Did you know that migraine is one of the leading causes of disability worldwide?

40% of patients have no diagnosis and more than 50% self-medicate with over-the-counter painkillers.

According to the Spanish Society of Neurology (SEN), migraine affects more than 5 million people in Spain, of whom more than 70% are severely disabled and 14% are moderately disabled.

In addition, 1.5 million people in Spain suffer from chronic migraine, so called when patients experience headaches 15 or more days a month. Resulting in decreased productivity, impaired quality of life and four to six times more disability than episodic migraine.

Definition of migraine

Migraine is a complex neurological disorder that also has vascular components. It is primarily considered a neurological disorder due to its origin in the central nervous system and its clinical manifestations affecting brain function.

Although primarily a neurological disorder, it also involves vascular changes. During a migraine attack, it is believed that there is dilation of intracranial and extracranial blood vessels, which contributes to the throbbing pain characteristic of migraine.

Neurogenic inflammation is also observed, where nerve endings release inflammatory substances around blood vessels in the brain.

Migraine is a complex problem related to the interaction between genetic, environmental and lifestyle factors. This interaction may manifest itself differently for each individual patient. Nutrition, gut health and support of mitochondrial function are important lifestyle-based treatment strategies for clinicians to consider when working with a patient suffering from chronic migraine.

Nutrition is one such lifestyle-based treatment strategy. Nutritional interventions that emphasise nutrients that support mitochondrial function (Co-Q10, Folates, B2, B6, Mg,…) are of specific importance.



  • They can vary, but are often presented as
    • Recurrent episodes of moderate to severe headache, usually unilateral, which may last from 4 to 72 hours.
    • Associated neurological symptoms may include nausea, vomiting, dizziness, and sensitivity to light (photophobia) and sound (phonophobia).
    • In addition, some people experience an “aura”, which are visual, sensory or speech symptoms that precede or accompany the headache.

Which disease can be confused with migraine?

The pain of a bleeding brain aneurysm can sometimes be mistaken for a migraine headache. Therefore, if you have a severe headache, go to an emergency department to rule out more serious causes.

Types of migraine

  • Migraine without aura: headache without previous neurological symptoms.
  • Migraine with aura: includes visual, sensory or speech symptoms before the headache.
  • Chronic migraine: migraine episodes that occur 15 or more days per month.

Possible causes of migraine

1. Excess Histamine

Excess histamine in the body can trigger migraines. The causes of this excess include:

  • Polimorfismos en el gen AOC1: este gen codifica la enzima diamina oxidasa (DAO), responsable de descomponer la histamina. Genetic variations may reduce their activity.
  • Excess endogenous production: caused by allergies, infections and other factors.
  • Inflammatory bowel disease: conditions such as Crohn’s disease and ulcerative colitis can decrease DAO activity.
  • Intestinal dysbiosis: an imbalance in the intestinal flora can increase histamine production.
  • Medicines: more than 90 drugs may inhibit DAO.
  • Stress: chronic stress can affect histamine levels and aggravate migraines.

Intestinal problems

Certain medicines

2. Oestrogens

Fluctuations in hormone levels, particularly oestrogen, can trigger migraines. Women may experience migraines during the menstrual cycle due to changes in oestradiol levels.

3. Elevated homocysteine levels

Elevated homocysteine may be linked to migraines. Causes include:

  • MTHFR polymorphism: this genetic variation can affect the methylation of homocysteine, increasing its levels in the body.

Genetic polymorphisms

4. Monosodium glutamate

Monosodium glutamate, a common additive in processed foods to improve their taste, can trigger migraines in sensitive people.

Diagnosis of migraine

In addition to specific examinations by your neurologist, it is advisable to investigate possible triggers, among other tests:

  • Blood tests: to assess histamine and homocysteine levels.
  • Serum DAO activity: to detect DAO enzyme deficiencies.
  • Allergy testing: to identify possible allergic triggers.
  • Genetic testing: to rule out polymorphisms in the DAO and MTHFR genes.


Once your neurologist has diagnosed the absence of a major cause. It is advisable, in addition to your pharmacological treatment, to rule out possible causes that may be behind it and that are preventing you from having a good quality of life.


Migraine is a multifaceted neurological disorder with significant vascular components. This combination of neurological and vascular factors is what makes it such a debilitating and difficult disorder to treat.

Although there are drugs that can help during attacks, it is essential to identify the underlying causes of migraine for effective and personalised treatment. This approach not only improves the patient’s quality of life but also reduces the frequency and intensity of your crises.

Request a free orientation appointment with Dra. Carmen Romero on WhatsApp 699 979 939.