Migraine

What is a Migraine?

A migraine is a neurological syndrome characterized by altered bodily experiences, painful headaches, and nausea. It’s a common condition which affects women more frequently than men. The typical migraine headache is 1-sided and pulsating, lasting 4 to 72 hours. Accompanying complaints are nausea and vomiting, and a heightened sensitivity to bright lights and noise. Up to one third of people who experience migraines get a preceding aura, in which they may sense a strange light or unpleasant smell. Some have noted that they smell burnt toast preceding a migraine.

Migraine is believed to be caused by the release of a chemical called serotonin or 5HT into the bloodstream from its storage sites in the body, resulting in changes in the neurotransmitters and blood vessels in the brain. Exactly what causes this to happen is still a subject for research and debate.

Although the exact cause of migraine remains unknown, the most widespread theory is that it’s a disorder of the serotonergic control system. Recently, PET scans have demonstrated the aura to coincide with spreading cortical depression after an episode of greatly increased blood flow (up to 300% higher than baseline). There also appear to be migraine variants that originate in the brainstem and involve dysfunction in calcium and potassium ion transport between cell membranes. Genetic factors may also contribute.

Signs and Symptoms

If you have 2 or more of the following symptoms during an attack it’s likely that you’re suffering from migraine:

• Intense throbbing headache, often on 1 side of the head only

• Visual disturbances (blind spots, distorted vision, flashing lights or zigzag patterns) – called

Aura

• Nausea and / or vomiting and / or diarrhea

• Increased sensitivity to light (photophobia)

• Increased sensitivity to sounds (phonophobia)

• Increased sensitivity to smells (osmophobia)

You may experience other neurological symptoms (known as aura), which is the 2nd most commonly seen form of migraine. Those who primarily suffer from migraine with aura may also have migraines without aura. Symptoms include:

• Stiffness of the neck and shoulders

• Tingling or stiffness in the limbs

• An inability to concentrate

• Difficulty in speaking

• Paralysis or loss of consciousness (in very rare cases)

A general rule of thumb is that if a headache and / or other associated symptoms prevent you

from continuing with normal daily activities it could be a migraine.

The signs and symptoms of migraine vary, so what one experiences before, during and after an attack cannot be defined exactly. The 4 phases of a migraine attack listed below are common but not necessarily experienced by all migraine sufferers. The phases experienced and the symptoms experienced during them can also vary from one migraine attack to another in the same migraineur (migraine sufferers):

• Prodrome, which occurs hours or days before the headache

• Aura, which immediately precedes the headache

• Pain phase, also known as headache phase

• Postdrome

Prodrome Phase

Prodromal symptoms occur in 40 to 60% of migraineurs, which may consist of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (such as chocolate), stiff muscles (especially in the neck), constipation or diarrhea, increased urination, and other visceral symptoms. These symptoms usually precede the headache phase of the migraine attack by several hours or days.

Aura Phase

For the 20 to 30% of people who suffer migraine with aura, this aura comprises focal neurological phenomena that precede or accompany the attack. They appear gradually over 5 to 20 minutes and generally last fewer than 60 minutes. The headache phase of the migraine attack usually begins within 60 minutes of the end of the aura phase, but it is sometimes delayed up to several hours, and it can be missing entirely. Symptoms of migraine aura can be visual, sensory, or motor in nature.

Some people experience the aura only, without the development of other symptoms or with only a mild headache.

Visual aura is the most common of the neurological events. There is a disturbance of vision consisting usually of unformed flashes of white, black, or rarely of multicolored lights (photopsia) or formations of dazzling zigzag lines. Some complain of blurred, shimmering or cloudy vision, as though they were looking through thick or smoked glass, and some cases tunnel vision. The somatosensory aura of migraine consists of a feeling of pins-and-needles in the hand and arm as well as in the nose-mouth area on the same side which can migrate up the arm and extend to the face, lips and tongue.

Other symptoms of the aura phase can include auditory or olfactory hallucinations, temporary dysphasia, vertigo, and hypersensitivity to touch.

Pain Phase

The typical migraine headache is unilateral, throbbing, moderate to severe and can be aggravated by physical activity. The onset is usually gradual. The pain peaks and then subsides, and usually lasts between 4 to 72 hours in adults and 1 to 48 hours in children. The frequency of attacks is widely variable, from a few in a lifetime to several times a week, and the average migraineur experiences from 1 to 3 headaches a month. The head pain varies greatly in intensity.
The pain of migraine is invariably accompanied by other features. Nausea occurs in almost 90% of people, while vomiting occurs in about one third. Many patients experience sensory hyperexcitability manifested by photophobia, phonophobia, osmophobia and need a dark and quiet room. Blurred vision, nasal stuffiness, diarrhea, polyuria, pallor or sweating may be present during the headache phase.

There may be localized edema of the scalp or face, scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness of the neck. Impairment of concentration and mood are common. Lightheadedness, rather than true vertigo and a feeling of faintness may occur. The extremities tend to be cold and moist.

Postdrome Phase

One may feel tired, have head pain, cognitive difficulties, ‘hungover,’ gastrointestinal symptoms, mood changes and weakness. Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise. Often, some of the minor headache phase symptoms may continue, such as loss of appetite, photophobia, and lightheadedness.

Triggers
A migraine trigger is any factor that leads to the development of an acute migraine headache. Certain factors have been identified which can trigger attacks which are known as ‘precipitants.’ The MedlinePlus Medical Encyclopedia offers the following list of migraine triggers:

• Allergic reactions

• Bright lights, loud noises, and certain odors or perfumes

• Emotional or physical stress

• Changes in sleep patterns

• Smoking or exposure to smoke

• Skipping meals

• Alcohol

• Menstrual cycle fluctuations, birth control pills, hormone fluctuations during the menopause transition
• Environmental

• Hormones

• Tension headaches

• Diet or food — foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG) or nitrates (like bacon, hot dogs, and salami), chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods.

The effects of migraine may persist for some days after the main headache has ended. Many sufferers report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed.

Unfortunately there is no cure for migraine, but it is possible to bring your condition under control. There is a wide range of treatments available, both orthodox and complementary, which can be very effective. However, migraine is a complex condition, and a treatment that’s successful for one person may have no effect or produce unacceptable side effects for another. It is important to persevere until you develop a management plan that works for you.