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Debates on Migraine

Editors: Messoud Ashina and Paolo Martelletti

Migraine pathophysiology is complex and many unanswered questions remain regarding the pathogenesis of migraine. Debates on complex scientific questions are important because they stimulate critical thinking and future directions. In a series of Oxford Union-style debates (for or against the motion), three topics were discussed at the 1st International Conference on Advances in Migraine Sciences (ICAMS 2022) held in Copenhagen, Denmark.

The Premonitory Phase of Migraine is due to Hypothalamic Dysfunction: Some people with migraine report non-headache symptoms before the onset of pain, commonly referred to as the premonitory (or prodromal) phase of migraine. It remains unclear whether any specific symptoms or biological processes are characteristic of this phase. 

Migraine Attacks are of Peripheral Origin: The mechanisms that initiate a migraine attack are unknown. Some evidence favors a peripheral origin, whereas other data suggest the origin is within the central nervous system. 

Migraine and Cluster Headache Are Two Distinct Disorders: The distinction between migraine and other primary headache disorders is substantiated in the diagnostic criteria, but some evidence suggest overlapping pathophysiological mechanisms. 

In this Series, we present key data for or against these motions, summarise lessons learned and provide future direction. For each individual review article, there is a video recording of the debate itself and a visual abstract.

  1. Women are disproportionately affected by migraine, representing up to 75% of all migraine cases. This discrepancy has been proposed to be influenced by differences in hormone levels between the sexes. One such...

    Authors: Aida Maddahi, Karin Warfvinge, Anja Holm, Jacob C. A. Edvinsson, Philip Victor Reducha, Spyridoula Kazantzi, Kristian A. Haanes and Lars Edvinsson
    Citation: The Journal of Headache and Pain 2023 24:154
  2. Tension-type headache (TTH) and migraine are two common primary headaches distinguished by clinical characteristics according to the 3rd edition of the International Classification of Headache Disorders. Migraine...

    Authors: Dilara Onan, Samaira Younis, William David Wellsgatnik, Fatemeh Farham, Saulius Andruškevičius, Ana Abashidze, Asel Jusupova, Yuriy Romanenko, Oxana Grosu, Meerimgul Zamirbekovna Moldokulova, Ulkar Mursalova, Saida Saidkhodjaeva, Paolo Martelletti and Sait Ashina
    Citation: The Journal of Headache and Pain 2023 24:92
  3. Migraine is a disabling neurological disorder whose diagnosis is based on clinical criteria. A shortcoming of these criteria is that they do not fully capture the underlying neurobiological factors and sex-spe...

    Authors: F. C. van Welie, L. A. Kreft, J. M. A. Huisman and G. M. Terwindt
    Citation: The Journal of Headache and Pain 2023 24:64
  4. Despite the pervasiveness of migraine, the underlying pathophysiological mechanisms initiating migraine attacks are far from well understood and are matter of scientific debate.

    Authors: Thien Phu Do, Anders Hougaard, Greg Dussor, K. C. Brennan and Faisal Mohammad Amin
    Citation: The Journal of Headache and Pain 2023 24:3
  5. Cluster headache and migraine are regarded as distinct primary headaches. While cluster headache and migraine differ in multiple aspects such as gender-related and headache specific features (e.g., attack dura...

    Authors: Mohammad Al-Mahdi Al-Karagholi, Kuan-Po Peng, Anja Sofie Petersen, Irene De Boer, Gisela M. Terwindt and Messoud Ashina
    Citation: The Journal of Headache and Pain 2022 23:151