MIGRAINES

Migraine is a complex neurological disorder that affects multiple areas and functions of the brain. They affect over 13% of the global population with females 2 times more likely than males (18 vs 10%) to suffer from the disease.

Migraines are a complex disorder, and as can be seen, multiple factors need to be taken into account before any new treatment is prescribed. If you would like to be considered for this class of medication a discussion with a headache specialist is therefore advised to review your individual treatment suitability.

The diagnosis of migraine is a clinical diagnosis, meaning it is made based upon characteristics rather than any specific tests, scans, or biomarkers.

There are a number of symptom descriptions that are used, and the one that is most formal is the International Classification of Headache Disorders (ICHD), which is available online. The criteria used to diagnose migraine in the ICHD are  at least five episodes lasting four to 72 hours that include at least one of the following:

• Nausea and/or vomiting
• Photophobia (light sensitivity)
• Phonophobia (noise sensitivity)
• Head pain with at least two of these characteristics:
  • Unilateral location (occurring on only one side)
  • Pulsating quality
  • At least moderate in severity
  • Aggravated by routine physical activity

These criteria are important to ensure that clinicians and researchers are speaking the same language. But there are some problems with focusing on those criteria, especially the features of pain.

SYMPTOMS OF A MIGRAINES

The headache may be preceded by a prodromal (warning) phase and followed by a postdromal (recovery) phase. Symptoms of these phases include hyperactivity, hypoactivity, mood changes such as depression and irritability, food cravings, increased yawning, fatigue, euphoria, and neck stiffness.

Typical migraine aura occurs before or during migraine and is experienced by about 25% of all migraine sufferers. The experience can be visual, sensory or result in problems with speaking or word finding.

Visual changes are the most common form of aura, occurring in more than 90% of those migraineur’s with aura. There can be spots, zigzags or crescents, flashes of light, or losing sight partially or fully. The shimmering that occurs in aura when vision is obscured is referred to as a ‘scintillating scotoma’, where a scotoma is a blind spot in vision.

Sensory changes are the second most frequent form of typical migraine aura. These may consist of tingling or numbness on one side of the face, body, or tongue.

A third form of typical aura results in problems with speech or language, such as being temporarily unable to speak, slurred speech, being unable to find the right word, or using the wrong word to express an idea.

All 3 common types of auras are considered typical if any one of them lasts between 5 minutes to one hour.