MIGRAINEMIGRAINEMIGRAINEMIGRAINEMIGRAINEFAQMIGR FAQFAQFAQFAQFAQFAQFAQFAQFAQFAQFAQFAQFAQFAQFAQ
The alt.support.headaches.migraines newsgroup was initiated by Leonard Zimmermann.
This part of the FAQ is now being comiled by Ronda Solberg (ronda@migrainepage.com)
This FAQ consists of information compiled from the group alt.support.headaches.migraine, as well as a number of published books and articles about headaches in general and migraines in particular. Neither I, nor most of the people on this group, are medical doctors. We have become experts on migraines because we are all patients. The purpose of this FAQ is to provide information about a condition you may either know, or merely suspect, you have. Its purpose is explicitly not to give advice.
Please read the FAQ before posting to the list. If the answer to your question is not in this FAQ, then by all means, post your question to the newsgroup.
When posting a follow-up to a message, make sure your subject line accurately represents your posting. If the topic of a thread drifts, change the Subject: line.
Please confine flame wars to private e-mail. Likewise, common electronic communications pitfalls should be recognized. Sarcasm doesn't take too well to ASCII. Be careful what you read into another persons' message with respect to emotion and intent.
Finally, attempt to limit quoting text from other postings. Quote only what is necessary to preserve context.
The answers listed below are compiled from published material and discussion from the group. Experiences vary, and yours may not match those listed.
Are migraines dangerous?
While migraines may be excruciatingly painful, the vast majority of them pose no serious health risks. However, not all painful headaches are migraines, and some can be indicative of more serious medical problems. You should always get a proper diagnosis from your doctor.
I've heard there are different types of migraine, what are they?
According to traditional classification schemes, the two most common types of migraine are classic, and common. In classic migraine, the headache is preceded by an "aura", which usually consists of visual disturbances (but can involve the other senses such as the sense of smell). Common migraine has no aura. See the FAQ part IV for information about cluster headaches, which are perhaps the third most common type of severe headache. Rare forms are discussed later in this FAQ.
I know that migraines are not generally life-threatening, but does getting them put me at risk for any more serious health problems?
How can I tell if I suffer from migraines?
There are other, potentially life threatening, medical situations that can mimic migraine (brain tumors, lesions, etc.). Therefore, it is advisable to see your doctor if you have not previously been diagnosed, especially if you have suddenly begun having severe headaches and were not previously prone to them.
What Are the Symptoms of Migraine?
Most obviously, headache, beginning as a dull ache of head and/or neck, and building to extreme, throbbing pain. Pain is usually, but not always, confined to one side of the head, and persists for at least several hours (or longer). After the pain subsides, the migraine sufferer is commonly left feeling tired or drained, and occasionally elated.
Other characteristic symptoms (may occur before and/or concurrently with headache):
Aura (usually preceding pain in classic migraines):
Other common symptoms:
What is the Physiology of Migraine?
While the exact physiological cause of migraine is poorly understood, researchers have made some progress in understanding what happens during an attack. Of course, there are various theories as to what causes them.
Vasocative Amine
The vasoactive (acting on blood vessels) amine (class of substances that can cause inflammation) theory seems to be the leading hypothesis about the cause of migraine. The release of these substances into the cranial blood vessels leads to an inflammatory reaction (i.e. painful, distended blood vessels). What causes this release is unclear, but it could be the result of pain information being transmitted by nerve fibers that run along the cranial arteries. When they are depolarized (sending signals) they release peptides into the vascular walls which can lead to this reaction.
Researchers do seem to agree that migraine is definitely a disorder of cerebral blood flow, and is under the control of many (poorly understood) factors.
That said, while most agree that cerebral blood flow changes are an important feature of migraine, and the distention of the blood vessels surrounding the skull is the cause of the pain, most researchers no longer support the idea that the blood flow changes are the actual cause of migraine.
Other substances and syndromes you may have heard about in relation to migraine:
Serotonin
Blood seratonin levels fluctuate during migraine (they increase during the pre-headache phase, and drop during the headache). This is likely to be caused by an alteration in blood platelets. Platelets, which store serotonin, exhibit chronic aggregation in migraine patients and increase their adhesiveness prior to an attack. They also affect the amount of vasoactive amines in the blood.
