10 October 2025, Friday

What is Migraine?

Migraine is a primary neurological disorder characterized by recurrent unilateral, pulsating headaches of moderate or high intensity, often accompanied by nausea, photophobia, and phonophobia.
According to the European Academy of Neurology (EAN), migraine is a disease with well-defined neurobiological mechanisms, and not merely a “response to stress” or “unhealthy lifestyle.” It is associated with hyperexcitability of the central nervous system, sensory filtering disturbances, and involvement of the trigeminovascular system.

 

Causes and Pathogenesis

Migraine has a genetic and neurovascular basis.

Key mechanisms include:

• Cortical Spreading Depression (CSD) — a wave of depolarization in the cerebral cortex, especially in migraine with aura
• Activation of the trigeminovascular system
• Release of neuropeptides, especially CGRP (Calcitonin Gene-Related Peptide), leading to vasodilation, neurogenic inflammation, and pain signaling

Risk factors and triggers:

• Genetic predisposition
• Female sex (3 times more frequent than in males)
• Menstrual cycle, hormonal fluctuations
• Stress, sleep disturbances
• Use of alcohol, caffeine, monosodium glutamate
• Fasting, strong odors, sensory overload

 

Classification and Types

According to the International Classification of Headache Disorders (ICHD-3, 2020), the following forms are distinguished:

1. Migraine without aura (up to 75% of cases)

•    Unilateral, pulsating pain that worsens with physical activity
•    Duration: 4–72 hours
•    Associated symptoms: nausea, photophobia, phonophobia

2. Migraine with aura

•    Aura precedes or accompanies the headache
•    Symptoms: visual phenomena (flashes, zigzags), paresthesias, aphasia
•    Aura duration: 5–60 minutes

3. Chronic migraine

•    ≥15 days of headache per month, of which ≥8 fulfill migraine criteria
•    Duration: ≥3 months

 

Diagnosis

Diagnosis is clinical, based on ICHD-3 criteria. MRI of the brain is indicated in atypical presentation or when secondary headache is suspected.

Diagnostic criteria (ICHD-3):

•    At least 5 attacks meeting the following criteria:

• Duration: 4–72 hours
• At least 2 of the following: unilateral location, pulsating quality, moderate/high intensity, aggravation with physical activity
• At least 1 of: nausea/vomiting or photophobia and phonophobia

Modern Treatment (According to EAN and NICE Guidelines)

1. Acute treatment (attack relief)
2. Preventive migraine therapy

Indications for preventive therapy:

• ≥4 attacks per month
• Reduced quality of life
• Adverse effects or low efficacy of acute treatment
• Chronic migraine

Botulinum toxin type A (Botox®):

• Indicated for chronic migraine (≥15 days/month)
• Efficacy confirmed by PREEMPT trials
• Administered every 12 weeks

Non-Pharmacological Approaches

• Cognitive behavioral therapy, biofeedback
• Trigger reduction: regular sleep, stable diet, stress reduction
• Moderate physical activity (proven to reduce attack frequency)
• Acupuncture – limited efficacy, may be used as adjunctive therapy

 

When to See a Doctor

• If headaches occur ≥4 times per month
• If standard analgesics are ineffective
• In the presence of severe nausea, vomiting, photophobia, or phonophobia
• If quality of life or work ability is impaired
• In case of sudden onset of “the worst headache of your life” (exclude subarachnoid hemorrhage)

Migraine is a neurobiological disease requiring a comprehensive approach and personalized therapy. Modern medicine offers effective strategies — from triptans and preventive medications to targeted monoclonal antibody therapy. Accurate diagnosis and early treatment can significantly reduce the frequency and severity of attacks, improving the patient’s quality of life.

 

Neurological Services & and botox injections in «VitaMed» MC (Yerevan, Charentsavan, Stepanavan)

 

Migraine treatment with botox injections	120.000 AMD
Initial consultation with a neurologist, including repeated consultation within 10 days	12.000 AMD
Initial online consultation with a neurologist, including repeated consultation within 10 days	10.000 AMD
Repeated consultation with a neurologist (3rd visit)	6.000 AMD