Headache

The pain and other symptoms of migraines and cluster headaches can add up to a lifelong disability — one that the medical community has not done enough to address.

The pain, the pressure, the way it ruins your mood — everyone has experienced a headache at one time or another. But whereas most are transient and easily managed, migraines are stubborn and debilitating.

Monoclonal antibodies and small-molecule antagonists that target CGRP or its receptor are already having a big impact on migraine. But they have the potential to do so much more.

Migraines are often associated with colourful visual disturbances called auras, but many mysteries remain about how they fit into the wider biology of the syndrome.

A new target for migraine treatments, electrical stimulation for cluster headache, and other highlights from clinical trials and laboratory studies.

Scientists are trying to work out why attacks become more and more frequent in some people — and how to reverse the process.

Misdiagnosis and lack of referral to specialists prevents people from getting the help they need.

Sex differences in migraine prevalence have been recognized for centuries, but researchers are still just beginning to understand the factors that put women at greater risk.

Neurologist Alexandra Sinclair explains why intracranial hypertension is a condition of concern — on this planet and beyond.

How researchers think about migraine in young people is shifting, offering hope for better long-term management of the condition.

Migraine is one of the world’s most prevalent diseases, and approximately 2% of the general population experiences chronic migraine. Edvinsson and colleagues argue that inflammation could have an important role in migraine chronification, through a mechanism termed neurogenic neuroinflammation.

Post-traumatic headache (PTH) is a common disabling consequence of mild traumatic brain injury. In this Review, Ashina et al. discuss possible pathogenic mechanisms of PTH, the research needed to improve our understanding, and drugs for prevention and treatment of persistent PTH.

Premonitory symptoms of migraine can start hours to days before the onset of headache. In this Review, Karsan and Goadsby discuss the phenotypes of these premonitory symptoms and the insights that they provide into the neurobiology of migraine.

In this Review, the authors describe the evidence for abnormalities in energy metabolism and mitochondrial function in migraine, consider the potential mechanisms and highlight treatments that affect metabolism. They conclude that migraine is a conserved adaptive response that helps to restore brain energy homeostasis.

Migraine is prevalent in the paediatric population and represents a major cause of disability. This Review outlines the epidemiology and natural history of paediatric migraine, discusses the recent landmark clinical trials of treatments for paediatric migraine and examines the best evidence-based interventions for this population in light of these new findings.

Cluster headache is characterized by unilateral headaches associated with ipsilateral autonomic features, such as lacrimation and rhinorrhoea. This Primer by May et al. discusses the pathophysiology, diagnosis and management of cluster headache in addition to the quality-of-life issues faced by patients.

Historically, preclinical pain research has been dominated by studies in male subjects. Jeffrey Mogil describes recent trends towards the inclusion of male and female subjects in research and the subsequent identification of qualitative sex differences in the mechanisms of pain processing.