Article by John Miller
What is Migraine?
Migraine is a chronic neurological disorder characterised by episodic attacks of head pain and associated symptoms. Migraine pain will always present on one side only (although the side can change between attacks). The pain is often described as throbbing and is of moderate to severe intensity. The pain will cause avoidance of normal activities such as attending school or going to work.
Sufferers will usually have one or more of:
Migraine headaches will last between 4 hours and in extreme cases up to three days.
What is Migraine with Aura?
Some migraine sufferers also experience an Aura. This aura typically consists of a combination of visual, sensory, and sometimes movement disturbances. These symptoms will be completely reversible and occur up to 60 minutes BEFORE the onset of a migraine. Visual symptoms can include seeing spots and lights or being aware of blind spots. Sensory symptoms can include tingling and pins and needles or numbness. Movement problems can include reduced coordination, dizziness and speech disturbance.
What Causes Migraine?
The truth is that we don’t know with absolute certainty what causes Migraine. Migraine was once thought to be initiated by problems with blood vessels. This theory is now largely discredited.
One current theory is that a phenomenon known as cortical spreading depression is responsible for the disorder. In cortical spreading depression, electrical activity is reduced over an area of the cortex (grey matter) of the brain. This results in the release of specific cells which then irritate nerves in the brain stem, causing the headache
Researchers feel there are three main factors that contribute to migraine and headache. They are:
Perhaps the many different presentations of migraine and headache are a result of these three factors in different proportions. Supporting this is that the presenting features of the different headache types overlap and it is difficult to make a diagnosis from these features alone. Research has shown that sufferers of common migraine (that is without an aura, for example visual or speech disturbances) and cervicogenic headache share similar symptoms. (Sjaastad O et al. Laterality of pain and other migraine criteria in common migraine. A comparison with cervicogenic headache. Funct Neurol 1992;7:289-94)
What are the Signs and Symptoms of Migraine?
While the theory is yet to be proven, there are a number of signs and symptoms that help us diagnose a migraine. These can include:
The diagnosis of ‘migraine’ is an umbrella term. This means that there are many different versions of a migraine, but they are all grouped under the same diagnosis. Your migraine may exhibit all of the symptoms listed above, or you may have four or five symptoms. Migraines are quite individual, and because of this your treatment must also be specific to you.
How is Migraine Diagnosed?
Migraine is best diagnosed by a Neurologist who specialises in migraine. Your doctor can refer you to a Neurologist.
Migraine is often missed in diagnosis due to a focus on only one symptom. To be sure of a diagnosis you should notice two or more of the mentioned symptoms. It is important to remember that not all symptoms associated with migraine are included in diagnostic criteria. If you are unsure of your diagnosis it is important to speak to someone experienced in the diagnosis and management of headache disorders.
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