Migraine is a neurological disorder characterized by the recurrence of debilitating headaches. The pain, which can last from three to 72 hours, is moderate to severe and often pulsating in nature. Other symptoms may include nausea, vomiting, and sensitivity to light, sound and/or smell. About fifteen percent of the world’s population have experienced a migraine headache.
Migraines are due to a combination of environmental and genetic factors with about two-thirds of patients having family members with the disorder. Experts believe that migraines are a neurovascular condition that leads to increased activity in the brain’s cerebral cortex and a dysfunction in the pain neurons in the brainstem.
Hormones may play a role as well. For example, while migraines are slightly more common among boys before puberty, they become two to three times more common in women than men post-puberty. Migraines also become less common during pregnancy, another factor suggesting the role of hormones.
The severity of pain, length, and frequency of migraines is extremely variable among patients. Some people experience only a few migraines in a lifetime while others suffer from them every week.
There are four basic stages during a migraine, although not all stages are experienced in every patient. These include the prodrome phase, the aura phase, the pain phase and the postdrome phase.
The prodrome phase occurs days or hours before the headache begins. Over half of migraine sufferers experience this phase and their symptoms vary widely. During this phase, patients may experience irritability, depression, stiff neck, fatigue, cravings, sensitivity to smells or noise, digestive problems or even euphoria.
Approximately one-third of migraine sufferers experience the aura phase. The aura occurs just before onset of the headache and typically last fewer than 60 minutes. This is typically a visual phenomenon but may also be a sensory, language or motor disturbance.
The pain phase, or the headache phase, involves moderate to severe throbbing pain in either one side (unilateral headache) or both sides of the head (bilateral headache) and sometimes the neck. Bilateral headaches occur more often in migraines without an aura. The pain may last anywhere from a few hours to several days. Physical activity often causes the pain to become more intense. Nausea occurs in about 90 percent of sufferers. Many patients also experience fatigue and sensitivity to light, smells and sound.
After the pain has subsided, some patients experience a postdrome phase that may involve head soreness and a feeling of being “hung-over.” This may include gastrointestinal problems, depression, weakness and/or foggy thinking. However, some patients feel unusually refreshed or euphoric after an attack.
Treatment for the occasional migraine may involve simple pain medication such as ibuprofen, Tylenol or caffeine. For those with frequent and/or severe migraines, preventative medications and more powerful pain-relieving drugs are often needed. In some severe cases, surgery may be required. Patients with frequent migraines learn to avoid personal triggers, including certain foods or situations.
Example: Joan’s headaches became so severe that she couldn’t leave the house for days. She would lay in bed for hours with the curtains drawn tightly shut. Her husband watched TV in the other room as she couldn’t handle sound or light.