Because they can cause such a multitude of unpredictable symptoms, it can be quite a challenge for someone who lives with migraines to describe them to someone else.
What’s more, each case is different, and not everyone who experiences migraines will go through the same thing.
One aspect of migraines most people can easily comprehend is the severe headache; but as a result of this, the terms migraine and ‘bad headache’ can often (incorrectly) be used interchangeably.
A consequence of this perceived interchangeability is that many who are affected by migraines will delay seeking treatment, or even choose not to do so altogether.
Migraines and headaches however are not the same. In fact, as we’ll discuss in this article, a considerable portion of migraine cases will not even involve a headache at all.
We thought we’d delve deeper into the subject this week, and investigate what constitutes a migraine with the help of two experts:
Rebekah Aitchison, a spokesperson from Migraine Action;
and Dr Jud Pearson from the National Migraine Centre.
As well as helping us to give you a clearer definition of what a migraine is and what form it may take, they also provided some valuable insight on how to recognise and effectively treat a migraine before the full range of symptoms manifest.
More than just a headache
First of all, what makes a migraine a migraine, and how is it different from a bad headache?
‘Migraines encompass a wide spectrum and can move up and down this in terms of severity,’ Dr Pearson explains, ‘but perhaps a useful way to define a migraine headache is as a headache which is disabling and stops you from doing your usual activities.’
Furthermore, a migraine may affect various parts of the body and not just the head:
‘Migraine is more than “just a headache”.’ Rebekah tells us. ‘It is a complex neurological condition, which can affect the whole body and result in many symptoms including a headache, but sometimes without a headache at all. It can be easily overlooked or mistaken for other conditions and can affect people in different ways.’
‘Hemiplegic migraine for example mimics the symptoms of a stroke, whereas abdominal migraines are too often unnecessarily treated as IBS or other stomach conditions.’
Rebekah goes on to say that the reasons why migraines affect some people and not others are yet to become clear:
‘Research is continuing, but at present we do not know what causes migraine; there is no clear diagnostic test and, as yet, there is no cure. However, there are many ways to help manage the condition and lessen its impact; ultimately reducing the disruption caused to everyday life.’
Characteristics of aura
Aura is perhaps one of the most difficult aspects of a migraine for those who experience them to describe. For many, it’s the series of signals warning that a migraine headache is on its way, as Rebekah explains:
‘Migraine aura is the collective name given to the many types of neurological symptoms, including visual disturbances but also pins and needles, slurred speech, and even paralysis down one side of the body, which may occur just before or during a migraine headache.’
‘Some assume that aura only presents itself visually (zig-zag lines appearing in your vision, flashing lights and so on), so many people may experience other aura symptoms without realising it is part of the aura.’
However, not everyone who gets migraines (migraineurs) will necessarily experience aura. In fact only a minority do: ‘Migraine without aura is a much more common variety.’ Dr Pearson explains. ‘80 percent or more of people with migraines do not have aura.’
Tackle it early
Being able to recognise symptoms early on is perhaps the most useful weapon in the migraineurs arsenal as, both our experts illustrate, it enables patients to take action.
‘Treat early. When symptoms begin, the earlier treatment is administered the more effective it will be.’ Dr Pearson tells us. ‘Try to have a snack and a drink if you can, and take 10mg domperidone and 600mg-900mg of aspirin. The aspirin should be dissolved in a sweet fizzy drink, preferably caffeinated.’
Rebekah advises: ‘We often recommend taking medication as soon as you see the early warning signs before gastric stasis begins (where in essence the stomach delays emptying, which may limit the absorption of medication and could be accompanied by a variety of symptoms, including nausea or vomiting). Taking medication with a fizzy drink is recommended to help absorption.’
Furthermore, it’s important to rest early so as not to exacerbate symptoms, as Rebekah illustrates:
‘Many sufferers try to carry on through the early symptoms of a migraine, and only rest when it becomes unbearable. For many, trying to carry on as normal can lead to a longer attack or heightening symptoms.’
‘We would recommend that sufferers take action in getting themselves to a safe place where they have what they need (be it a dark cool room, or a place they can lie down with a hot water bottle), as soon as they can to help limit the ferocity and time span of the attack.’
Who is more susceptible?
It is estimated that between 65-80 percent of migraineurs are women, ‘with initial onset occurring most frequently between puberty and menopause.’ Dr Pearson explains. ‘There is certainly a hormonal profile which plays a part in the onset of migraine in some, but not in all.’
This may go some way towards explaining why they are so much more common in women than they are in men, as Rebekah illustrates:
‘Under the age of 12 both girls and boys are just as likely to experience migraine. From puberty (which is a key time for many to experience their first attack) the number of female sufferers increases, predominantly due to hormonal aspects. But the menstrual cycle is not a trigger for all women, so keeping a diary is key for every sufferer in finding triggers and helping to take control of attacks. After the menopause migraine once again becomes just as prominent in men as in women.’
So can migraines completely go away?
Like other chronic conditions, the complexion of migraine can change over time, as Dr Pearson explains: ‘They may become less severe with age, and some older people may even develop symptoms similar to silent migraine (where the symptoms of aura are present but a headache is not).’
But Rebekah stresses that each case is different, and unfortunately not everyone will experience migraines with diminishing frequency.
‘It is always worth speaking to your doctor about any changes or contacting us here at Migraine Action on our helpline. Until there is a cure for migraine, ascertaining triggers, noting early warning signs and receiving medication that is best for you can all help to manage the condition.’
Can a doctor help?
In short, yes. Many people with migraine might presume that there is little aside from painkillers that can help, but there are a host of other options.
‘Acute treatment is available on prescription from a doctor, as are preventative medicines.’ Dr Pearson explains. ‘For those who have tried everything, and over-the-counter and prescription medications have been insufficient, a GP can refer a patient for specialist help at a headaches clinic or with a neurologist. Here at the National Migraine Centre we see patients from all over the country on a self-referral basis.’
Dr Pearson also points out that the overuse of certain treatments can actually lead to worsening symptoms; so if migraines are occurring frequently, expert help is definitely advised:
‘The potential risks of medication overuse is important for those with migraine to be aware of, as it can become a real problem. Those who experience migraines more often than 2-3 times per week are putting themselves at risk of inducing further migraine and making headaches more frequent if they continue to take medication.’
‘For those who fall into this category, special treatment may be required; so it is vital to see a doctor in this case, who can refer a patient to the appropriate person.’
You find out more about the National Migraine Centre, including how to book a consultation, by visiting their website, or calling them on 020 7251 3322.
The Migraine Action Helpline: 08456 011 033 is open weekdays from 10am to 4pm; and you can find more information relating to migraines, and their services, over on their website.