What They Are & Why They Occur
Migraines are a disabling, recurrent, neurovascular headache disorder, affecting around one in seven people worldwide. There appears to be a genetic predisposition to migraines, so those with a close relative who suffers may be more susceptible to developing the condition themselves. However, it is important to remember that genetics are not your destiny, and environmental factors still play a huge role.
The Key Differences Between Headaches & Migraines
Most of us will experience headaches in our lives, and they can come in many different forms. It’s important to recognise the difference between them and migraines so that the most appropriate treatment can be sought. Take note of these pointers:
While no headache is pleasant, the pain of a migraine is much more severe than an average tension-type headache. Sufferers will often be required to stop activities and lie down to rest in a dark room. The type of pain experienced also tends to differ, with migraines described as a throbbing or pulsating pain, whilst tension-headaches tend to be more of a constant, steady, dull ache in the head.
Typically, migraines present with unilateral pain on one side of the head, whereas tension headaches usually start in the back of the head or forehead, then spread.
Migraine sufferers will often experience symptoms in addition to head pain. For example, many also experience nausea, vomiting, digestive issues and sensitivity to light, noise, movement and smell.
Headache is actually only one stage of migraine. Many sufferers also experience a prodrome up to 24 hours before an attack. Symptoms such as sensitivity, irritability, food cravings or difficulty concentrating are warning signs that a migraine is coming. Shortly before a migraine, 10-30% of sufferers will experience an aura, which is a range of neurological symptoms that can include visual disturbances, numbness, tingling or weakness, disturbed speech and memory changes. The phenomenon is unique to migraine and will not be experienced by those suffering other types of headache.
Tension headaches and migraines have a different pathogenesis or manner of development. Migraines involve the activation of the trigeminal nerve, a major pain pathway in the brain. This is thought to induce pain responses and an inflammatory cascade of events. Tension headaches are usually caused by a tightening in the muscles of the face, neck or scalp, resulting in a pinching of the nerve or its blood supply that creates the sensation of pain or pressure.
The Various Types Of Migraines
The types of migraines experienced by sufferers can vary widely. There are some common features, however, and sufferers may experience more than one of the below:
MIGRAINE WITHOUT AURA
Also known as ‘common migraine’, 70-90% of sufferers experience migraine without aura. Attacks usually last between four and 72 hours. The headache is usually on one side of the head, with a throbbing or pulsating pain that affects normal daily life and will worsen with exercise such as walking or climbing stairs. Sufferers may also feel nauseous, have diarrhoea or become sensitive to light (photophobia) and/or sound (phonophobia).
MIGRAINE WITH AURA
Aura is a term used to describe a neurological symptom of migraine, which typically precedes the headache. Visual disturbances are the most common neurological symptoms. Others include numbness or tingling, pins and needles, weakness on one side of the body (hemiplegic migraine), dizziness or vertigo, and issues with speech, hearing and memory. Magnesium deficiency might contribute to migraine with aura, so increasing magnesium-rich foods such as leafy green vegetables (e.g. spinach, chard, kale and collard greens) and taking a magnesium supplement could help.
EPISODIC VS CHRONIC MIGRAINE
An alternative way of classifying migraines is based on frequency of attacks. An episodic migraine sufferer endures fewer than 15 headache days a month. Chronic migraine, which affects less than 1% of the population, describes those who suffer with 15 or more headache days a month. The majority of those suffering chronically often return spontaneously to episodic migraines.
Throughout the reproductive years, menstruation is one of the most significant events related to migraine attacks in women. Menstrual migraine typically occurs during a five-day window that starts two days before your period. Studies suggest that, compared with migraine at other times of the cycle, menstrual attacks last longer, are more severe, more likely to relapse, less responsive to treatment, and associated with greater disability. A drop in oestrogen appears to play an important role in hormone-associated migraine. This would explain why menstrual migraines tend to occur immediately before menstruation and during the pill-free period in women using combined oral contraceptive pills.
Abdominal migraine is an episodic condition mainly affecting children between the ages of three and ten years, although it can also affect adults. It is characterised by recurrent episodes of moderate-to-severe abdominal pain, usually near or behind the belly button, lasting from two to 72 hours. This may be accompanied by lack of appetite, nausea or vomiting. As children with abdominal migraine grow older, about half of them ‘grow out’ of abdominal migraine by the age of 14-16 years. However, abdominal migraine has been clearly shown to be a precursor of the development of head migraine, with around 70% of sufferers going on to develop migraine with or without aura. The cause of abdominal migraine is poorly understood, with more research needed, but genetic factors have been said to play a part.
Keep A List Of Your Triggers Handy
To initiate the cascade of events in a migraine attack, triggers are usually necessary. Migraine sufferers have a higher vulnerability to triggers than non-sufferers, as well as their own level of sensitivity. Commonly reported triggers include sleep deprivation, skipping meals (causing blood sugar crashes), hormonal changes (drops in oestrogen), certain foods (in particular, cheese, chocolate and wine) and certain medications. Stress is the most commonly reported trigger for migraine attacks. Relaxation, stress management, resilience techniques and therapies are therefore an important part of an effective management plan. Meditation has been shown to be particularly effective in controlling migraines, with several studies reporting positive results.
Key Migraine Misconceptions
A lot of people don’t realise poor gut health may be a key contributing factor. There is a clear association between the prevalence of migraines and digestive disorders such as irritable bowel syndrome (IBS), irritable bowel disease (IBD), coeliac disease and gastro-oesophageal reflux (GORD). Emerging research suggests live bacteria supplements may be of benefit. A recent clinical trial found the 14 strains of live bacteria in Bio-Kult Migréa significantly reduced both episodic and chronic migraine frequency and severity in as little as eight weeks. Another misconception is that you shouldn’t exercise with migraines. While there are arguments for both sides, there is evidence suggesting gentle to moderate cardiovascular exercise may be beneficial; by activating multiple pain modulatory mechanisms it might decrease the intensity of migraine pain.
What To Do If You’re Suffering Continuously
If you’re experiencing severe or frequent migraine symptoms (on more than five days a month), the NHS says you should see your GP even if painkillers such as paracetamol or ibuprofen are effective at controlling the pain. Migraines are a complex neurological issue and preventative treatment could help.
When it comes to diagnosis, there’s no specific test, so your GP will look to identify a pattern in your symptoms. That’s why all experts advise starting a migraine diary, recording details about your attacks for a few weeks and taking it along to show your doctor. This diary should include the date, the time, what you were doing when the migraine began, how long the attack lasted, what symptoms you experienced and what medication you took (if any).
The Migraine Trust says the six to eight hours prior to a migraine attack are also important to record. Details could include what medication or vitamins you took; what you ate; how much sleep you had; what exercise, social or work activity you did; what the weather was like. If applicable, recording details of your menstrual cycle each month can also be helpful.
Read more about migraine symptoms, including when to seek emergency medical help, at NHS.uk. For further advice on starting a migraine diary, including free downloadable templates, visit MigraineTrust.org.
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