Glossary

Migraine Glossary

 

A

Abdominal migraine – a migraine seen most often in children. It presents with gastrointestinal episodic attacks of abdominal pain and/or discomfort, nausea and/or vomiting, The attacks may occur infrequently, chronically or at predictable intervals.

 

Abortive (acute) medications – medicine which is taken at the time of initial symptom onset. The aim of this treatment is to stop the progression of the migraine attack.

 

Acute – sudden, abrupt onset

 

ACT (Acceptance and Commitment Therapy) – often paired with Mindfulness based therapy, is a psychological technique which aims to develop psychological flexibility. It combines mindfulness skills with the practice of self-acceptance. In ACT, a person commits to facing the problem rather than avoiding stresses. Often ACT therapy is encouraged as part of a holistic approach to migraine management.

 

Agonist (receptor)  – a substance that activates a receptor. An antagonist is the opposite.  Triptans, for example, are selective serotonin receptor agonists. They stimulate serotonin, a neurotransmitter found in the brain to reduce inflammation and constrict blood vessels, thus relieving the migraine attack.

 

Aimovig (Erenumab) – Monoclonal antibody used as a migraine preventative. It is an inhibitor (a substance which blocks the action) which attaches to the CGRP receptor. As at Jan, 2020, Novartis (the company marketing Aimovig in Australia) withdrew its application to have the medication listed on the PBS.

 

Ajovy (Fremanezumab) – Monoclonal antibody used as a migraine preventative. It is an inhibitor (a substance which blocks the action) which attaches to the CGRP peptide (small protein). Available in Australia as a subcutaneous injection.

 

Alice in Wonderland Syndrome (AIWS) – Named after the story character, it is believed to be a type of migraine aura in which a person has episodes of distorted perception of body size.

 

Analgesic – pain relief medicine which may be bought over the counter or by prescription.

 

Antagonist – see also agonist. A substance that blocks or acts against a receptor. It reduces or stops a biological response. The CGRP class of medications are antagonists – they act against the expression of CGRP.

 

Antiemetic – a medication used to treat nausea and vomiting. Examples include: Stemetil (Prochlorperazine); Maxolon (Metoclopramide); and Zofran (Ondansetron).

 

Ataxia – difficulty with muscle co-ordination during voluntary movement. This can affect things like walking, speech and swallowing for example.

 

Aura – Fully reversible, visual, sensory or other CNS (central nervous system) symptom(s) that are usually followed by headache and associated migraine symptoms. Auras occur in up to 20% of migraine patients. Aura may include changes in vision, speech, smell or cognition. Some people may experience numbness, weakness or vertigo.

 

B

Brainstem migraine – also called Migraine with Brainstem Aura (ICHD-3 preferred term), previously known as Basilar Artery Migraine; Basilar Migraine; Basilar-type Migraine. This migraine with aura has a range of symptoms which may include: blurred vision, decreased consciousness, ataxia, slurring of speech, sensory changes on both (bilateral) sides of the body and vertigo.

 

Botox –   is used as a preventative treatment for chronic migraine by blocking activation of nociceptive (pain) pathways and decreasing various pro-inflammatory neurotransmitters. Treatment consists of a set of small injections into 31-39 sites in 7 muscles of the head and neck. 

 

C

CBT (Cognitive behaviour therapy) – also known as CBMT (Cognitive behaviour modification therapy) – a type of psychotherapy which aims to help change unhelpful or unhealthy ways a person thinks, feels and reacts. It encourages positive, healthy coping strategies. Often used as part of a holist approach in the management of migraine.

 

CGRP (Calcitonin gene-related peptide) – a neuropeptide (small protein found in the brain and elsewhere) which plays a central role in the pathophysiology of migraine.

 

CGRP monoclonal antibody (CGRP mAb) – a new class of medications used as preventative treatment for migraine. As at August, 2020, three medications in this class are available in Australia: Aimovig ( Erenumab) produced by Novartis; Ajovy (Fremanezumab) produced by Teva; and Emgality (Galcanezumab) produced by Eli Lilly. Each of these is administered monthly (or may be quarterly in the case of Ajovy) by intramuscular injection. A fourth, Vyepti (Eptinezumab) by Lundbeck, is administerd by IV infusion and is not yet available in Australia.

 

Chronic migraine – is defined as being when a person has headache at least 15 days per month with 8 of those being migraine days, over a period of 3 months.

