Migraines: what causes them, and what actually brings relief

Humanity has grappled with migraine for so long that its first written description dates back to 1550 BC. The ancient Egyptian medical text known as the Ebers Papyrus refers to a 'disease of one half of the head' and recommends treating it by anointing the scalp with fried catfish. Strange as that sounds by today's standards, the passage is evidence of just how early migraine was recognised.

The illness's name also has ancient roots. The second-century Roman physician Galen used the term 'hemicrania' — literally, 'half of the skull' — a term that evolved over centuries into today's word 'migraine'. Galen's own treatment of choice was blood-letting, which happened to be his answer to nearly everything.

By the 20th century, the medical establishment had begun approaching migraine from a very different angle: repressed emotion. Combined with the fact that migraine is far more common in women than men, this theory led to the illness being dismissed for decades and filed under 'hysteria' — an approach science has since thoroughly rejected.

The real shift began in the latter half of the 20th century with the vascular theory: the idea that migraine pain came from excessive dilation of blood vessels in the brain. That theory dominated for decades and formed the basis for the first migraine-specific drugs, triptans, which relieve pain by narrowing blood vessels.

Over the past two decades, however, researchers discovered that migraine is not purely a vascular event but a complex neurological process that begins in the brain itself — specifically in the brainstem and the trigeminal nerve system. This new understanding showed that a migraine attack begins in nerve cells, not blood vessels, and that a protein called CGRP sits at the centre of the process.

The discovery of CGRP — calcitonin gene-related peptide — marked a genuine turning point in migraine treatment. This protein is released during a migraine attack and triggers nerve inflammation and pain signalling. The new drug class developed over the past decade targets CGRP or its receptor directly, blocking attacks before they start — the first treatment in history designed specifically for migraine.

These drugs are making a real difference for patients. Previous generations of preventive treatment — beta blockers, epilepsy drugs, antidepressants — were not designed for migraine, and their side effects frequently caused patients to stop treatment. CGRP-targeted drugs, being migraine-specific, tend to be both more effective and generally better tolerated.

Yet migraine remains widely misunderstood. According to the World Health Organization, migraine ranks among the leading causes of disability worldwide, but many workplaces and communities still regard it as 'just a headache'. That misconception makes it harder for patients to access treatment and to be understood at work.

Why migraine occurs three times more often in women is also now better understood: fluctuations in oestrogen levels, particularly the drop before menstruation, stand out as a major trigger for attacks. That link also helps explain why hormonal treatments work for some patients.

Migraine research continues to move quickly today: brain-imaging techniques have begun tracking the moment an attack begins in real time, a new generation of drugs is in development, and genetic studies are mapping the genes that determine susceptibility. After 3,500 years, migraine is finally being taken seriously as a distinct disease in its own right.