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Migraine, one of the most common conditions humans have been afflicted with, has been with us for thousands of years. First described in the Ebers papyrus, written in about 1500BC, St Paul is believed to have been a sufferer of this condition.

Migraine is a specifically human ailment with, as far as is known, no other animal being subject to it. It affects young and old and can last a lifetime. It can be a very disabling condition, interfering with our ability to perform our role in society to the fullest extent. It is estimated that in Europe alone, the condition accounts for €27 billion a year in lost productivity.

And yet it is all but ignored by health professionals. So what is this condition? And what makes it sorelevant to society today?

It is stated that migraine affects 15 per cent of the population, or about one billion people worldwide, with women more commonly affected than men. The original derivation of the name (hemi crania) refers to the not infrequent manifestation of headache that affects only half of the head; more frequently, the pain is much more diffuse, throbbing, worse in the morning, and may be associated with various other symptoms like nausea and vomiting.

Migraine accounts for €27 billion a year in lost productivity

More recently, it has been shown that migraine is also very common in childhood, affecting up to one in five children, starting even in babies as a colic of unexplained nature – often referred to by the confusing term of intestinal migraine.

In this group of patients, it often results in poor school attendance. It has been estimated that from the point of view of lost time and incapacity, migraine is not far removed from other more threatening conditions, including cancer.

And in spite of its overwhelming prevalence, and despite the plethora of theories adduced to explain it, we are still far from clear what precisely causes this condition and how to prevent and treat it.

It is postulated that there are usually two clear phases of a migraine attack. Firstly there is constriction of the arteries in and around the brain; this might lead to a phenomenon known as the aura, whereby the patient experiences a kaleidoscope of interweaving colours associated with the headache.

This can occur at night-time, resulting in disturbing dreams and nightmares. It is then followed by a phase of dilatation of the blood vessels, which presumably leads to swelling and oedema of the brain, sometimes accompanied by nausea and vomiting.

No doubt, these mechanisms are mediated by hormone activity, such as serotonin or even spread of abnormal electrical waves within the brain. Why some people are much more prone to migraine than others is also rather a mystery. However, it is well-established that there is a strong genetic component, and it is not unusual for children suffering migraine to have a parent who is also a sufferer.

Migraine shares similarities with other conditions, such as epilepsy and depression – often an accompaniment of any chronic, painful condition. Many drugs have been used to alleviate the symptoms of migraine with varying effect. The latest to be added to the armamentarium include the circadian rhythm-controlling drug melatonin.

As in most conditions where medical treatment may not be optimal, many sufferers resort to treatments that have not been proven scientifically to be effective. For instance, most scientifically-controlled, clinical trials have shown that acupuncture has, at best, only a placebo effect. Many other drugs obtainable over the counter have never been subjected to rigorous clinical testing.

If migraine was simply a nuisance headache, one perhaps could be taught to grin and bear it. However, recent evidence has shown that migraine has long-term effects on the brain with demonstrable pathology, including small areas of damage (micro-infarcts), in the white matter of the brain. This is the case particularly in patients with migraine associated with aura, indicating, perhaps, that the reduced blood supply can be a causative agent in this variety of migraine.

Research about the causes and treatment of this condition is going on apace, and it is to be hoped that this could result in a definite advance in the effective management of this all-too-human condition.