Migraine — master index¶
Last full audit: 2026-08-30 · Literature sweep: 2026-10-27 · 18 wiki pages (12 curated, 6 draft pending independent audit) · 400-paper master bibliography · 6 landmark-paper notes · 29-document guideline registry · ClinicalTrials.gov IDs rechecked 2026-10-27 · 16 open research questions + 5 grounded dot rows
The condition in five sentences. Migraine is a recurrent neurological disorder diagnosed from attack phenotype: ICHD-3 distinguishes migraine with and without aura and defines chronic migraine as at least 15 headache days per month, including at least 8 migraine-feature days (IHS 2018, PMID 29368949). It affects about 1.2 billion people in GBD 2023 and concentrates disability in adolescence through midlife, particularly among women, while mortality-based measures largely miss its impact (GBD 2023 Collaborators 2025, PMID 41240916). Trigeminal sensory signaling and CGRP are validated therapeutic biology, cortical spreading depolarization is the leading aura substrate, and polygenic neuronal and vascular signals coexist without a clinical biomarker (Ashina 2021, PMID 33773610; Fraser 2019, PMID 31847045; Hautakangas 2022, PMID 35115687). Evidence-rich NSAIDs and triptans remain acute anchors, while conventional preventives, onabotulinumtoxinA, CGRP antibodies and preventive gepants reduce attacks with bounded mean effects and substantial individual variation (Karlsson 2024, PMID 39293828; Dodick 2010, PMID 20487038; Lampl 2023, PMID 37208596). The practical frontier is comparative sequencing, prevention of chronification, non-stigmatizing medication-overuse care, reproductive safety, patient-weighted outcomes and evidence that crosses from association or mechanism to clinical selection.
Start here: overview.md. The research frontier is OPEN-QUESTIONS.md, including the Dots not yet connected table. Build history is in LOG.md.
Reading paths¶
- Clinical path — overview → classification and diagnosis → acute treatment → preventive treatment → guidelines → red flags and safety
- Mechanism path — trigeminovascular biology and CGRP → aura and cortical spreading depolarization → biomarkers
- High-frequency path — chronic migraine and chronification → medication-overuse headache → neuromodulation and behavioral care
- Life-course path — epidemiology and burden → children and adolescents → sex hormones, pregnancy and lactation → comorbidity and vascular risk
- Frontier path — OPEN-QUESTIONS → clinical-trials landscape → biomarkers → statistics sheet
- Human path — patient experience and advocacy → patient-voice themes → epidemiology and burden
Wiki pages¶
| Section | Page | Scope | Status |
|---|---|---|---|
| Foundations | overview.md | Classification, burden, mechanisms and treatment map | curated |
| Foundations | classification-and-diagnosis.md | ICHD-3 criteria, aura, frequency classes and mimics | curated |
| Foundations | epidemiology-and-burden.md | Prevalence, disability, life course, care gaps and economic burden | curated |
| Mechanism | trigeminovascular-biology-and-cgrp.md | Trigeminal pathways, CGRP, sensitization and target validation | draft |
| Mechanism | aura-and-cortical-spreading-depolarization.md | Aura biology, CSD, mimics and headache linkage | curated |
| Clinical | acute-treatment.md | NSAIDs, triptans, gepants, ditan, routes and sequencing | curated |
| Clinical | preventive-treatment.md | Conventional, CGRP and toxin options with quantitative effects | draft |
| Clinical | chronic-migraine-and-chronification.md | Transition risk, reversal, PREEMPT and refractory care | curated |
| Clinical | medication-overuse-headache.md | Diagnosis, causal ambiguity, withdrawal and prevention strategies | curated |
| Clinical | neuromodulation-and-behavioral-care.md | Devices, CBT, biofeedback, sleep and implementation | curated |
| Population | migraine-in-children-and-adolescents.md | Pediatric phenotype, placebo response, school and treatment | curated |
| Population | sex-hormones-pregnancy-and-lactation.md | Menstrual patterns and reproductive treatment safety | draft |
| Risk | comorbidity-and-vascular-risk.md | Mood, sleep, epilepsy and vascular association boundaries | curated |
| Policy | guidelines.md | International and national recommendation concordance/disagreement | draft |
| Frontier | biomarkers.md | Genetic, molecular, imaging and electrophysiological candidates | draft |
| Frontier | clinical-trials-landscape.md | Registration history, active programs and design gaps | draft |
| Human | patient-experience-and-advocacy.md | Invisible disability, stigma, work, family, access and organizations | curated |
| Safety | red-flags-and-safety-concerns.md | Secondary-headache patterns, urgent pathways and medication safety | curated |
Literature layer¶
| Artifact | Contents |
|---|---|
| BIBLIOGRAPHY.md | 400 unique PMID-verified papers, grouped by topic and indexed by citing pages |
| notes/ | 6 structured notes: ICHD-3, STRIVE, PREEMPT, CHAMP, acute network meta-analysis and migraine GWAS |
| guidelines/REGISTRY.md | 29 international/regional/national documents, recommendation map, supersession chains and watch list |
| statistics/STATISTICS.md | Reusable burden, diagnostic, treatment, pediatric, reproductive and biomarker figures with context |
| patient-voice/ | Ethical method, 8 listed organizations, 9 evidence-backed themes and annotated sources |
Evidence and curation state¶
The full build was completed on 2026-08-28, and the separate 2026-08-30 audit promoted all 18 pages. The 2026-10-13 literature sweep left six pages draft; this 2026-10-20 sweep edited three of those drafts (biomarkers.md, clinical-trials-landscape.md, guidelines.md) and did not touch the 12 curated pages. It added three PubMed-verified papers (one REFORM amylin analysis and two Headache republications of the 2026 AAN/AHS prevention pair), rechecked cited ClinicalTrials.gov IDs, and restored Headache Australia to the verified organization table. The 2026-10-27 sweep edited three of the same drafts (biomarkers.md, preventive-treatment.md, sex-hormones-pregnancy-and-lactation.md), added six PubMed-verified records (one a medRxiv preprint, flagged as such), four statistics rows and OQ-12/OQ-16 evidence, and again left the 12 curated pages untouched. Details and source-access limits are in LOG.md.