They're pre-headaches, post-headaches, sensitivities, nausea, fatigue and can even bring on food cravings.

它們有頭痛前後的症狀、敏感、噁心、疲勞等問題，甚至會對食物產生渴望。

But most of all they are painful and frustrating for those who suffer from them.

但最重要的是，受到那些症狀困擾的人，都很痛苦且感到挫折。

For years they were misunderstood, but now we know it comes down to two main things,

多年來它們都受到誤解，但現在我們知道偏頭痛歸咎於兩個主要因素，

your genes and your brain.

基因和大腦。

To really understand why migraines are so much more than headaches, first we have to know what headaches are.

要真正了解為何偏頭痛不只是頭痛，首先必須知道頭痛到底是什麼。

My name is Rashmi Halker Singh.

我是 Rashmi Halker Singh。

I'm a fellowship trained board, certified headache neurologist here at Mayo Clinic.

我是通過資格考的研究醫生，梅奧醫學中心認證的頭痛神經學家。

I'm also the headache fellowship program director here at Mayo Clinic in Arizona.

同時也是亞利桑那州梅奧醫學中心的頭痛研究計畫主任。

There's actually a huge book called the International Classification of Headache Disorders, which

其實有一本很厚的書叫「國際頭痛疾病分類」，

has maybe 300 different diagnoses of different types of headache.

其中不同類型的頭痛也許有 300 種不同診斷。

So when we say headache, all we mean by that is pain above the neck.

說到頭痛時，我們所說的就是脖子以上的疼痛。

And yes, migraines are pains above the neck so they are headaches, but again, suffering

沒錯，偏頭痛是脖子以上的疼痛，所以是頭痛沒錯，但一樣

from a migraine attack is much more than just having a headache.

受到偏頭痛困擾不只是頭痛那麼簡單。

So migraine is actually a problem of brain dysfunction.

偏頭痛其實是腦功能障礙。

It's a genetic disorder that is very common.

它是相當常見的遺傳疾病。

So by diagnostic criteria you need to have recurrent headaches, whether it happened infrequently

因此，根據診斷標準，你要有經常性的頭痛，不管是偶爾發作

or frequently, lasting 4 to 72 hours without medication.

還是經常發作，在沒有藥物治療下，持續 4 到 72 小時。

And then in addition to that, the pain has to have at least two of the following four symptoms.

除此之外，疼痛必須至少有以下四種症狀中的兩種。

The pain needs to be moderate or severe in intensity, and more intense on one side of the

疼痛強度要在中度或強烈，頭的另一邊有更強烈的

head, throbs or pulses, and gets worse with activity.

抽痛或跳動，並隨著活動而惡化。

But to stay on theme, a migraine is more than just experiencing pain.

但言歸正傳，偏頭痛不只是經歷疼痛而已。

You also have to have either a sensitivity to light or sound or nausea.

你還會對光線、聲音有敏感性，或者感到噁心。

In fact, migraine attacks come in four stages with a painful headache being just one of them.

事實上，偏頭痛發作分為四階段，痛苦的頭痛只是其中之一。

Before the headache stage, some people, about one fourth of migraine sufferers, will experience

在頭痛階段之前，大約四分之一的偏頭痛患者，

what is called an aura.

會經歷俗稱的「預兆」。

When someone has a visual aura, they will see light spots, jagged lines, things like that in their vision.

有人會有視覺上的預兆，他們會看到光點、鋸齒線，那些東西會出現在他們的視覺中。

Sometimes people will have a sensory aura as well in which they'll have like pins and

有時他們會有感覺上的預兆，他們會感覺有別針

needles, tingling sensation up one limb.

和大頭針，在腿上發出刺痛的感覺。

And again, this typically lasts 5 to 60 minutes and is typically followed pretty much

而且，這通常持續 5 到 60 分鐘，

immediately by the headache.

之後緊接著頭痛。

But before that, migraine sufferers will experience a prodrome, the first stage in the migraine attack.

但在那之前，偏頭痛患者會經歷前驅期，這是偏頭痛發作的第一階段。

This stage can last an entire day and includes symptoms like increased yawning, trouble concentrating,

這個階段可以持續一整天，包括增加打哈欠、注意力不集中

increased urination and even cravings for things like chocolate.

