Migraines

Most people have headaches. But migraine is different from other headaches. Not only is it a severe headache with an intense throbbing pain on one side of the head (although a third of the attacks can affect both sides) it can last up to three days. And the headaches are often accompanied by visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound (phonophobia) and light (photophobia), and tingling or numbness in the extremities or face. Occasionally sensitivity to smell (osmophobia), diarrhoea, stiffness and other symptoms can also occur. Sometimes these symptoms can start before the headache and are often called the aura phase. Since it presents in many different ways, migraine is often misdiagnosed.

Susceptibility to migraine is normally inherited. For many years, it was thought that abnormally dilated blood vessels caused migraines. Advances in imaging technology now allow scientists to observe the brain during a migraine attack. This has led to the discovery that certain parts of the brain appear to be in a hypersensitive state, reacting excessively to stimuli such as emotion, an overload of sensory impulses, or any sudden change in the internal or external environment. The brain starts to 'shut down', a process starting at the back of the brain in the visual cortex and working slowly forward. The pain nucleus of the trigeminal nerve (a major nerve in the face) is triggered and pain is felt in the head or upper neck. Blood flow to the face and scalp increases. Essentially, migraine seems to be caused by the interaction between the brain and blood vessels in the skull. Treatment can be aimed at constriction of dilated arteries to abort each headache as it comes or at the brain itself in an attempt to prevent the headaches altogether.

Migraine ranks in the top 20 of the world's most disabling medical illnesses. About 10% of the Australian population, including children, suffer from migraine. Almost three times as many women as men get migraines, with about two million Australians suffering from this disease. In addition to the attack-related disability, many of these people live in fear of an attack and have to cope with regular and frequent disruption to work and family obligations. While most sufferers experience attacks once or twice a month some experience attacks on a near-daily basis.

It can start in childhood but most often starts in 20s and 30s. The good news is that migraines can be successfully managed with a combination of treatments.

FIVE STAGES

Generally, migraine can be divided into five stages:

1. Early Warning Symptoms (prodromol)

Many migraine sufferers experience symptoms for up to 24 hours before the attacks start. These symptoms may include:

changes in mood, varying from feeling elated to feeling depressed and irritable

nausea, changes in appetite, constipation, diarrhoea

drowsiness, incessant yawning,

difficulty finding the right words (dysphasia)

dislike of light and sound

difficulty in focusing eyes

changes in behaviour, hyperactive, obsessional, clumsy, lethargic

muscular symptoms, general aches and pains

fluid balance changes, thirst, passing more fluid, fluid retention.

2. Aura

About 20 to 30% of sufferers also experience aura. Usually this includes visual disturbances such as bright zigzag lines, flashing lights, difficulty in focusing or blind spots. This lasts from five to sixty minutes then the vision normally restores itself. Aura may also affect speech or the sense of touch. When several aura symptoms are present, they usually follow in succession. Migraines with aura are called Classical while those without are called Common.

3. Headache

The headache phase can last up to three days. It is often a throbbing pain and on one side of the head, but can affect both. Movement makes the pain worse. The most common accompanying symptoms in this phase are nausea, vomiting and sensitivity to light, sound and smell. Eating, especially starchy foods, can help.

4. Resolution

The way an attack ends varies greatly. Sleep is restorative for some. Being sick can also help, especially for children.

5. Recovery (postdromol)

A feeling of being drained may exist for about 24 hours, others may feel energetic or even euphoric.

There are other types and patterns of migraine but these are rare.

TRIGGERS

It is believed that there are many triggers and these vary from person to person and, indeed, from attack to attack for the same individual. Sometimes a combination of triggers may be needed to precipitate an attack.

Dietary Triggers

May include:

missed, delayed or inadequate meals

caffeine (coffee and tea) withdrawal

certain wines, beers and spirits

chocolate, citrus fruits, aged cheeses and cultured products (chocolate and other sugar cravings may be prodomal not triggers)

peas, corn, foods with high acidity—onions, garlic, wheat, egg plant, green peppers, strawberries, and potatoes

monosodium glutamate (MSG)

dehydration.

Environmental Triggers

May include:

bright or flickering lights, bright sunlight

strong smells, e.g. perfume, gasoline, chemicals, smoke-filled rooms, various food odours

travel, travel-related stress, high altitude, flying

weather changes, changes in barometric pressure (likewise, decompression after deep-sea diving)

loud sounds

going to the movies

computers (overuse, incorrect use).

Hormonal Triggers

Hormonal fluctuations are implicated as a significant trigger for women. Hormonal triggers may be:

Climacteric (final menstrual period)

Menstruation (a UK study found 50% of women more likely to have migraine around menstruation)

Ovulation

Oral contraceptives

Pregnancy (may worsen for first few months but in two thirds of women improves in latter part)

Hormone replacement therapy (HRT)

Menopause.

Physical and Emotional Triggers

May include:

lack of sleep or oversleeping (even as little as half hour difference in routine, e.g. sleeping in on weekends)

illness such as a viral infection or a cold (if taken cold and migraine medication, remember that many cold remedies contain pain-killers)

back and neck pain, stiff and painful muscles, especially in scalp, jaw, neck, shoulders, and upper back

sudden, excessive or vigorous exercise (regular exercise can however prevent migraine, if migraine is triggered by a blow to the head a doctor should be consulted)