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 everyday activities such as attending school or going to work.
Migraine sufferers will usually have one or more of:
- photophobia (hypersensitivity to light),
- phonophobia (hypersensitivity to noise).
Migraine headaches will usually last between four 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. Tingling, pins and needles or numbness may be your sensory signs. Movement problems can reduce coordination, dizziness and speech disturbance.
What Causes Migraine?
The truth is that we don’t know with absolute certainty what causes migraines. One current theory is that a phenomenon known as cortical spreading depression is responsible for the disorder. In cortical spreading depression, electrical activity reduces over an area of the brain’s cortex (grey matter). Specific cells released irritate nerves in the brain stem, causing headaches.
Researchers feel three main factors contribute to a migraine and headache. They are:
- Pain causing structures in the head;
- Pain causing structures in the neck; and
- Serotonin – the chemical.
Perhaps the many different presentations of migraine and headache resulting from these three factors in different proportions. Supporting this is that the presenting features of the other headache types overlap, and it is difficult to make a diagnosis from these features alone.
Research has shown that sufferers of a common migraine (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 a Migraine?
While the theory is yet to be proven, several signs and symptoms help us diagnose migraines. These can include:
- Headache attacks lasting 4 to 72 hours.
- A one-sided headache, although a headache can shift sides within and between attacks.
- Pulsating or throbbing headache.
- Moderate to severe intensity, which limits daily activities.
- Physical activity aggravates.
- Sensitivity to light or sound.
- Nausea and or vomiting
- The development of disturbance of your vision or an aura. This usually comes before the migraine starts and commonly lasts about 60 minutes.
The diagnosis of a migraine is an umbrella term. There are many different versions of a migraine. They are all grouped under the same umbrella migraine diagnosis. Your migraine may exhibit all of the symptoms listed above, or you may have four or five symptoms.
Migraines are individual, and because of this, your treatment must also be specific to you. Please consult your health professional for their professional opinion.
How is Migraine Diagnosed?
Migraine misdiagnosis can result from 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 diagnostic criteria are required.
Your GP can refer you to a Neurologist who specialises in migraines.
Headache - Migraine
Specific Migraine - Headache Types
- Neck Pain
- Bulging Disc
- Wry Neck
- Text Neck
- Pinched Nerve
- Cervical Radiculopathy
- Facet Joint Syndrome
- Neck Sprain
What is a Primary and Secondary Headache?
The International Headache Society classifies headaches as Primary or Secondary.
Secondary headaches. Caused by an underlying problem and can include a post-whiplash headache, neck headache, jaw headache and drug withdrawal headache. “Ice cream headache” is a secondary headache caused by extreme cold within your mouth. In other words, a secondary headache is a symptom of something else being wrong rather than the cause itself. Treatment for a secondary headache involves treating the source, e.g. loosen some stiff upper neck joints or stop eating ice cream!
It is also important to point out that many headache sufferers may suffer multi-source headaches. For example, a migraine sufferer may simultaneously experience a tension-type headache and neck headache. Treatment will vary depending upon your specific symptoms and headache source.
Please consult with your healthcare practitioner for an accurate diagnosis and treatment pathway.
More info: Headaches & Migraines
When Should You Be Concerned about a Headache?
Unfortunately, in a small percentage of patients, there is a sinister cause of your head pain, which require investigation. We call these Red Flags because they can be vital signs of more sinister underlying conditions such as brain tumours, aneurysm, stroke, meningitis and other systemic illnesses. If you experience any of the following symptoms, please seek the urgent advice of your healthcare professional.
You MUST thoroughly investigate any Red Flags!
Please check with your doctor to investigate further if your headaches have any of the following characteristics. Your headache is:
- History your worst ever headache or a different headache to your usual.
- Exertion triggers your headache (e.g. exercise, cough, sneeze or sex).
- Age is higher than 50 years.
- Despite treatment, your headache persists.
- Acute onset.
- Central nervous system findings. e.g. motor weakness, memory loss, slurred speech.
- HIV or another immune system compromise
- fEver or other systemic symptoms, e.g. weight loss, rash.
If you have any of the above HEADACHE Red Flags symptoms, we strongly recommend that you consult your doctor immediately.
Less Urgent & Severe Headache Types
Fortunately, most headaches do not require urgent medical investigation and should respond positively to treatment depending upon an accurate diagnosis.
For specific advice, please consult your doctor or headache physiotherapist.
Suffering a Headache or Migraine?
If you are suffering from a headache or migraine, it is appropriate that your first step is to consult your doctor. Your doctor will examine you and then determine if a neurological opinion is required and whether a CT or MRI scan of your head is necessary. In the vast majority of cases, your scans will be reasonable. Occasionally, scans can identify significant but luckily uncommon headache sources such as an aneurysm or tumour.
If Your Scan is Normal?
Firstly, you should feel relieved. Scans will rule out the more sinister causes of headaches or migraines.
Discovering Your Headache Source?
We recommend that you should then commence a process of elimination, starting with the most commonly diagnosed and easily fixed sources.
Researchers believe that at least one in four headaches are neck origin. A thorough examination of your neck by a skilled headache physiotherapist is your next port of call. You'll have over a 25% chance that your physiotherapist will confirm and then relieve your headache at your first consultation.