排尿增加，甚至會對巧克力產生渴望。

Finally after the headache phase has ended a lot of my patients will tell me,

最後頭痛階段結束後，很多病人會告訴我

you know, Doc, I have this like headache hangover.

醫生，我這好像宿醉的頭痛。

And that's what we would call a Migraine postdrome.

這是偏頭痛的後期症狀。

This is not fully understood exactly just yet, but we think it's probably a recovery phase within the brain.

目前還尚未完全理解這點，但我們認為這可能是大腦內的恢復階段。

And they might feel just really tired or fatigued or still have trouble concentrating.

他們可能會感到疲勞或疲憊，注意力甚至仍難以集中。

Just kind of still recovering from the whole episode.

像是整個事件仍在復原。

So when we think about Migraine, those would be the four phases.

想到偏頭痛時，會有四個階段。

Most of what we know has to do with the pain phase.

我們所知的大部分都與疼痛階段有關。

And what we know is not a lot.

而我們所知的非常有限。

It was once thought that migraines were caused by constriction and dilation of the blood

曾經有人認為偏頭痛是因向大腦供血的血管

vessels that supply blood to the brain...

收縮和擴張所引起的......

But we know that's not the case anymore.

但已經知道完全不是這回事。

We know that Migraine is actually a problem of brain dysfunction.

我們知道偏頭痛其實是腦功能異常。

It originates from the brain itself.

它源自於大腦本身。

And it's a problem of pain processing.

是處理疼痛的問題。

And there's a whole host of different components involved in this whole pain processing abnormality.

整個處理疼痛的異常中，涉及到整個宿主不同的部分。

And because of that, there's lots of different genes involved as well.

因此，有很多不同的基因也參與其中。

A few genes have been identified, but we're still learning more about this.

已經找出部分基因，但我們仍須進一步了解。

So we know that genes are a part of migraines, you can be genetically predisposed to have these painful headaches.

我們了解到基因也是偏頭痛的一部分，那在遺傳上就容易有討人厭的頭痛。

And researchers have identified the part of the brain involved with migraines and the

研究人員已經確定大腦中與偏頭痛相關的部分，

lingering pain associated with them.

以及相關的持續性疼痛。

Really a lot of our emphasis on migraine has to do with something called the trigeminal

的確，偏頭痛有許多重點都與三叉神經尾核有關，

nucleus Caudalis, which is, something in the brainstem that's really important for pain processing.

它是腦幹中負責處理疼痛的重要東西。

And when a migraine attack occurs, there are what we'd call trigeminal

偏頭痛發作時，我們所說的三叉神經

afferents or nerve endings that also become activated and they will release CGRP.

或神經末梢也會受到刺激，並釋放 CGRP。

CGRP stands for Calcitonin Gene-Related Peptide, and when released helps the pain continue,

CGRP 的全名是抑鈣素基因系肽，釋放後有助於疼痛持續，

resulting in the long-drawn out painful migraine headache.

導致長期痛苦的偏頭痛。

Now, how this exactly works is still unknown, but the correlation between CGRP's and migraine

目前還不清楚到底是如何運作，但 CGRP 和偏頭痛之間的相關性

headaches has actually led to some better treatment options for patients.

其實為患者帶來更好的治療選擇。

For the first time in history, we have preventive treatments designed to treat migraine based

有史以來首次，我們在偏頭痛發作時，根據在大腦中所知的情況，

on what we know as to what happens in the brain during a migraine attack.

採取預防性治療來對付偏頭痛。

And a lot of research has shown us that if you, you know, infused CGRP in a patient who's

許多研究表明，如果在患有偏頭痛的患者中輸入 CGRP

susceptible to having Migraines, you can trigger a migraine attack.

會引發偏頭痛的發作。

And if you block CGRP, that reduction in CGRP levels correlates with migraine improvement.

而如果你阻斷 CGRP，那 CGRP 程度的降低與偏頭痛的改善有關。

So based on that information, we've been able to develop some new medications.

因此，基於這些資訊，我們已經能開發出一些新藥物。

So you know, this is a really exciting time in the migraine world.

這在偏頭痛界真的是振奮人心的時刻。