Migraine with and without Aura

Migraine has a strong genetic component. In a Danish population-based survey of migraine using IHS criteria, the sex- and age-standardized risk of suffering from migraine with aura and migraine without aura among first-degree relatives was 1.9 (95% CI, 1.6-2.2) and 1.4 (95% CI, 1.0-1.8), respectively. This suggests that migraine without aura is caused by a combination of genetic and environmental factors, whereas migraine with aura is more heavily influenced by genetic factors.

Proposed modes of inheritance for migraine include autosomal-recessive inheritance for migraine with aura and sex-linked transmission, multifactorial, or autosomal-recessive inheritance for migraine without aura. Russell's epidemiology study, which included a segregation analysis of migraine with and without aura, found that both entities have multi-factorial inheritance. This analysis cannot detect genetic heterogeneity and therefore cannot exclude a mitochondrial or Mendelian pattern of inheritance. Migraine is very common. No single gene could be the cause of migraine either with or without aura; if it were, it would be more common than any other known disease-causing gene.

Migraine with aura and migraine without aura are associated with the familial hemiplegic migraine locus on chromosome 19p based on sibling pair and parametric linkage analysis of28 unrelated migrainous families. Genetic linkage is also supported by a twin study using a polygenic, multifactorial model. In men, concordance rates were 22% in monozygotes and 4% in dizygotes. In women, concordance rates were 32% in monozygotes and 19% in dizygotes. This study estimated that 40-50% of a patient's liability to migraine is based on genetic factors; this estimate is much higher than those of previous twin studies.

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