 

Complimentary treatments – treatments used alongside standard medical treatment e.g.: acupuncture; vitamins; and relaxation techniques.

 

Comorbid – co-existing. When a patient has more than one condition at the same time.

 

Cortical spreading depression – this is a pathophysiological event that is thought to be present in several transient neurological disorders, including migraine and its variants. It is a slowly propagating wave of changes in brain electrical activity. Sometimes called spreading depolarization. It is thought that an initial increase, then sustained decrease in electrocortical activity and associated initial vasodilation and then prolonged vasoconstriction may be part of migraine. Recently some authors are questioning the role of CSD in migraine.

 

CT scan – computerized tomography scan. An imaging procedure uses x-rays and digital computer technology to provide detailed two and three-dimensional pictures which can help to identify issues and aid with diagnosis. This type of scan can make an image of every type of body structure at once, including bone, blood vessels and soft tissue.

 

D

Diagnosis of exclusion – when there is no specific test for a condition, other possibilities are ruled out.

 

Differential diagnosis – sometimes several conditions share common signs and symptoms. This is the process of distinguishing between these conditions to make a correct diagnosis.

 

Diplopia – double vision. When a person sees a double image where there should only be one. The two images can be side by side, on top of one another, or both.

 

Ditans – are a new class (serotonin 5-HT1F receptor agonists) of migraine abortive medications. They are different to the triptan class in that they do not have vasoconstricting effects. As at August, 2020, Lasmiditan (Reyvow) produced by Eli Lilly is the only ditan. It is not yet available in Australia.

 

E

Emgality (Galcanezumab) – A CGRP monoclonal antibody used for the preventative treatment of migraine. Available in Australia as a monthly subcutaneous injection.

 

Episodic migraine – Migraine attacks which occur on 14 or less days per month.

 

Ergotamine – Ergotamine and the related drug DHE (dihydroergotamine) are among the oldest migraine medications. This class of medications may also be known as: ergots, ergot derivatives, and ergot alkaloids. They act by attaching to specific serotonin and dopamine receptors in the brain. This class of medications, while available in Australia, has limited use; often only administered via IV in a hospital setting.

 

G

Gepant – Small molecule CGRP antagonists (about 500 times smaller than CGRP monoclonal antibodies) which are used to abort a migraine attack. As at August, 2020, no medications of this class are available in Australia. However, the following are available in the United States: Ubrelvy (Ubrogepant) by Allergan; and Nurtec (Rimegepant) by Biohaven. Atogepant (Allergan) and Vazegepant (Biohaven) are in various trial stages.  

 

H

Hemipariesis – weakness on one side of the body

 

Hemiplegia – paralysis on one side of the body

 

Hemiplegic Migraine – a rare migraine sub-type with aura. It causes temporary weakness or paralysis on one side of the body. Speaking and swallowing may also be affected. Familial hemiplegic migraine (FHM) is caused by specific genetic mutations.

 

Hyperosmia – an over-sensitivity or intolerance to odours.

 

I

ICHD -3 (International Classification of Headache Disorders, 3rd edition) – An international guide for the diagnosis and classification of headache disorders. https://ichd-3.org/

 

Ictal and Interictal stages – Ictal is used to refer to the period of actual migraine attacks. Interictal refers to the period between attacks.

 

M

Medication Overuse Headache – an alternative term could be Medication Adaptation Headache or Medication Response Headache. Previously called rebound headache. A headache caused by a cycle of pain and overuse of pain relief medications or triptans.

 

Migraine with aura – (previously called: classic migraine) sensory disturbances occur before a headache begins

 

Migraine without aura – (previously called: common migraine) there is no aura present before a migraine headache attack occurs

 

Mindfulness – psychological techniques used to enhance moment-to-moment awareness of one’s experience without judgment. The aim is to be fully present, but not reactive or overwhelmed by circumstance. Often makes use of meditation practices.

 

Monoclonal Antibody – An antibody (a protein produced in the body to fight against substances) which is a clone developed from a single, specific cell which, in turn, binds to a selected, precise substance. The anti-CGRP medications are monoclonal antibodies. See also CGRP.

 

MRI – magnetic resonance imaging. A medical imaging procedure which uses a magnetic field to produce high resolution images in 2 or 3D.

