What Is Migraine?

Migraine is more than just a headache. It can be a debilitating condition which has a considerable impact on the quality of life of sufferers and their families. Attacks can be completely disabling, forcing the sufferer to abandon everyday activities for up to 3 days. Even in symptom-free periods, sufferers may live in fear of the next attack.

 

If you have two or more of the following symptoms during an attack it is probable that you are suffering from migraine.

 

Neurological disturbances lasting around 15-60 minutes which normally occur before the headache begins; most commonly visual disturbances including blind spots, flashing lights or zig-zag patterns; confusion, inability to concentrate, problems with articulation or co-ordination, or tingling, pins and needles or numbness on the affected side. These symptoms, known as aura are most often identified with migraine but in fact only about 10-15% of sufferers experience them. Migraine with aura was formerly known as classic migraine.

 

Although some people experience aura symptoms only, the attack normally proceeds after a short interval in the same way as migraine without aura, formerly called common migraine, with some or all of the following symptoms:

 

• Intense throbbing headache, often on one side of the head only
• Nausea and/or vomiting and/or diarrhoea
• Increased sensitivity to light (photophobia)
• Increased sensitivity to sounds (phonophobia)
• Increased sensitivity to smells (osmophobia)

 

You may also experience stiffness of the neck and shoulders, tingling or stiffness in the limbs, an inability to concentrate, difficulty in speaking, or in rare cases paralysis or loss of consciousness.

 

A general rule of thumb is that if a headache and/or other associated symptoms prevents you from continuing with normal daily activities it could be a migraine.

 

Although headache is the most obvious event during a migraine some migraineurs start to feel "strange" a day or so before the attack begins. These strange feelings, known as the prodrome, are the first signs of the attack and can include cravings for certain foods, excitability, hyperactivity, tiredness, yawning or a change of mood.

 

Migraine attacks normally last between 4 and 72 hours and sufferers are usually symptom free between attacks.

 

Understanding Migraines

Most patients develop their first migraine headache in adolescence or early adulthood. Many women report that headaches worsen before or during the menstrual period, (estradiol levels fall after ovulation and before menstruation, and this fall could account for headaches at these times). Pregnancy may improve, worsen, or have no effect on migraine. In any individual woman, each pregnancy may affect migraine differently.

 

Despite the fact that 1 in 4 households in Canada have someone effected by migraine headaches, migraine is still not considered by many employers and insurers to be a legitimate medical problem. Migraine, however, can cause significant disability and costs the Canadian work force 7 million workdays each year! (these are only the reported cases the actual figures may be double that, 14 million work days per year!). The leading doctors in the areas of neurology and head pain have themselves stated that this disease is grossly misunderstood and misdiagnosed. In fact, 60% of women and 70% of men with Migraine have never been diagnosed with this disease!

 

For many years, research scientists believed that migraines were linked to the dilation and constriction of blood vessels in the head. Although this is one of the physiological effects during a migraine, investigators now believe that migraine is caused by inherited abnormalities in certain cell populations in the brainstem. Research indicates that there is a migraine pain center located in the brainstem, a region at the base of the brain. As neurons fire, surrounding blood vessels dilate and become inflamed, causing the characteristic pain of a migraine. In order to keep this process in check, prompt treatment is of the essence. A person may inherit a genetic predisposition for developing migraine headaches, but other factors such as stress, triggers, hormonal changes, or sleep disturbances are necessary to experience a migraine. At The Ontario Migraine Clinic our goal is to maintain proper balance of these other factors that affect the individual. This is managed through a specific individualized treatment program and educating patients of specific triggers and lifestyle changes that may be needed.

 

Migraine 'With Aura' versus 'Without Aura'

Migraine headache is subdivided into two different types: Migraine With Aura and Migraine Without Aura. Most patients do not have an aura, which is a brief period immediately prior to the headache during which a neurological event occurs. This event is most commonly a brief period of abnormal vision, such as seeing spots, zig-zag lines, or unusual colors. Less common auras include weakness in an arm or leg, “funny” feelings (tingling, pins and needles) in an arm or leg, and trouble speaking or understanding other's speech. Auras typically last less than one hour and completely resolve.

 

What Causes Migraine and Who Gets Migraine Headaches?

Migraine headaches are now known to have a genetic factor that predisposes individuals that are carrying these genes. Carrying these “migraine” genes is in itself not a problem, and will not necessarily mean that the carrier will ever experience a migraine. This is consistent to the fact that all genes are not expressed unless there is “pressure” that will “turn on “ their function. These genes have to be “turned on” to cause a migraine. Migraine genes can be “turned on” or strongly influenced by environmental factors. A person may inherit a predisposition for developing migraine headaches, but other factors such as stress, food triggers, environmental triggers, hormonal changes, or sleep disturbances are necessary to experience a migraine.

 

There is always a combination of factors needed to lead a migraine. It is the sum total of these that will push an individual to experiencing a migraine. What seem to trigger an attack one day will not the next. There is a reason for this. The days when no migraine manifests even though the “known trigger” was experienced, is because the total influencing effect of all the factors present (genetic, internal and external factors) at that time were not enough to cause a migraine. Think of it as a points system. If you need 10 points to get a migraine, and each factor is worth lets say 1, 2, 3 or 5 points, having one or two factors may not be enough to give you a migraine. Lets say that the genetic factor for migraine is worth 5 points, a change in atmospheric pressure may be worth 2 and fatigue 2, this in itself will only add to 9. Then, the next factor, lets say a glass of red wine (which would be called the trigger) will push you to 10 and a migraine.

 

On another day, the atmospheric pressure may be at zero points. Using the previous example, if all other factors are equal, an individuals point total will only add to 8, and that individual will not experience a migraine. This person may think that only sometimes red wine gives them a migraine. When in fact it is only one of many factors that is contributing to a total that will lead them to a migraine.

 

As our health is put under stress via internal or external factors, our ability to cope with these changes decrease. The ability of our body to maintain equilibrium is essential for maintaining proper health. An example of this, is temperature control. When we are warm, our body has a mechanism in place to make us perspire and cool us down. When we are cold, our body will shiver to bring our temperature up to normal. A problem will arise when we put ourselves in a situation that our bodies can’t cope with, such as going outside when it is too hot or too cold. If we stay in those environments for too long we can suffer from heat stroke or hypothermia. Our bodies are not able to compensate for the prolonged drastic change and we develop a problem. Similarly, if we put too much pressure on a bone it will break, or, if we put specific stress on our body, we can develop a migraine.

 

Over time, we can create a problem with our ability to effectively cope with stress. This may be caused by various lifestyle factors and choices. For example, missing one night of sleep can diminish our immune system cells by 25%! This depletion of immunity can lower our body’s ability to regulate other systems. This leads to a lowered ability to cope with further stress. This in turn can also trigger a migraine.

 

The manner by which our treatment at The Ontario Migraine Clinic works, is by improving your own ability to maintain balance when influenced by internal or external factors. If your body can maintain a strong balance, factors that would normally cause imbalance and therefore attribute to migraine, will not have the same impact.