Familial migraine across three generations: A case series on genetic predisposition, vascular comorbidities, treatment challenges

Background: Migraine is a highly prevalent neurological disease and has a significant genetic basis and shows co-occurrence in families across multiple generations. Familial migraine can differ in terms of onset, severity, triggers, and response to treatments, which can complicate management. In this case series, we share the clinical presentations, comorbidities, and treatment responses in three generations of female patients with migraine.

Methods: In this study, we identified a 67-year-old grandmother, a 48-year-old mother , and a 24-year-old young adult female with a history of migraine. Clinical data such as onset, duration, severity, associated symptoms, comorbidities and response to treatment were collected either through interviews with patients or from medical records. Drug treatments and responses were analyzed to recognize treatment response patterns across generations.

Results:

• The proband (24 years of age) has chronic, refractory migraine with pulsating headaches, photophobia, phonophobia, nausea, and loss of appetite lasting 2–3 days per episode. Despite the treatment with naproxen, sumatriptan her symptoms remain uncontrolled.
• The mother (48 years of age) developed migraine post-delivery and has a history of hypertension. She experiences moderate intensity attacks associated with photophobia and ophthalmic features, which are responsive to non-steroidal anti-inflammatory drugs and beta-blockers.

The grandmother (67) suffers from episodic migraine with hypotension, triggered predominantly by stress and fatigue. Her symptoms are mild, and well-managed with analgesics and lifestyle modifications.