Migraines are a common and distressing disorder which can limit the person’s quality of life. Studies have shown the incidence of migraine to be 9-10%. From this about 17% of suffers are the female population in comparison to 6% of suffers from the male population. Thus, about 2 million Australians can be expected to suffer from migraine with about 1.5 million women and about 500,000 men respectively. It is thought that more women suffer migraines than men due to hormonal factors. Migraines can occur throught childhood however they are most common in the 20’s and 30’s and become less frequent in the 40’s. Migraines may occur recurrently over many years or even decades. Frequency may vary greatly in the same person over time, from a few years up to several weeks.
- Cortical changes
- Interaction between the brain and the cranial blood vessels
- Dietary Triggers
- Environmental triggers
- Hormonal triggers
- Physical and Emotional Triggers
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
- Aggravated by movement
(b) There is at least one of the following associated symptoms:
- 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
- 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)
Stages of Migraine
Migraine can be divided into five distinct phases:
1. Early Warning Symptoms (prodromol)
Usually people experience warning symptoms 24 hours before the migraine. These symptoms arise from the hypothalamus of the brain. These symptoms include:
- Changes in mood
- Gut symptoms, nausea, changes in appetite, lack of appetite, constipation, diarrhoea
- Neurological changes, drowsiness, incessant yawning, dysphasia, dislike of light and sound, difficulty in eye focus
- Changes in behaviour
- Muscular symptoms ( aches and pains)
- Fluid balance changes (thirst, passing more fluid and fluid retention)
Visual disturbances are the most common symptoms. These include difficulty focusing on one spot, bright zigzagging lights and flashing lights. 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. Aura less commonly affects speech or sensation.
The headache phase can last up to three days. It is often throbbing and on one side of the head, but can affect both with movement making it worse. It can be on the same or opposite side to the aura. The most common accompanying symptoms in this phase are nausea, vomiting and sensitivity to light, sound and smell. Eating starchy foods can help during this phase. The symptoms can be more distressing than the headache itself.
In some cases sleep is restorative, in children being sick can make them feel much better. For others effective medication can improve onset of migraines. 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.
Treatment of Migraine
Each individual needs to develop their own migraine management plan that will improve their lifestyle such as modifications, medication and therapies.