Migraine – ‘a common and distressing disorder’
‘Migraine is a common and distressing disorder. It is not likely to take life but can destroy the quality of life at what might have been its most rewarding moments1.’
Studies have shown the incidence of migraine to be 9-10%, about 17% of the female population and 6% of the male population. So, about 2 million Australians can be expected to suffer from migraine, about 1.5 million women and about 500,000 men. It is thought that more women suffer migraine than men due to hormonal factors.
‘Onset of migraine is from childhood onwards but most commonly in the 20s and 30s and relatively infrequently after the age of 40; therefore, prevalence increases from the first to fourth decades and thereafter declines. Migraine may nevertheless be a significant health issue among children2.’
Read more about migraine at Virtual Medical Centre
Symptoms
The International Headache Society classifies a headache as a migraine when:
(a) the pain can be classified by at least two of the following;
one sided
moderate to severe
throbbing
aggravated by movement
(b) there is at least one of the following associated symptoms:
nausea
vomiting
photophobia (sensitivity to light)
phonophobia (sensitivity to noise)
(c) the headache lasts for between 4 and 72 hours.
Other symptoms that may be experienced include
osmophobia (sensitivity to smell)
aura (visual disturbances such as bright zigzag lines, flashing lights, difficulty in focusing or blind spots lasting 20-45 minutes)
difficulty in concentrating, confusion
a feeling of being generally extremely unwell
problems with articulation or co-ordination
diarrhoea
stiffness of the neck and shoulders
tingling, pins and needles or numbness or even one-sided limb weakness
speech disturbance
paralysis or loss of consciousness (rare).
Migraine may occur recurrently over many years or even decades. Frequency may vary greatly in the same person over time, from a few a year up to several a week.
Stages of Migraine
Migraine can be divided into five distinct phases:
1. Early Warning Symptoms (prodromol)
A significant number of migraineurs experience warning symptoms for up to 24 hours before the attacks start but may not recognise these signs until they know what to look for. These symptoms include:
changes in mood, varying from feeling elated, on top of the world and full of energy, flying through the day’s work and accomplishing twice as much as usual, to feeling depressed and irritable
gut symptoms, nausea, changes in appetite (intense hunger or sugar craving: may consume a whole packet of biscuits or chocolates), lack of appetite, constipation, diarrhoea
neurological changes, drowsiness, incessant yawning, difficulty finding the right words (dysphasia), dislike of light and sound, difficulty in eye focus
changes in behaviour, hyperactive, obsessional, clumsy, lethargic
muscular symptoms, general aches and pains
fluid balance changes, thirst, passing more fluid, fluid retention.
All these symptoms arise in the hypothalamus, the deep-seated part of the brain.
2. Aura
Aura accompanies migraine attacks for about 20 – 30% of migraineurs. The most common aura symptoms are visual disturbances such as bright zigzag lines, flashing lights, difficulty in focusing or blind spots. Aura affects the visual field of both eyes despite often seeming to affect one only and lasts 5-60 minutes then the vision normally restores itself. Less commonly aura affects sensation or speech. When several aura symptoms are present, they usually follow in succession.
3. Headache
Those experiencing classical migraine (migraine with aura) may or may not have a gap of up to an hour between the end of the aura and the onset of the head pain and may feel a bit ‘spaced out’ during the gap. Regardless of whether one experiences migraine with aura, or common migraine (migraine without aura), the headaches are similar. The headache phase can last up to three days. It is often throbbing and on one side of the head, but can affect both. It can be on the same or opposite side to the aura. Movement makes it worse. The most common accompanying symptoms in this phase are nausea, vomiting and sensitivity to light, sound and smell. Eating can help especially starchy foods. The symptoms can be more distressing than the headache itself.
4. Resolution
The way an attack ends varies greatly. Sleep is restorative for some. Being sick can make children feel much better. For others effective medication can improve attacks. For a few nothing works except the headache burning itself out.
5. Recovery (postdromol)
A feeling of being drained may exist for about 24 hours, others may feel energetic or even euphoric.