You are on page 1of 6

Migraine Is Not a Headache. Migraine is an enigmatic ailment, often thought to be simply a bad headache.

In fact, migraine is a neurological disease that affects 15% of the population, predominantly women, and is a common cause of disability. Menachem Goldstein had a government job and went to night law school. He graduated at the top of his class but, to the surprise of his classmates and professors, only applied for legal jobs within the government agency where he’d been working, although he could have gone to any top law firm in his town and made significantly more money. What held him back? “Migraines,” he says. “I had seniority in my government job, which meant more flexible hours and a significant amount of sick leave each year. I could never have held onto a job in a law firm – when a migraine strikes, I can be confined to a dark room for days.” In a way, Menachem is fortunate because, given some accommodation, he could continue to be a productive member of the work force. For others, the disease can be devastating: migraine is the 12th most disabling condition in the U.S. Scores more, like Menachem, base many of their important life decisions – such as how to earn a living, where to live, or what to eat – in order to accommodate their condition. Migraine costs the U.S. economy $20 billion in lost revenues each year. Between 12 and 15 percent of the U.S. population (over 37 million people), and 10 percent of the world population suffer from migraines, one of the least understood and most undertreated medical conditions. In addition to their condition, people with migraine also suffer from the lack of awareness others have about the disease. There is a common misconception that a migraine is just a bad headache. Migraine is not a headache. It is a serious genetic, chronic, episodic, neurological disease, of which headache is one of the symptoms, and for which there is no cure. And yet despite the number of people affected, many physicians still misdiagnose migraine as tension headaches, sinus trouble, hypochondria or simply drugseeking.

Nevertheless, “it’s a systemic illness,” emphasizes Dr. David Dodick, a neurologist at the Mayo Clinic. A migraineur (the technical term for a person who suffers from migraine) has a neurological condition all the time – not just when in pain. He or she has migraine even when not having a migraine attack or episode, and much of the treatment must focus on controlling the condition to prevent, as much as possible, those attacks from happening. Fortunately, lifestyle changes and new advances in medicine can provide more relief than was available even just a few years ago. The Progression of a Migraine Attack A migraine attack consists of four phases, although not every migraineur experiences all four each time. Phase 1: Prodrome or “preheadache” This phase can occur hours or even days before the full-blown attack. The person may experience a variety of symptoms, including neck stiffness, mood disturbances, increased urination or food cravings. Some symptoms can be very idiosyncratic. Pessy Feld recalls calling the dentist for an emergency appointment when one of her molars began causing pain. She thought she’d need root canal. Instead, dental X-rays showed the tooth was perfect. After ruling out other conditions, the dentist suggested she keep a diary. After a few months she realized the toothache was a new part of her prodrome – a warning that three to four days later, she’d be in the throes of a migraine attack. Now, she’s actually grateful for the toothache – “It gives me an opportunity to rearrange my schedule a few days ahead of time if I can,” she says. Phase 2: Aura It’s the most famous migraine symptom, but only 20 percent of migraineurs have them. Auras are visual, auditory or sensory disturbances. They can include:
  

visual distortions, seeing flashing lights, wavy lines, spots, partial loss of or blurry vision hallucinations of odors that aren’t really there tingling or numbness of the face or extremities

    

slurred speech or difficulty finding words confusion partial paralysis auditory hallucinations or loss of hearing hypersensitivity to feel and touch or loss of sensation

Migraine auras may have affected the world of art more than any other disease – from the odd imagery of Lewis Carroll’s Alice in Wonderland, which gave its name to one kind of migraine – the Alice in Wonderland syndrome, in which the person sees himself getting smaller or bigger and time seems to warp – to the paintings of Vincent Van Gogh. One type of visual disturbance associated with migraine is even known as the Seurat effect, since patients start seeing the world in points or pixels of color, much like the artist Seurat’s pointillism style. Just as most migraineurs never experience an aura, some can have only auras and no other symptoms of an attack. Phase 3: Pain Migraine pain is excruciating and can involve the whole body, not just the head. (In fact, in children, it may often manifest as abdominal pain.) Symptoms of this phase include:          Headache pain, usually on only one side of the head at a time Hypersensitivity to sound and light Nauseas, vomiting Diarrhea or constipation Dehydration or fluid retention Runny nose or nasal congestion Hot flashes alternating with chills Dizziness Confusion

Migraine pain can last days, even weeks. A “typical” migraine, if there is one, lasts from one to 72 hours. Once the pain lasts longer than three or four days, the person is considered in status migrainosus and should seek medical help, not only because physicians may prescribe other pain medication, but also because there is an increased risk of the attack developing into a medical emergency. Phase 4 : Postdrome

