The hallmarks of migraine: a paper and a wager

The story behind "Hallmarks of primary headache: part 1 – migraine"
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BioMed Central
BioMed Central BioMed Central

Hallmarks of primary headache: part 1 – migraine - The Journal of Headache and Pain

Background and aim Migraine is a common disabling conditions which, globally, affects 15.2% of the population. It is the second cause of health loss in terms of years lived with disability, the first among women. Despite being so common, it is poorly recognised and too often undertreated. Specialty centres and neurologists with specific expertise on headache disorders have the knowledge to provide specific care: however, those who do not regularly treat patients with migraine will benefit from a synopsis on the most relevant and updated information about this condition. This paper presents a comprehensive view on the hallmarks of migraine, from genetics and diagnostic markers, up to treatments and societal impact, and reports the elements that identify migraine specific features. Main results The most relevant hallmark of migraine is that it has common and individual features together. Besides the known clinical manifestations, migraine presentation is heterogeneous with regard to frequency of attacks, presence of aura, response to therapy, associated comorbidities or other symptoms, which likely reflect migraine heterogeneous genetic and molecular basis. The amount of therapies for acute and for prophylactic treatment is really wide, and one of the difficulties is with finding the best treatment for the single patient. In addition to this, patients carry out different daily life activities, and might show lifestyle habits which are not entirely adequate to manage migraine day by day. Education will be more and more important as a strategy of brain health promotion, because this will enable reducing the amount of subjects needing specialty care, thus leaving it to those who require it in reason of refractory condition or presence of comorbidities. Conclusions Recognizing the hallmarks of migraine and the features of single patients enables prescribing specific pharmacological and non-pharmacological treatments. Medical research on headaches today particularly suffers from the syndrome of single-disease approach, but it is important to have a cross-sectional and joint vision with other close specialties, in order to treat our patients with a comprehensive approach that a heterogeneous condition like migraine requires.

This was not the first time in which I coordinated a large effort on the Journal of Headache and Pain. Surely, this was the time in which I enjoyed more ... as the story begins and ends with a wager. 

The wager was to coordinate a complex task, in which the idea was to bring together a set of recognized experts in their respective fields, together with some "future experts", to get to a simple point: creating a "masterpiece" for migraine-related science. But also, creating a ground for a cultural position on the way in which migraine is approached. But also, combining different expertise and experiences, mixing that of recognized scientists and clinicians with that of people who are promising in their fields, the so called future experts. And, in the middle of this, we had to put together all of the knowledgeable about migraine. This could be quite complex, and boring: so, we turned it into a funny activity. And we did it.

Synthesizing a 47-page long paper is almost impossible, but here I wish to provide some ideas on the worth of this work. We decided that the idea behind the term "hallmarks" should not be strict, i.e. the most typical and distinctive sign and symptoms, but large: and we included issues related to personal impact, economic evaluation, workplace impact, pharmacovigilance...so not only a strict scientific and clinical paper, but a cultural one. Although simple, our conclusion on the most relevant hallmark of migraine, was that migraine has common and individual features together. The common ones basically include migraine clinical manifestations, i.e. unilateral location of headache, with pulsating quality, pain of moderate/severe intensity, which is aggravated by physical activity and associated to either nausea, photophobia or phonophobia. Apart from this, migraine is a land of heterogeneity, which likely reflects genetics and molecular bases, as well as the different exposure to environmental factors. All of this determines a variable response to treatments and the need to manage migraine with a multi-modal approach.

However, medical research on headaches particularly suffers from the syndrome of single-disease niche sub-specialties, determining a poor propensity for comparison among different disciplines and areas of intervention, including medical, behavioral and related to prevention in a public health perspective. The output of this monolithic approach is that research results might be brilliant, but yet lack a systematic project articulation. This is evident in the little to no interpretative vision of research findings, resulting in a reduced attractiveness of funding.

This is precisely the cultural value of the hallmarks of migraine paper: presenting an updated view on migraine knowledge with a paramount vision on the persons who suffer from it. Researchers and clinicians with an interest on migraine must have a cross-sectional and joint vision with other niche disease specialties and must stop relegating themselves to the role of fine technicians in the service of an organ or a function.

Presenting this view on migraine was our wager. We did it and we enjoyed while doing it: so enjoy reading as we enjoyed writing.

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Go to the profile of Paolo Martelletti
3 months ago

A seminal paper to be scattered everywhere in a still jeopardized scientific area. Great leadership of Alberto Raggi in coordinating 40 global authors.

Go to the profile of Alberto Raggi
3 months ago

Thank you prof. Martelletti: a great opportunity for me and for a fantastic group of authors!

Go to the profile of Wei Wang
3 months ago

Excellent work!

Follow the Topic

Headache
Life Sciences > Health Sciences > Clinical Medicine > Neurology > Neurological Disorders > Headache
Migraine
Life Sciences > Health Sciences > Clinical Medicine > Neurology > Neurological Disorders > Headache > Migraine

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