MIGRAINE
This sheet was written for the Disability Information and Resource Centre (DIRC) by the Migraine Society of Australia. The Society has since closed down and donated its library to DIRC at 195 Gilles Street, Adelaide, South Australia. Anyone wanting more information can visit the DIRC library, and/or telephone, not email, the Society’s former enquiries ‘officer’ on (08) 8344-3709 or from outside Australia +61 8 8344 3709.
Most people think of migraine as a headache. In fact not only is migraine much more than a headache, there are even headacheless types of migraine. The symptoms of migraine are too many to list here. However, only a small portion of them present in any one attack.
There are three main types of migraine:
Migraine without aura (common migraine)
Migraine with aura (classical migraine)
Migraine aura without headache (migraine equivalent)
Of these migraine without aura is easily the most common, hence its traditional name common migraine. (Classical migraine was so called, not because it was a classic form, but because it was described in the literature of Classical times.) The newer names describe the essential nature of the types of attack.
That migraine is so widely thought of as a headache has had two major adverse consequences. One, by ignoring ‘gastric stasis’ (see below), a symptom experienced in some degree by up to 95% of migraineurs, medication has often not worked. Two, headacheless forms have been significantly under-diagnosed—especially in children.
Phases and symptoms of migraine attacks
A migraine attack can pass through up to five phases. Not all phases will be present in every attack, and only about one fifth of migraineurs experience phase 2 or auras.
The first and last of the five phases have been by far the least studied, and so little is known about them.
Phase 1. The prodrome begins hours or up to 2 days before phases 2 and 3, and the symptoms are less dramatic than those that follow. Typical symptoms include: mood changes such as irritability, crankiness & depression; food craving or loss of appetite; tiredness, yawning, clumsiness; fluid retention; increased sensitivity to light, sound, touch and even odour.
These premonitory symptoms are often mistakenly lumped together with auras (see phase 2) and referred to as ‘warning signs’. Although both do warn of an impending attack they are distinctly different.
Phase 2. The aura usually lasts for about 20 minutes to 30 minutes. Aura is a very misunderstood and so misleading word. When applied to migraine it has nothing to do with haloes and the like, even though migraineurs experience numerous forms of visual aura. Migrainous auras, or focal cerebral disturbances, can affect all the senses: the visual, tactile (e.g. pins & needles, numbness), olfactory (e.g. imagined & recalled smells), oral (e.g. strange tastes) and aural (e.g. tinnitus). There are other forms too, including: poor concentration, incoherence & slurred speech, mental confusion, distorted spatial perception, amnesia, sleepiness, clumsiness, poor cöordination & sense of balance, dizziness; hallucinations, and even sweats, muscle jerks & spasms.
The aura—and especially the first one experienced—can be distressing even terrifying to children and adults.
Phase 3. This phase is commonly known as the headache phase. The headache is often unilateral, and may be centred in the eye or the temple. It often throbs (in time with the pulse), and is aggravated by physical activity.
As the headache begins so too in many migraineurs do nausea and vomiting. In addition to nausea and vomiting a small number of migraineurs also experience diarrhoea &/or frequent and copious urination. If present nausea, vomiting and diarrhoea make taking medication orally or by suppository difficult to impossible. (For more on nausea and vomiting see below ‘gastric stasis’.)
During this phase migraineurs will be hypersensitive to light and/or sound and/or smell, and will usually want to lie down in a dark quiet room. Concentration will often be poor and focusing difficult.
Children too young to say that light or sound is hurting them may squint or close their eyes, or cover their ears with their hands. Although rare, children especially may experience moderate to high fever during this phase. Fortunately for most children this—often the worst—phase, usually lasts no longer than an hour. In children especially the headache tends to end after vomiting ceases and/or with sleep.
Phase 4. The main single characteristic of resolution is deep sleep. Vomiting is also common, giving way to deep sleep. If drugs have been taken for the attack they will affect the length and ‘symptoms’ of the resolution and possibly the recovery.
Phase 5. The recovery, postdrome or hangover may last for days. It is often characterized by weakness, tiredness, exhaustion, limited food tolerance, copious urination or diuresis, and mild headache. It can be severe enough to prevent return to school or work. Most children recover quite quickly after the headache and so do not experience this phase to any significant degree.
Gastric Stasis
Gastric stasis means roughly that the working of the gastrointestinal system slows or even stops; the stomach does not empty, digestion ceases. This causes most migraineurs to suffer symptoms ranging from mild stomach discomfort, through nausea, to uncontrollable vomiting—and sometimes diarrhoea. During gastric stasis tablets and capsules are either poorly absorbed or remain intact for hours. There are several ways of overcoming this problem—once it is known about. So, not only is headache just one of migraine’s symptoms, but often it can not be attacked until gastric stasis is dealt with.
Cause and Triggers
Migraine is almost certainly genetically caused, and so can not be cured. It can however be treated, controlled or managed. Migraine attacks can be triggered (not caused) by numerous things including: hormones; stress, and relaxing after a period of stress; glare and flicker; missed meals, fasting, exertion and consequent low blood sugar levels; too much or too little or irregular sleep, cigarette smoke, scents, certain foods, certain rapid changes in weather … . When triggers can not be found or avoided migraineurs need to look for treatments, and that means consulting your doctor.
Natural remissions
During the courses of their lives many people have one or more migraine free periods. These intervals may last for weeks, months and sometimes years. Some luckier people’s migraines stop—often for no apparent reason—never to return. When most migraineurs pass through middle age and onwards attacks tend to become less frequent & less severe. The number of migraineurs, although small as a per centage, who on any one day enter a migraine free period or whose migraines stop never to come back is quite large. This has had an unexpected consequence.
Every so often a practitioner of a therapy that has little relevance to migraine presents to the media one or two people who claim to have been ‘cured’. These ‘cured’ persons usually say that after treatment they have been headache free. But as everyday significant numbers of migraineurs enter a temporary or permanent migraine-free period, most of these ‘cures’ are probably examples of spontaneous remission. To check whether these therapies are efficacious, those claiming to be cured need to be followed up six & twelve months later.
Other web-sites
The web-sites listed below are recommended as reliable providers of accurate information. (That a site is not listed is not meant to suggest that it is not a reliable provider of accurate information. For most of the organizations listed more information is available to their financial members than non-members.)
ACHE (American Council for Headache Education) www.achenet.org
American Headache Society (for US Headache Consortium’s Headache Guidelines) www.ahsnet.org
International Headache Society www.i-h-s.org
National Headache Foundation (Chicago) www.headaches.org
The Migraine Association of Canada www.migraine.ca
World Headache Alliance (umbrella body for associations of migraineurs) www.W-H-A.org
For information on drugs:
Australian Prescription Products Guide www.appco.com.au/appguide/
Prepared by Peter Adamson, former President Migraine Society of South Australia (organisation no longer in existence).
