Migraine

11.16.2016 | Teri Robert

Migraine is a genetic neurological disease characterized by episodes commonly called migraine attacks. Based on the World Health Organization’s estimate that 12 percent of the American population has migraine and U. S. government census statistics, nearly 39 million Americans have migraine disease. Migraine affects women more frequently than men. The prevalence of migraine in women is 18 percent; in men, it’s six to eight percent.

A migraine isn’t simply a bad headache. A migraine includes other symptoms and can, in fact, occur with no headache at all. Other symptoms may include:

  • photophobia (enhanced sensitivity to light)
  • phonophobia (enhanced sensitivity to sound)
  • osmophobia (enhanced sensitivity to odors)
  • aphasia (loss or impairment of the power to use or comprehend language)
  • allodynia (when ordinarily painless stimulus is experienced as being painful)
  • nausea
  • vomiting
  • diarrhea
  • mood swings
  • food cravings
  • neck pain
  • visual disturbances
  • hemiplegia (one-sided paralysis)
  • paresthesia (abnormal or unpleasant sensation often described as numbness or as a prickly, stinging, or burning feeling)
  • rhinorrhea (runny nose)•nasal congestion
  • facial pain
  • vertigo and others.

The cause of migraine disease is not yet fully understood. At this time, it’s thought to be caused by genetic predisposition and a hyperexcitable brain that reacts strongly to stimuli that are migraine triggers.

Migraine triggers are stimuli that bring on a migraine attack. Triggers vary from one person to another and can change over time. Triggers also tend to be stackable or cumulative, meaning that that some triggers might not bring on a migraine if we counter just one, but "stack" two or more together, and they do bring on a migraine.

Common migraine triggers include:

  • Changes in weather or barometric pressure
  • Hormonal fluctuations
  • Some foods and beverages
  • Skipped meals or irregular eating schedules
  • Bright or flickering lights
  • Loud noises
  • Sleep issues including too much sleep, too little sleep, interrupted sleep, poor quality sleep, and an irregular sleep schedule.
  • Dehydration
  • Fragrances, chemical fumes, odors
  • Physical exertion including orgasm
  • Excessive heat
  • Stress. Before accepting that stress itself is a trigger, migraineurs should carefully look for potentially avoidable triggers that they encounter during stressful times. These include:
    • Not consuming enough fluids, and becoming dehydrated.
    • Consuming too much caffeine.
    • Skipping meals or eating on an irregular schedule.
    • Sleep issues.
    • Crying.

A diagnosis of migraine is incomplete without specifying which form(s) of migraine. There are several forms of migraine, and it’s not unusual for patients to have more than one type. For example – Few people who have migraine with aura have aura with every migraine, so most have both migraine with aura and migraine without aura.

Here is a listing of forms of migraine as outlined in ICHD-3:

  • 1.1 Migraine without aura
  • 1.2 Migraine with aura
    • 1.2.1 Migraine with typical aura
      • 1.2.1.1 Typical aura with headache
      • 1.2.1.2 Typical aura without headache
    • 1.2.2 Migraine with brainstem aura
    • 1.2.3 Hemiplegic migraine
      • 1.2.3.1 Familial hemiplegic migraine (FHM)
      • 1.2.3.1.1 Familial hemiplegic migraine type 1
      • 1.2.3.1.2 Familial hemiplegic migraine type 2
      • 1.2.3.1.3 Familial hemiplegic migraine type 3
      • 1.2.3.1.4 Familial hemiplegic migraine, other loci
    • 1.2.3.2 Sporadic hemiplegic migraine
    • 1.2.4 Retinal migraine
  • 1.3 Chronic migraine
  • 1.4 Complications of migraine
  • 1.4.1 Status migrainosus
  • 1.4.2 Persistent aura without infarction
  • 1.4.3 Migrainous infarction
  • 1.4.4 Migraine aura-triggered seizure
  • 1.5 Probable migraine
  • 1.5.1 Probable migraine without aura
  • 1.5.2 Probable migraine with aura
  • 1.6 Episodic syndromes that may be associated with migraine
  • 1.6.1 Recurrent gastrointestinal disturbance
  • 1.6.1.1 Cyclical vomiting syndrome
  • 1.6.1.2 Abdominal migraine
  • 1.6.2 Benign paroxysmal vertigo
  • 1.6.3 Benign paroxysmal torticollis

At this time, there is no cure for migraine disease. There are, however, good treatments available for both acute and preventive treatment. Migraineurs who are not experiencing successful treatment and management with their doctors may need to seek care from a qualified migraine specialist. It’s important to note that neurologists aren’t necessarily migraine specialists, and migraine specialists aren’t necessarily neurologists. Both the American Headache Society and the Migraine Research Foundation have areas on their web sites to help locate migraine and headache specialists:


Sources
Headache Classification Committee of the International Headache Society. “The International Classification of Headache Disorders, 3rd edition (beta version).” Cephalalgia. July 2013 vol. 33 no. 9 629-808.