A migraine attack isn’t over when the pain ends. This post-headache period may last for hours or days. Studies have shown abnormal cerebral blood flow and EEG readings for up to 24 hours after the pain stops. People report feeling like a zombie and often assume it is a side-effect of medications, but in fact this may be part of the attack itself. They also may experience depression or elation, extreme fatigue, difficulty concentrating and temporarily impaired mental agility. Migraine and Stroke There seems to be a link between migraine and stroke. A study published in the British Medical Journal reported they may double the risk of stroke, perhaps triple it in people who have migraines with aura. The risk hike was greatest for women under 40. The National Migraine Association reports that more people die each year from migraine-related strokes than are killed by hand guns. Although this sounds frightening, the Stoke Association emphasizes that the risk of stroke, even among people with migraine, remains very, very low. However, it is very important for people with migraine also to manage any other factors known to increase stroke risk, such as excess weight, high blood pressure or high cholesterol, smoking or estrogen use. Cause of Migraine The physical process of a migraine attack still is not well understood. Scientists do know that during an attack, the arteries in the brain contract and blood flow is reduced. This seems to be caused by a malfunction in the central nervous system. They also know there is a genetic component. If someone has a parent with migraine, there’s a 50% chance they will too. If both parents are migraineurs, the risk is 75%. So far, three migraine genes have been identified. On the other hand, many triggers of migraine attacks are well documented. Changes in barometric pressure, lack of sleep, irregular meal schedules, bright lights, dark alcohol, chocolate, dairy products, MSG, strong perfumes and caffeine are common triggers. New Treatments and Research Migraine treatment has made huge strides in the last twenty years, with new medications developed to address various parts of the migraine cycle. Some

prescription drugs work to prevent or reduce the number of attacks. Others are designed to abort an impending attack, and others still address the pain. Because of the variety of new medications available, it is important for people with migraine to be treated by a neurologist with experience in this area. Not all medications work for everyone or every kind of migraine. Most people need a period of trial and error to see which medications will be effective for them. In addition, there may be some relatively simple measures that can be quite helpful. Obviously, once someone has identified his triggers, it is vital to avoid them as much as possible. Regular exercise and taking care to remain wellhydrated is also very important in reducing the frequency of attacks in most migraineurs. Professor Lyn Griffiths, director of the Genomics Research Center at Griffith University in Australia, is one of the world’s leading experts in migraine research. So far three specific genes have been linked to migraine. In addition to the genetic causes of the disease, Griffiths’ research has shown that some vitamins may play a role in reducing the frequency and severity of attacks. “We used folate, B6 and B12 in combination,” she says, and found that people who suffer from migraine with aura, “particularly those with a mutation in a specific gene … associated with migraine” were most likely to respond. “A DNA test can be used to identify those with the mutation or, yes, you could just try vitamin supplementation,” she suggests. Migraines in Children Up to 2% of kids under age 7 and 10% of kids under age 15 suffer from migraine. While older children’s symptoms more closely resemble those of adults’, in preschoolers, symptoms can be no more than paleness, severe abdominal pain, vomiting and a strong need to sleep. Thus the condition is easily mistaken for “stomach flu”. Migraine is the most common cause of acute and repeated headaches in children, and yet probably the most underdiagnosed. Many kids with severe, chronic “sinus” pain are actually suffer from misdiagnosed migraine. So if a child has recurrent bouts of these symptoms, it’s worth discussing the possibility with a physician.

Living With Migraine There is no cure for migraine. However, by learning to be aware of what they experience during an attack, migraineurs may become better at warding off a fullblown attack, or at least managing it in relation to the rest of their lives. The best way to learn one’s triggers is to keep a daily diary for a few months, keeping track of any unusual sensations and events and when migraine attacks occur. Realizing you are in the predrome phase gives you an opportunity to take medication early, when it can still stop the attack from progressing and, as in Pessy Feld’s case, reorganizing you schedule and commitments to another time, so you don’t have to cancel important events at the last minute. Being open with family and friends about the disease will also help them understand how they can help you. Leah Sarah Cohen – who never leaves the house without sunglasses – recalls how her daughter warned her before a school show that during one particular song, there would be a flashing mirrored ball above the stage. “She knows flashing lights are one of my triggers. Thanks to her warning, I was able to throw my coat over my head before the number with the flashing lights started. Otherwise, I’d have been out for the rest of the week.” And she was able to enjoy her daughter’s performance. It’s a bit trickier if it’s your boss or mother-in-law whose perfume sets you off. But if you’re able to communicate openly and explain that their favorite scent could disable you for days or even possibly land you in the emergency room, people usually will be more accommodating.