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Migraines... Just a headache or something worse?!


Migraines are one of the many types of headaches that occur. In the UK, it is estimated that 190 000 attacks happen every day in the UK and there are around 6 million people who have suffered from migraines. Some people experience them infrequently whilst others experience them more chronically. One of the definitions of a chronic migraine (according to the International Headache Society), is that chronic sufferers experience headaches for at least 15 days of the month for three months. This is speculated to be around 1 in 1000 people. It has been found that there is a genetic component to migraine occurrence and unfortunately it affects women x3 more likely than men.


Seeing as it can be an incredibly debilitating condition as well as relatively common in the UK, it is helpful to know a bit more about them. 


4 Stages of a Migraine


Migraines tend to go through 3-4 phases before they disappear. 


  1. Premonitory phase:

This can start 24-72 hrs before the actual headache begins. In this time, something triggers off the start of the migraine process causing an imbalance to the ‘homeostasis’ in our neurochemistry. 


Symptoms can include:

-photophobia

-fatigue

-depression

-cravings

-stiffness in the muscles especially neck


Known triggers are:

-emotional stress

-hormones

-alcohol

-bright lights

-odors

-weather

-not eating

-smoke

-sleep disturbances

-exercises

-neck pain



The theory is that for some reason, peoples brains have sensitivities to these triggers which then will trigger the cascade of events of the migraine. The thought is that the change in the homeostasis causes the hypothalamus (structure found deep in the brain) to process differently. The hypothalamus is responsible for regulating the processes in our body that we don’t have control over such as body temperature, appetite and thirst and it is important in the regulation of hormones. This often explains the symptoms experienced in a migraine. 


It is in the first phase that treatment is started as it helps to give the best outcome and resolution of the headache. 


  1. Aura phase


About ⅓ of migraine sufferers experience the aura phase. The aura phase is characterized as neurological symptoms that develop which are fully reversible. 


Symptoms include:

- Visual aura: spotted and blurred vision

-Sensory aura: tingling on one side of the body/face

-Language aura: difficulty with words and speech

-Motor aura: weakness on one side of the body 


The theory behind the aura phase is that the stimulation in the brain develops into ‘Cortical Spreading Depression’ which essentially means that the brain fire off neurones across the cortex of the brain and remain ‘uncharged’ after firing off , triggering these symptoms that affect vision, movement, speech and sensation. 


  1. Headache Phase 


This is the start of the head pains portion of the migraine process. A typical migraine presents as a pulsating, throbbing headache that is one sided (although it can present on both sides). It can be associated with nausea and vomiting, sensitivity to light and sound and some people also experience a hyposensitivity to touch in certain parts of the body. 


The pain is often aggravated by turning one's head, sneezing and coughing. Referred pain in the neck can also be experienced a long side the head pain. 


The theory behind this phase is that the Trigeminal Nerve (a nerve that supplies the sensation of the face around the forehead (ophthalmic division), cheek (maxillary division) and the jaw (mandibular division)), is sensitized by the pain signals firing off from the dura mater. The dura mater surrounds the cortex of the brain and has lots of pain receptors on it. It’s sensation is also supplied by the trigeminal nerve so the interplay of these two structures cause the pain to appear on the head and face in this phase. This phase can last a few days. 


  1. Postdrome phase


In the postdrome phase, there are a lingering of symptoms that eventually taper off as things settle down. The nervous system remains sensitized for a while which means it has a lower threshold to pain causing normal movements and stimuli to trigger off painful responses that normally wouldn't. 



Management 


Depending on whether one experiences chronic migraines or not will determine the type of management one will receive. There are a selection of prescribable drugs to try to prevent them from happening in chronic cases as well as drugs for stopping migraines developing into the headache phase if managed sufficiently in the premonitory phase. One would have to speak to their doctors to receive the appropriate advice regarding medication usage. 


Other recommendations to support medication use are resting in a dark, quiet room, having a cool cloth on the head and keeping one's fluid in take up. 



 

Other types of Migraines


It is worth mentioning that there are many other types of migraines out there that affect people of all ages.


-Abdominal migraines- affect younger children 

-Basilar type migraine- affect children and adolescents especially teenage girls around menstruation

-Hemiplegic Migraine- affects one side of the body. Known to have a strong genetic link

-Menstrual migraine-affects women around their period. This is likely due to the link of the hypothalamus being an important structure in regulating hormones. 

-Migraine without headache-These people experience may of the other debilitating symptoms without the headache 

-Opthalmaplegic migraine- These people experience visual problems coupled with the aura symptoms 

-Retinal migraine- These people experience visual loss or disturbances in one eye

-Status Migrainosus- This is a rare and severe form of migraine that causes such disabling symptoms for 72 hours or more often ending in hospitalization. 


If you are unclear whether you experience migraines or are managing it effectively, contact your GP to discuss your options.

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