What is a migraine?
A Migraine is a recurrent severe and chronic type of neurological headache that affects more than 15% of the adult population in the UK and out of that it is 3 times more likely to affect women. A migraine cause’s moderate to severe throbbing pain concentrated within half of the face and is normally accompanied by additional symptoms like nausea, vomiting, sensitivity to light and loud noises. One third of migraine sufferers experience an aura which can warn the sufferer of the near onset of a migraine. Aura symptoms can include flashing lights in their vision, numbness, tingling and even weakness. Migraines with aura and migraines without aura create the two main migraine classifications used by medical professionals.
What does a migraine feel like?
Migraines cause intense severe throbbing and pulsating ache that develops around the forehead, eye socket and temple over one side of the face. A migraine builds up gradually and is precipitated by an aura in certain sufferers. Migraines commonly begin as a generalised headache over the temple or forehead, as the headache develops it tends to focus on one side of the face. In some cases however the headache may initially be focalised to one side of the face and then become more generalised.
The phases of a migraine attack
Migraines are categorised into phases, not all sufferers experience all of the phases with every migraine and the symptoms of each phase vary dramatically. The first phase is the prodrome which is almost like a warning phase that can occur days or hours in advance of a migraine. The symptoms of a prodrome can include altered mood, irritability, restlessness, fatigue or dizziness. The next phase is the aura which only one third of sufferers experience. The aura is a warning sensation that immediately precedes the migraine. Aura symptoms vary greatly but can include visual disturbances like seeing shinning flashing lights, zigzag formations or a blurry cloudy haze. An aura can also cause sensory changes making you hyper sensitive to touch or tingling and numbness that spreads from the arm up into the affected side of the face. In some cases sound and smell hallucinations have been reported.
The pain phase or headache phase as described above has a gradual onset and lasts for anything from 2 to 78 hours. In most cases the throbbing pain that concentrates over one half of the face is accompanied by one or more additional symptoms. The most common additional symptom is nausea and dizziness that often leads to vomiting. Some sufferers experience neck stiffness, diarrhea, tinnitus and sensitivity to light and sound which often results in people seeking a quiet and dark room. Lying on the bathroom floor with the lights off or retreating to bed until the attack is over is very common. Often a migraine gradually subsides although some sufferers find that after they are sick or sleep for a couple of hours the attack stops suddenly.
The postdrome phase is the recovery phase after the pain of the headache has subsided. Often a lower grade of headache is left or simply just residual tenderness over the area where the pain was concentrated during the pain phase. Sufferers report feeling fatigue, restlessness, irritability, mood swings and an inability to concentrate on tasks for up to 2 days after a migraine.
Depression is a common aftermath feeling during the recovery after a migraine. In people who suffer recurrent migraines or severe headaches depression is three times more likely to develop.
Why & when does a migraine happen?
Migraines are very unpredictable in the sense that every sufferer experiences the headache differently. Attacks can happen as often as several within a couple of weeks or months to occasionally as once or twice a year. The severity of pain levels and the combination of symptoms experienced is unique to each sufferer.
The underlying cause of migraines is not fully understood yet although there are theories linking them to hormone levels or chemical changes within the brain. With migraines being three times more likely to affect a women and with attacks reported to happen in a lot of cases in coordination with a female’s menstrual cycle when hormone levels are fluctuating at their highest. Although the exact reason why a migraine develops is not completely understood yet however key factors that precipitate a migraine have been identified. However like all other aspects of migraines triggers, they vary greatly between sufferers.
Most triggers identified have a direct effect on your body stimulating either a chemical or hormonal reaction. Stress is a common factor in particularly after long hours of working in a pressurized environment to meet deadlines or under exam revision or indeed after the hours of concentration during the exam itself. The awkward posture that your body holds after hours of working at a desk also doesn’t help by adding stress and strain onto the neck and upper shoulder muscles. High levels of anxiety, tension and deep depression have all been recognised as initiating a migraine.
