Understanding migraine

Abstract

Better characterisation of migraine is critical to enhancing its diagnosis, assessment and, ultimately, effective treatments. The aim of this thesis was to better characterise migraine through more detailed investigation of selected headache-related factors and to compare these factors with those seen in other commonly occurring recurrent headaches. The factors investigated in this thesis were neurochemical profile, cervical musculoskeletal impairments, and patient experience, represented by pain and disability characteristics, emotional state and other personal factors. This thesis provides deeper information regarding the nature and characteristics of migraine compared with non-migraine headaches (tension-type and cervicogenic headaches). This thesis has established the potential of GABA as a biomarker for migraine and implies the possible role of GABA in the disease process. This thesis has also characterised migraine according to cervical musculoskeletal impairments and patient experience embodying disability, pain, central sensitisation, and other personal factors. The implications for clinical practice are to assess cervical musculoskeletal impairments and patient experience to facilitate differential diagnosis and prognostication, and to educate patients on the nature of their headaches. Findings from the thesis may also be used by guideline developers, providing stimulus for further discussions on the definition of migraine and reporting of participant selection criteria, with reference to this definition, in clinical trials. Future research directions are identified in validating GABA as a migraine biomarker and elucidating its pathophysiology. By characterising migraine more fully, findings from this thesis will inform the development of effective treatments that could possibly target GABA or clinical characteristics found to be present in migraine. Ultimately this should achieve better health outcomes for people with migraine.