Anyone that suffers from migraines, or has even had just one, knows that they are nauseating, painful, and debilitating. They can render you absolutely helpless and hopeless. I can think back to the worst “headache” of my life, and it doesn’t come close to touching my migraines. Fortunately, I have great support to help me manage them. My sister is a neurologist specializing in headaches and this is her article. It was originally posted by Global Chatter Magazine. Here is a direct link to Migraine: More than “Just a headache”
by: Abigail L. Chua, DO (Neurologist, Headache Specialist)
Anyone who has ever had a migraine knows the feeling all too well. Intense throbbing pain, extreme sensitivity to light, sound or smell, as well as nausea, vomiting, disorientation, confusion, inability to work and loss of focus are just some of the symptoms that a person with migraines (a ‘migraineur’) can experience. This experience is not only painful but can also be very debilitating.
Migraine is a complex neurologic disease. It falls under the category of a “primary headache,” meaning that there is no other disease or dysfunction causing the pain (such as infection or tumor). It affects approximately 11% of the world’s population and is ranked as the sixth leading cause of disability worldwide (with headaches in general ranking third overall) by the World Health Organization. The condition tends to run in families and affects women more than men. The typical characteristics of migraine include a moderate to severe throbbing/pulsating pain, usually affecting one side of the head, that worsens with movement and is accompanied by various combinations of nausea, vomiting, light sensitivity (photophobia) and sound sensitivity (phonophobia). Some patients experience a “warning sign” or aura prior to the start of their headache, while others are given no warning at all. Though some migraineurs’ attacks have specific triggers, others do not. To complicate the matter, some migraineurs do not feel any head pain at all with their migraines. The frequency and duration of migraine attacks can vary from person to person; patients who experience more than 15 migraines a month are diagnosed with “Chronic Migraine” and those with less than 15 migraines a month are given a diagnosis of “Episodic Migraine”.
Regardless of the frequency of a migraine attack, each episode has the potential to cause significant pain and disability. This is because migraine is so much more than just a headache. In fact, there are actually four distinct phases to a migraine attack: the initial premonitory phase, then an aura, followed by a headache, and lastly the postdrome phase.
The premonitory phase occurs in about 70% of migraineurs. It begins hours to days prior to the onset of actual head pain, meaning that the individual may already be experiencing disturbing or troublesome symptoms even before what they believe to be their actual “migraine” starts. Premonitory symptoms can vary and include symptoms such as depression, euphoria (a heightened feeling of wellness), increased sensitivity to light, sound or smell, trouble speaking, food cravings, gastric disturbances such as diarrhea or constipation, and neck stiffness.
When it occurs, the migraine aura usually develops over 5-20 minutes and, in most cases, lasts less than 1 hour. Migraine auras can differ from person to person and may involve visual changes such as partial loss of vision or a blind spot (also known as a scotoma), visual hallucinations, traveling sensations of pins and needles along the body (paresthesias), weakness in the arms or legs, difficulty speaking, and changes in consciousness. These symptoms can be frightening and patients experiencing their first aura are sometimes brought to the emergency room as these symptoms can oftentimes mimic signs of stroke.
The migraine headache itself is usually described as a one-sided, pounding or throbbing pain that worsens with movement. It can occur at any time of day and may last several hours to several days. The aforementioned light and sound sensitivity issues associated with migraine remain prominent. Additionally, significant nausea may be experienced which can sometimes lead to vomiting. Many patients also develop significant scalp tenderness that makes it difficult for them to brush their hair or lie down. Also, the symptoms of their premonitory phase may extend into their headache phase, making the experience that much more debilitating.
Lastly, even when the head pain has subsided, the migraine patient may continue to feel unwell. This postdrome phase, also called the “headache hangover” can leave some patients feeling exhausted, lightheaded, irritable and confused. Less commonly, some patients may experience an unusual sense of wellness. The postdrome phase usually lasts less than 12 hours but can go on for more than a day.
In combination, these phases of migraine clearly separate this condition from the tight, “stress” headaches most people have experienced in their lives. The entire “migraine experience” can be hours to days long and unfortunately, some patients may even suffer weeks, months or even years of continuous, unending headache. Not surprisingly, migraine can lead to physical, psychological, social and economic suffering that affects not only the individual but also their loved ones.
As a headache specialist, I have seen patients whose lives have been devastated by their migraines. Unfortunately, many individuals with migraine suffer alone and feel misunderstood. Well-meaning friends and family offer words such as “Oh, I get headaches too” or “Why don’t you just take some ibuprofen?” without realizing how hurtful those words can be. It can be difficult for migraineurs to convey the full impact of their migraine and even more difficult for persons without migraine to understand their pain. Because of this, many migraine sufferers can go for years before they seek help for their condition. The pain and disability associated with migraine have led to some patients losing their jobs, dropping out of school or becoming alienated from friends and family. Many go about their lives suffering in silence, unable to find relief.
From my time spent treating headache patients, I have learned that migraine does not need to be a hopeless condition. Although there is no cure for migraine (yet), there are many treatment options available, with many more currently being researched. One of these options may be right for you or your loved one.
There are many misconceptions to migraine and it is easy for patients to feel lost and misunderstood. If you or a loved one is suffering from headaches, please see your doctor. You can also learn more about migraine at the following websites:
American Headache Society:http://www.americanheadachesociety.org/
American Migraine Foundation:http://www.americanmigrainefoundation.org/
American Headache and Migraine Association:https://ahma.memberclicks.net/
Abigail L. Chua, DO
(Neurologist, Headache Specialist)