 

N

Neurotransmitter – chemical molecules which are produced (released) by neurons (nerve cells) to transmit messages from cells of the body to target cells (in muscles, glands, or other nerves, including the brain). Examples of neurotransmitters include Dopamine; Serotonin; Endorphins; Gamma-aminobutyric acid (GABA); Epinephrine; and Acetylcholine.

 

Nociception – the experience of pain caused by noxious stimuli, be they mechanical, chemical or thermal in nature.

 

NSAIDS (Nonsteroidal anti-inflammatory drugs) – are often used both as acute medications and preventative treatment for migraine. Examples in this class include: Aspirin; Ibuprofen; Naproxen; and Celecoxib.

 

O

Opiods – a class of pain-relieving drugs resembling opium. Drugs in this class include codeine, oxycodone and morphine.

 

P

Photophobia – an intensified sensitivity and/or intolerance to light. Photophobia is very common with migraine. Light may contribute to precipitating an attack in some people.

 

Photopsia – is a distortion or change in the visual field. A migraine aura may be one cause.

 

Postdrome – the last phase of a migraine attack. Some symptoms continue after the headache dissipates. They may be anywhere in the body and last over several days. Examples include sensitivity to touch, aches and stiffness, fatigue and mental fogginess.

 

Prodome – the first phase of a migraine attack. A medical term for early signs or symptoms, prior to actual headache. This phase may last hours or days and people may learn to sense these early feelings, avoid any known triggers, take any recommended medication and relax. Symptoms may vary for each person, and may change over time for each person. They may include things like difficulty concentrating at the usual level, feeling of low mood, being irritable, sensitivity to lights and sound, or fatigue.

 

Prophylactic (Preventative) – a medicine that is used daily (or on a regular basis) as a preventative of migraine attacks.

 

R

Receptor – a molecule or cell that recognises receives or binds to a specific chemical or stimulus.  

 

Refractory migraine – This is not a term officially listed in the ICHD-3. However, it is used to describe migraine which is unresponsive or difficult to treat. It causes significant impairment to quality of life.

 

Retinal migraine – Repeated attacks of monocular visual disturbance, including scintillations, scotomata or blindness, associated with migraine headache.

 

S

Scintillating scotoma – a common visual aura which may include temporary partial loss of vision. Often presents as bright flashing lights.

 

Stages (Phases) of a migraine attack – Prodrome (premonitory), Aura, Attack (headache), Postdrome

 

Status Migrainosus – also known as intractable migraine or Status Migraine. This is a persistent, intense migraine attack lasting over 72 hours.

 

T

Tinnitus – ringing or other sound in the ears.

 

Triggers – some people can notice things which may initiate a migraine attack. Examples may include lights, dehydration, alcohol, changes to sleep patterns, particular foods and vigorous exercise.

 

Triptans – the “gold standard” for treating acute migraine attacks. Triptans are selective serotonin receptor agonists which means they stimulate serotonin (a neurotransmitter in the brain) to reduce inflammation and constrict blood vessels, and alleviate the migraine attack. 7 triptans are available in Australia. Each has slightly different properties and each person reacts differently to them: Almotriptan (Axert); Eletriptan (Relpax); Frovatriptan (Frova); Naratriptan (Amerge); Rizatriptan (Maxlt); Sumatriptan (Imitrex); and Zolmitriptan (Zomig). Care should be taken in the use of triptans to avoid medication overuse headache.

 

V

Vertigo – a sense of dizziness or that you or your surroundings are spinning. Often associated with Vestibular Migraine.

 

Vestibular Migraine – a type of migraine which includes vertigo, dizziness or balance problems with other migraine symptoms.

 

Visual snow syndrome (VSS) – characterized by continuous visual snow (VS), i.e., tiny flickering dots in the entire visual field (resembles a badly tuned television). Additional visual symptoms, such as photophobia and palinopsia ("afterimages" and "trailing") are often present.

 

Vyepti (Eptinezumab) – a CGRP monoclonal antibody (blocker) used for migraine prevention. Vyepti is administered quarterly by IV infusion. It is not available in Australia as at August, 2020, but is available in other parts of the world.

 

Z

Zofran – brand name for Ondansetron. Used as an antiemetic.

 

 

Further reading:

More information about types of migraine.

More information about treatment options.

 

 

 

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  • Alissa Gigliotti
    published this page in Resources 2020-12-19 15:44:41 +1100