Migraine
Recurrent attacks of moderate-to-severe headache with nausea, light/sound sensitivity, lasting 4–72 hours. Affects ~14% of adults, women 3× more than men. The lab role is small: rule out anaemia, iron deficiency, thyroid, and (in older onset) inflammatory headache mimics.
What it is
Migraine is a recurring neurological disorder of episodic headache attacks driven by trigeminovascular activation and central sensitisation. Attacks last 4–72 hours, typically unilateral and pulsating, moderate to severe, worsened by physical activity, and accompanied by nausea / vomiting / photophobia / phonophobia. ~30% of patients experience aura — transient visual, sensory or speech symptoms preceding the headache. Migraine is the second-leading cause of years-lived-with-disability worldwide. Common triggers include sleep deprivation, missed meals / dehydration, hormonal cycle (especially perimenstrual), specific foods (aged cheese, processed meat, red wine), stress let-down, and bright/flickering light. Lab evaluation is limited — there's no migraine-specific marker — but reversible contributors should be screened.
Key lab markers
- Haemoglobin, ferritin — iron deficiency / anaemia worsens migraine; treatable contributor.
- TSH — both hypo- and hyperthyroidism increase headache frequency.
- Magnesium — low magnesium associated with migraine; supplementation has modest evidence.
- Vitamin D — deficiency linked to higher migraine frequency.
- CRP / ESR — non-specific but if new headache after 50, consider giant cell arteritis (P0 mimic).
- Imaging (MRI brain) — not routinely needed for typical migraine; ordered if red-flag features.
Symptoms
- Unilateral or bilateral moderate-to-severe throbbing headache
- Nausea, sometimes vomiting
- Photophobia, phonophobia
- Worsening with physical activity
- Aura: visual zigzags / flashing lights / blind spots, tingling, speech disturbance (typically 5–60 min before headache)
- Post-attack 'hangover' — fatigue, cognitive fog (sometimes 24+ hours)
When to discuss with a doctor
Headaches that interfere with daily life, ≥4 days/month, or escalating severity warrant primary care visit. Red flags requiring urgent assessment: sudden 'thunderclap' headache (subarachnoid haemorrhage), new headache after 50 (giant cell arteritis, mass lesion), headache with fever / neck stiffness (meningitis), headache with focal neurological deficit / confusion (stroke, mass), pregnancy + headache + hypertension (pre-eclampsia). Migraine treatment is two-tracked: acute (triptans, NSAIDs, anti-emetics) + preventive (when ≥4 attacks/month — propranolol, topiramate, amitriptyline, or modern CGRP-targeting agents). Mediora.AI screens the contributory labs; migraine diagnosis and treatment are neurology / GP.