Most people would describe a headache as a dull pain, a feeling of pressure, perhaps accompanied by a stiff neck — an inconvenience, but not something requiring medical assistance. However, the more than one billion people who experience migraines and cluster headaches have a very different understanding. For them, a headache is a much crueller condition. Attacks strike repeatedly, each one capable of delivering unfathomable pain that lasts anything from minutes to days. These primary headache disorders are no mere annoyance — they are debilitating conditions which the medical community must do more to alleviate.
A lack of appreciation of the impact of migraines and cluster headaches has long been reflected in the funding made available for their study. Researchers are gradually gaining a better understanding of these conditions, but there are still many questions for which the answers are not clear. The reason certain people experience migraine attacks more frequently over time, for instance, is uncertain, although progress is being made to understand so-called chronification. Likewise, the factors that underpin the higher rate of migraines in women are under investigation, with hints emerging that more than just hormones are at play. And the link between pain and aura — the transient neurological disturbances, often visual in nature, that sometimes accompany a migraine — is coming under increasing scrutiny.
As the biology of headache disorders becomes clearer, clinical advances will surely follow. The arrival of therapies targeting calcitonin gene-related peptide and its receptor is rightly seen as a highlight of recent years, and many hope that the approach will yet yield greater benefits. But drugs alone will not address the shortcomings in the care currently afforded to people with headache disorders. Non-pharmaceutical therapies are attracting increasing attention for the treatment of paediatric migraines. And for people with cluster headaches, removing the barriers to getting an accurate diagnosis could have as great an impact as any drug.
We are pleased to acknowledge the financial support of Lundbeck in producing this Outlook. As always, Nature retains sole responsibility for all editorial content.