Migraine is a chronic neurological disorder characterized by recurrent attacks of pain that generally impair the quality of life.

The pain is severe, throbbing and usually on one side of the head. The severity of the pain, duration of the headache, and frequency of attacks are variable. A migraine lasting longer than 72 hours is termed status migrainosus.

Migraine is a paroxysmal disorder with a natural fluctuation between a low and a high frequency pattern in part influenced by modifiable (such as lack of a regular diet and physical activity, obesity) and non-modifiable risk factors (age and gender). Increased attack frequency can lead to the so-called ‘chronic migraine’ (CM), which then becomes less responsive to acute as well as prophylactic migraine medications.

There are four possible phases to a migraine, although not all the phases are necessarily experienced:

  • the prodrome, which occurs hours or days before the headache
  • the aura, which immediately precedes the headache
  •  the pain phase, also known as headache phase
  • the postdrome, the effects experienced following the end of a migraine attack

Its etiology is far from resolved. There is some evidence that migraine is an inherited condition. Migraine affects over 15% of the general population, with around 10% of migraine patients suffering from weekly attacks.

Obesity

The relationship between migraine and obesity is complex and still unclear, as the two conditions share some pathogenic determinants and may influence one another. Recent studies suggested a potential role of obesity on migraine outcomes. Obesity occurs with several chronic pain syndromes. Obesity and migraine are both highly prevalent disorders in the general population. An increasing number of reports suggest that obesity is a risk factor for migraine progression and migraine frequency in adults as in children.

Antiphospholipid syndrome

Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by the presence of arterial or venous thrombosis.

In APS patients, the most common venous event is deep vein thrombosis of the lower extremities, and the most common arterial event is stroke. In pregnant women affected by APS, there is an increased risk of recurrent miscarriage, intrauterine growth restriction, and preterm birth.

Other common findings, although not part of the APS classification criteria, are low platelet count, heart valve disease, and livedo reticularis (skin finding that appears as a lace-like purplish discoloration of the skin). There are also associations between antiphospholipid antibodies (a group of antibodies that are detected in the serum of patients with a variety of conditions, including autoimmune disorders) and headaches, migraines, and oscillopsia (a visual disturbance).

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