Sleep deprivation and fatigue are considered as trigger factors as is poor eating habits, dehydration and excess alcohol intake. In many cases there is intolerance or an overload of a certain food type to blame, caffeine being the most common example along with the food additive tyramine, citrus fruit, cheese and chocolate. In some cases the chemicals in certain medication have also been found to trigger attacks most commonly sleeping tablets, contraceptive pill and HRT (hormone replacement therapy). Menopause itself is also classed as a trigger. Another common issue is environmental factors with bright flickering lights, loud noises or bangs and strong smells.
How is a migraine diagnosed?
Your GP or therapist will be able to diagnose you by taking a full history of your headache symptoms including when they start, how long they last for, where exactly do you feel the headache and what activities normally pre-empt the headache. Most importantly the GP will ask you whether you experience any additional symptoms like flashing lights, nausea or vomiting, dizziness to differentiate it from other headache diagnosis. It is incredibly helpful for a GP if you can identify and note down the frequency, time and duration of your migraine, what phases of the migraine you suffer from and within each phase what your normal symptoms are.
The migraine trust has a fantastic online and printable migraine diary that guides you though what to record and how to quantify it. It helps you to identify the trigger for your migraine so check it out at http://diary.migrainetrust.org/. This will help with your diagnosis and will also dictate what type of treatment is prescribed. No X-rays or further investigation should be needed to confirm the diagnosis.
What treatments options are available for migraines?
Prevention is the key for migraine treatment, identifying your trigger factors is vital and adjusting your lifestyle and habits to avoid these triggers is your first line of defense against migraines. Some patients continue to experience quite severe migraines even after making the lifestyle changes, in these cases your GP may prescribe you with specific preventative medication. Over the course of your diagnosis and treatment it might be very useful to note down the different types of medication you have been prescribed and how they affected your migraines. This is very helpful for your GP and for you when discussing your case or a change in prescription at a later date. The types of medication vary dramatically depending on the migraine symptoms and are based more on the severity of the symptoms rather than the frequency of the attacks. Often anti-nausea medication will be given in conjunction with painkillers in cases greatly affected by vomiting and nausea. Allot of medications are taken as soon as a migraine is felt coming on either in the prodrome or aura stage. These medications can help stop the migraine from developing into the painful headache stage. As well as these preventative medications your GP may prescribe stronger medication to use during a headache for times when the headache starts rapidly with no warning or when the preventative medication is not strong enough to stave an attack. This type of medication is often termed as rescue medication and if you find yourself often in the situation where you need to use your rescue medication then it suggests that your preventative medication isn’t quite strong or efficient enough for you. As with all prescribed medications, your GP will talk you through all of the possible side effects. If you do suffer from any side effects or changes that you think are significant you should notify your GP and note it in your migraine diary. In some cases where medication is taken often a chronic daily headache can develop as well as the migraine this is a low grade daily headache that results from overuse of medications that contain codeine or caffeine. Recently Botox has become a registered preventative treatment for some cases of migraine, please ask you GP about this option.
Some sufferers find physical treatments helpful like applying a covered ice or heat pack to the neck or upper shoulders may help to relax any muscular strain or spasm. Many people find manipulative therapies such as chiropractic, osteopathy or physiotherapy to be helpful in alleviating any neck, shoulder and upper back tension. Some people also find acupuncture very helpful to alleviate the headache levels. Massage therapies and therapies like Bowen technique are very good at reducing the muscular tension and alleviating the pressure around the neck and shoulders. Postural therapies like Alexander Technique is effective for teaching your body how to hold a good posture as is Pilates and Yoga for strengthening your postural muscles. It is vital to take a look at your diet and also at your eating habits ensuring that you are eating at regular intervals and drinking enough fluids. If this is a concern then it is advisable to consult a dietician or nutritionist who can examine your daily diet and suggest where and what improvements you could make. Some sufferers also find homeopathy and naturopathy very helpful.
Remember that the best way of reducing your migraines is to identify the trigger; your migraine diary is an incredibly important tool to help you do that. With time you will learn how to manage your migraine best.