnormal processing of signal transmission from perivascular neurons to the meninges or overexcitation of the brain's stem pain centers involving endogenous neurotransmitters such as calcitonin gene-related peptide (CGRP), substance P, pituitary adenylate cyclase-activating peptide, neurokinin A, and other vasoactive peptides. The role of genetics has been reported, with a significant percentage of migraine sufferers having a first-degree relative with migraine. With an estimated lifetime prevalence of 16% in the general population, migraine is the most common class of headaches encountered in persons seeking care for a headache, with a peak incidence between the 20s and mid-50s in age females are twice as likely as males to be afflicted, while boys in the pre-pubertal period are more likely to be affected. Epidemiologically, migraine has been described as amongst the world's third most common illnesses and the leading cause of disability in people aged 50 years or younger. Some migraine has also been associated with prodromal phases, pre, with, or post-head, with common prodromal symptoms characterized by neck stiffness, neck pain, food craving, hypo or hyperactivity, depression, and repetitive yawning. Aura is a complex neurological motor, sensory, or visual manifestation that appears a few minutes before or concurrently with the headache and lasts up to an hour with or after the headache. The International Classification of Diseases, Tenth Revision (ICD-10) classification of this headache includes migraine with aura, migraine without aura, status migrainosus, complicated migraine, and other types of migraine. In addition, in one of their latest update in 2020, the European Headache Federation classified it as refractory or resistant migraine. The American Headache Society is also in synchrony with the definition of this type of headache to be more than five attacks to include characteristics like unilaterality of pain, pulsation, aggravating factors like walking, as well as photophobia, phonophobia, nausea, and/or vomiting that must be present during the episodes of attack in the absence of any other etiological explanation. The International Society of Migraines described this headache as recurring with at least five episodes that persist for at least four to 72 hours when untreated or undertreated. Several schools of thought have classified this headache as pulsating, throbbing pain with varied efforts to construct consistently accepted diagnostic criteria. Migraine is a primary headache disorder, often manifesting as an acute or chronic neurological condition. Many people often term recurrent occurrences of headaches to be migraine.
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