Dr. Alexandra Sinclair: 5 Factors That Increase the Likelihood of a Migraine Attack
Dr. Wala’a Hafez has long considered migraine one of the most mysterious neurological disorders in history. While physicians once dismissed it as merely severe headache or the result of psychological stress and suppressed emotions, recent research has fundamentally transformed our understanding of its mechanisms, paving the way for the development of treatments that target the disease’s root causes for the first time. According to an extensive report published by The Guardian, experts explain how medicine has shifted from centuries of speculation and superstition to an era of targeted therapies, offering patients genuine hope for controlling the condition and reclaiming their quality of life.
◄ What happens inside the brain?
Professor Alexandra Sinclair, Professor of Neurology at the University of Birmingham and President of the British Association for the Study of Headache, clarifies that migraine is not just a headache, but a complex neurological disorder arising from the activation of what is known as the “trigeminovascular system.” She states, “The trigeminal nerve is the largest sensory nerve in the head. When abnormally stimulated, it releases a chemical substance known as CGRP (Calcitonin Gene-Related Peptide), which activates pain centers in the brain and triggers a migraine attack, ranging from moderate pain to pain that is completely disabling in daily life.”
◄ Stages of a migraine attack
Physicians no longer view migraine as merely hours of headache; rather, it is a sequence of consecutive stages:
1. Prodrome: This phase may begin up to a day before the pain, and includes:
• Frequent yawning
• Fatigue and exhaustion
• Frequent urination
• Mood changes
• Cravings for specific foods, such as chocolate or cheese
Researchers note that this food craving is not a cause of the attack, as previously believed, but rather an early sign of the impending attack due to changes in brain activity.
2. Aura: This is a pre-headache condition, known as “aura,” affecting approximately 30% of patients. It may include:
• Visual disturbances (inability to tolerate light or sound)
• Numbness in the face or limbs
• Temporary difficulty speaking
3. Headache phase: This stage typically lasts between 4 and 72 hours, accompanied by:
• Pulsating pain, often on one side of the head
• Extreme sensitivity to light
• Sensitivity to sounds
• Nausea or vomiting
• A desire to lie down and avoid any stimuli
4. Postdrome phase: After the throbbing in the head subsides and the pain ceases, the patient may feel as though they have completed a marathon that drained their energy. This state can last up to two days, during which the patient experiences fatigue and difficulty concentrating, as if the brain requires a recovery period.
◄ Why does it affect women more?
Dr. Sinclair explains that data indicate women are more affected, suffering from migraine at a rate nearly double that of men. This is attributed to several intersecting factors, most notably:
• Hormonal changes
• Differences in brain sensitivity to pain substances
• Genetic predisposition
Attacks often peak during the most productive years of life, between puberty and menopause, making migraine a primary cause of reduced functional and social performance for many sufferers. The World Health Organization classifies migraine among the most disabling diseases globally, as its effects extend beyond pain to disrupt education, work, and family life. Experts emphasize that many patients still face social stigma, as migraine is often dismissed as “just a headache,” despite being a genuine neurological condition that can prevent sufferers from living their lives for consecutive days.
◄ What increases the likelihood of an attack?
Several factors may raise the probability of an attack in genetically predisposed individuals, including:
1. Lack of sleep or oversleeping
2. Dehydration and insufficient water intake
3. Psychological stress
4. Sudden cessation of caffeine consumption
5. Exposure to extreme heat
Regarding the use of phones and screens, scientific evidence remains inconclusive as to whether they are a direct cause of migraine, although many patients experience extreme light sensitivity during attacks.
◄ An unprecedented therapeutic revolution
Specialists describe the discovery of CGRP’s role as a turning point in migraine treatment. Instead of relying solely on painkillers or traditional medications, two new categories of treatments have emerged that target the biological cause of the attack directly:
• “Gepants,” which are tablets that block CGRP receptors.
• Monoclonal antibodies, usually administered via monthly injections to prevent attacks.
Experts confirm that these drugs have sparked a true revolution in migraine treatment over the past four or five years, reducing the frequency and severity of attacks for many patients. However, their high cost remains a challenge to accessibility for all.
◄ The right treatment makes the difference
Specialists stress that migraine is no longer the mysterious condition that baffles physicians. Science now understands the neurological mechanisms behind it and possesses more precise and effective treatments. However, experts assert that true success does not depend on medication alone, but also on rapid diagnosis, patient awareness, and facilitating access to specialized care, because the right treatment can be the difference between losing the ability to work and regaining a normal, productive life.
