Migraine: Facts and Figures

Overview

In my third post, I am going to talk about another brain disorder called Migraine. The word migraine can be described as a severe headache and remains an important health problem in the world affecting most often adults. Here I will describe what this disease is, what the symptoms are and how to prevent it. Subsequently, I will talk about pathophysiology of this disease and gender dependence of it. Lastly, I will explain about different types of migraine and what is in fact considered to be a migraine requiring a medical attention.

• Migraine

Migraine is a neurological disease (headache) that can cause notably severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea (being sick to your stomach), vomiting, and aura which can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty in speaking. Migraine attacks can last for hours to days, and the pain can be so bad that it interferes with your daily activities. Your migraine will likely get worse with physical activity, lights, sounds or smells. According to the Global Burden of Disease (GBD) 2019 study, the estimated global prevalence of migraine increased from 721.9 million in 1990 to 1.1 billion in 2019, so now migraine affects an estimated more than 15% of people worldwide, occurs most often among people aged 20 to 50 years. Another study shows that more than one in seven adults in the United States is affected by migraine attacks. This has been an alarm for many scientists and researchers for better and efficient understanding. The following are changes that one might experience one or two day before migraine:

• Constipation

• Mood changes, from depression to euphoria

• Food cravings

• Neck stiffness

• Increased urination

• Fluid retention

• Frequent yawning

Although these are reported to be common among pre-attack stage, these cannot absolutely apply to everyone. During attack, as it was said, pain that throbs or pulses, sensitivity to light, sound, etc. and vomiting are common.

• Prevention

If you get migraine headaches, you may not be able to prevent them completely, but you can take steps to get them less often. You can try to prevent migraine pain or find migraine relief in different ways. Aerobic exercises like walking, jogging, running, and cycling are associated with a decrease in migraine attacks, moreover, managing stress is a prominent method on prevention of migraine. Sleeping, eating, and exercise on a regular schedule, may also be effective in prevention of migraine symptoms. However, during the attack, migraine cannot be prevented completely but some medicines such as Aspirin, Naproxen, etc. are often prescribed as a cure.

• Pathophysiology

Two factors that influence the threshold of a person’s susceptibility to a migraine attack and also the mechanisms that trigger the attack and the associated symptoms need to be considered. Theories about pathophysiology are based on the anatomy and physiology of the pain-producing structures within the skull. Acute migraine attacks occur in the context of an individual’s inherent level of vulnerability. The greater the vulnerability or lower the threshold, the more frequent attacks occur. Attacks are initiated when internal or environmental triggers are of sufficient intensity to activate a series of events which culminate in the generation of a migraine headache which involves bursts of electrical activity that start in the vision center of the brain. This can also described as a functional consequence of inheriting migrainous genes.

Almost many are aware of four stage (phase) of migraine respectively named Prodrome, Aura, Headache, Postdrome. Prodrome (pre-attack symptoms), aura and headache (attack) are already explained. Postdrome is the phase after the attack and you might feel drained, confused, fatigue, unable to concentrate and washed out for up to a day.

Migraine is about 3 times more common in women than in men and for women ages 18 to 49, migraine is the leading cause of disability throughout the world. Accordingly, migraine is considered mostly a woman’s complaint. Different mechanisms have been evaluated to explain these differences. Neurologist Jan Lewis Brandes, founder of the Nashville Neuroscience Group, says “migraines can be triggered by hormonal fluctuation. Migraines are slightly more common in men than in women until women begin menstruation. And once they begin to menstruate, and hormones begin to fluctuate up and down, the number of their migraines increases dramatically”. Although it must be said that most studies agree that there are no gender-related differences in attack frequency.

• Types

There are several types of migraines and you can see a brief list of them and a bit of explanation here:

1. Migraine with aura (complicated migraine): Around 15% to 20% of people with migraine headaches experience an aura.

2. Migraine without aura (common migraine): This type of migraine headache strikes without the warning an aura may give you.

3. Migraine without head pain (Silent migraine): This type includes the aura symptom but not the headache that typically follows.

4. Chronic migraine: A chronic migraine is when a migraine occurs at least 15 days per month. The symptoms may change frequently, and so may the severity of the pain.

5. Status migrainosus: This is a rare and severe type of migraine. The headache pain and nausea can be extremely bad.

But there are over 150 types of headaches and one may not consider his or her headache as an absolute migraine. Migraine is categorized as a primary headache, meaning that it isn’t caused by a different medical condition. In the table below you can see migraine compared with other types of headaches.

Conclusion

It is very useful to discuss this disease with your doctor. Migraines are often undiagnosed and untreated, so if you regularly have signs and symptoms of migraine, keep a record of your attacks and how you treated them. You can discuss them with your doctor for better approach.