More than just a “bad headache,” migraine pain and associated symptoms affect 29.5 million Americans. Women are almost three times more likely to suffer from migraines than men.
Migraine is characterized by throbbing pain, usually located on one side of the head, often accompanied by nausea and sensitivity to light and sound. The combination of disabling pain and associated symptoms often prevents sufferers from performing daily activities. Symptoms, incidence and severity vary by individual. Attacks can last anywhere from four to 72 hours and tend to occur in three phases: pre-headache, the headache itself and post-headache. The pre- and post-headache phases can last for hours to days with symptoms such as muscle tenderness, fatigue and mood changes.
Less than one-third of sufferers experience what is known as “aura.” They may see light flashes, blind spots, zigzag lines, and shimmering lights or experience numbness and tingling in the arm and face prior to the head pain and other symptoms. Aura symptoms last less than one hour and typically resolve before the head pain begins. Aura may occur with some, but not all attacks.
Migraines afflict both women and men, although three times more women experience migraines. Peak prevalence for migraine is between 20-45 years old for both genders. Migraine is often hereditary. Onset can occur in childhood. If both parents have them, there is a 75 percent chance their children will have them; when only one parent is a migraine sufferer, there is a 50 percent chance the child will be afflicted. If even a distant relative has migraine headaches, a 20 percent chance exists that any offspring will be prone to migraines.
Many things may trigger a migraine. Triggers are not the same for everyone and what causes a migraine in one person may relieve it in another. Triggers may be cumulative – with exposure to multiple triggers migraines may be more likely to occur. Triggers may include one or more of the following categories: diet, activity, environment, emotions, medications and hormones.
While there are no definite answers to the cause of migraines, healthcare professionals are gaining an understanding of what happens when a migraine attack is in progress. Current theory suggests that migraines are triggered from within the brain itself. Once an attack begins, the pain and other symptoms of migraine arise from an inflammatory process resulting from an interaction between the trigeminal nerve and blood vessels in the coverings of the brain. Serotonin (also known as 5-hydroxytryptamine or 5-HT), a naturally occurring chemical in the brain, has been implicated in this inflammatory process. Pain signals are sent from the blood vessels along the trigeminal nerve into the brainstem. Here, pain processing centers can become sensitized or overloaded by the incoming pain signals and begin to spontaneously fire. This can result in skin sensitivity on the head/scalp. Patients may note that “my hair hurts,” or that they have to take off glasses or jewelry during a migraine.
Once these symptoms occur, medication may not be as effective as it would be if taken earlier in the attack. Repeated pain signaling over time may be responsible for chronic (daily) migraine.
Migraine sufferers may experience a variety of headache presentations including sinus pain, neck tension, menstrual migraine or have aura without headache. Most migraine occurs episodically; however, 10 million Americans have chronic headache (15 or more days per month). Many of these people experience episodic migraine that evolved over time to chronic migraine.
Migraine can be effectively managed. With the help of a healthcare provider, patients can identify and alleviate their symptoms with an appropriate treatment regimen. Medications generally fall into two categories:
- Preventive - Taken on a daily basis, preventive medications can help reduce the number of attacks in patients who experience more than two migraines per month.
- Abortive - Abortive therapy treats the symptoms of migraines after the attack begins. Many medications available to treat an acute attack must be taken as soon as the attack occurs, otherwise they may be less effective.
Non-drug treatments can be effective, especially when used in conjunction with medication. Strategies include relaxation techniques, proper sleep and diet habits, exercise, and avoidance of behaviors or situations that may trigger an attack. Biofeedback has also been used successfully, as have acupuncture, massage, and simple heat and cold applications.
