How frequently have you heard the word ‘migraine’? I bet very often. It is used to describe a headache but in reality it is a very severe headache that includes flashes of light, blind spots, sensitivity to sound and nausea. For those affected, it is an intense, excruciating experience lasting hours, sometimes days. And it is not rare either. There are an estimated 3 million Australians who suffer from migraines.
So what is the difference between a headache and a migraine? The stages and intensity of a migraine differentiates it from a simple headache. Typically, it unfolds in 4 quite clearly identifiable steps. If you suffer from some of these intense headaches, it is very important to understand the different symptoms you are experiencing throughout each of the stages. It helps the doctor with diagnoses, and with the time and dosage of the medication to be administered. Not everyone goes through these stages in exactly the same way or with the same symptoms, so try and document yours well.
The stages of a migraine:
For most sufferers flashing signs precede a migraine.
- Early warning (Prodromal): This stage involves some physical and mental warnings that can start about 24 hours before the onset of a full-blown migraine
- Lethargy, mood swings, sugar cravings and thirst are some of them.
- There could also be physical symptoms like a stiff neck or frequent urination.
Because these symptoms, such as tiredness or mood swings could also have other triggers, they often do not provide clues right away. Only a repeated pattern observed over a period of time can help predict a migraine.
- Aura: This stage is mostly about neurological impulses.
- Changes in the brain’s cortex affects vision and the person may see coloured spots, stars, flashing or flickering lights.
- There may be a blind spot making it impossible to drive or do any physical activity.
- Hallucinations are quite common.
- In severe cases there may be partial and temporary paralysis and fainting.
- Sensory symptoms include a tingling feeling on the face, hands or limbs.
- The person may have difficulty concentrating and expressing themselves.
Worrying as this stage is, unfortunately for some, it may be the sign of a migraine attack coming on (in some cases an attack does not follow the aura).
- The headache: Here it is.
- Severe, throbbing, unbearable pain. It may be on one or both sides of the head, in the area behind the eyes.
- There may be increased sensitivity to light and sound.
- Often, physical movement makes the ache worse and all the person can do is lie down and rest.
- Resolution and recovery: This is called the Postdromal stage.
- Sleep, even for a couple of hours is known to help end the headache.
- The recovery period, however, is longer and can take 24 hours. The person may feel exhausted, there is the remnant of a headache and a slightly nauseated feeling. GPs often describe it as similar to a hangover.
It is important to know that not all migraines go through all phases or they may merge. For instance, the aura may be followed so quickly by the headache that it may feel like one stage.
As always start with your GP. If your headaches are frequent, intense and don’t respond to OTC painkillers, you must see your GP. As a first step, you may be asked to record your headaches – the more information the GP has on the frequency, intensity, length and location of the ache – the more effective will be the medication prescribed.
Here is the challenge with finding the right treatment. As with complex neurological conditions, it is a combination of drugs and dosage that will be the most effective and the best combination has to be worked out by your GP. The treatment falls into three broad categories.
- Pain relievers: Medically called acute or abortive medicine these are,
- OTC painkillers for minor or moderate attacks to provide relief. There are migraine-specific painkillers for more severe attacks
- Triptans, which constrict blood vessels and block pain pathways can be quite effective
- Anti-nausea medication may also be prescribed to ease the symptoms.
For severe cases there is stronger medication available, but it must be taken under the guidance of a GP and specialist.
- Preventive treatment: For those who suffer from more than 4 migraine attacks a month, preventive medication is often prescribed. Your GP will decide whether to prescribe them for daily use or only when there is a predictable trigger.
- Cardiovascular drugs like beta blockers and calcium channel blockers which are commonly used to treat hypertension and heart disease may help reduce both, frequency and severity of a migraine.
- Antidepressants are sometimes prescribed to reduce severity by manipulating serotonin and other brain chemicals.
Almost all preventive treatment involves side-effects and must be constantly monitored and reviewed by your GP.
- Complementary therapy: Given the strong side-effects of medication, GPs often recommend complementary treatment such as acupuncture, aromatherapy, hypnotherapy, biofeedback etc. to reduce the dependence on drugs.
There is a lot of support for migraine sufferers. Headache Australia has online resources and runs seminars to help sufferers and their carers. They provide strategies to uncover triggers, manage workplace relationships and find effective migraine management plans. Others, such as US-based Mayo Clinic and WebMD, UK-based Migraine Trust etc. have websites that provide exhaustive information. So if you find yourself struggling with the condition, reach out and seek help, and always consult your GP.