Magnesium and Spreading Depression
Spreading depression, characterized by a gradual wave of decreased cortical activity that starts at the back of the brain and gradually moves toward the front, occurs in people suffering from classic migraine. It coincides with the symptoms of the aura. This effect can be induced in animals, and is more easily induced when the magnesium (Mg) concentration is low. Not surprisingly, Mg tends to be low in classic migraine sufferers, especially during an attack.
Reduced Cerebral Blood Flow
Following the spreading depression, classic migraine sufferers also experience a wave of reduced cerebral blood flow that follows the same pattern. It could be a response to the decreased activity from the spreading depression, but this is just a theory. Reduced cerebral blood flow also occurs during the aura phase. Blood flow is increased during the pain phase of the migraine.
While reduced blood flow has not been consistently demonstrated in common migraine, there is evidence that common migraine sufferers do experience an increase in cerebral blood flow during the headache phase.
Circadian pattern of migraine
There is some evidence that migraines are more likely to occur at certain times of the day. The most frequent period of onset seems to be the mid to late morning. This pattern, which follows that of myocardial infarction and platelet aggregability, among other things, suggests that alteration of vasomotor tone may be involved in migraine initiation. Another study suggests a possible link of migraine occurance to the environmental factors that entrain the routines of peoples' lives.
What Can Trigger a Migraine?
Regardless of the physiological underpinnings, many migraine sufferers have identified things that seem to trigger an attack. While triggers are different for everyone, some of the most common ones are listed below:
Environmental Factors:
Food/Drink:
Other:
What non-drug treatments can help to decrease the pain of migraine?
The #1 treatment seems to be sleep, preferably in a dark, quiet room or with a sleep mask. Some find keeping the TV on, turned to PBS or a station with a low noise level helps. Other methods include:
What non-drug treatments can help to prevent migraines?
If your migraines are triggered by computer use try:
If your migraines are triggered by low blood sugar and you are in search of the best snack to ward them off, try (assuming these are not also triggers for you):
Is it true that women are more likely to suffer from migraines?
Yes. Women are more likely to be classic or common migraine sufferers. Estimates vary, but they hover at around 70%.
At what age do migraines usually start?
Migraines can begin at any age, but most develop them around adolescence or in the 20's.
Are migraines hereditary?
Usually. Most migraine sufferers have a close family member who also gets them. According to Neil Raskin in his book Headache: 50-60% of parents of migraineurs have a history of migraine vs. 10-20% of parents of headache-free subjects.
How frequent are most migraines?
Frequency is highly variable, and to some extent depends on what your individual triggers are. In general, common migraines are said to occur more frequently than classic ones, and no matter what type you suffer from, the frequency usually decreases with age.
I also get tension headaches. Is that normal?
Yes, migraine sufferers also commonly get tension headaches. Tension headaches are characterized in part by an inability to relax the scalp and neck muscles. Low serotonin has been implicated in tension headache pain. They worsen with vasoconstrictive drugs, and get better with vasodilators.
Is there a relation between migraines and motion sickness?
Many migraine sufferers suffered from motion sickness as children, and continue to suffer from it as adults. Migraine sufferers may also be more prone to motion sickness.
Is there a relation between migraines and allergies?
There may be a connection between allergies and migraines, although the results are somewhat inconclusive. Some believe that food allergies can cause migraines, and that histamine levels in the blood can trigger a headache. Others are finding a connection between migraines and other types of allergy (such as asthma, hives and rhinitis). There is some indication that this association is stronger in children.
Some famous people with migraine:
Thomas Jefferson, U.S. Grant, Woodrow Wilson, Lewis Carroll, Edgar Allen Poe, Virginia Wolf, George Eliot, George Bernard Shaw, Frederic Chopin, Peter Tchaikovsky, St. Paul, John Calvin, Julius Caesar, Queen Mary Tudor of England, Peter the Great, Elizabeth Barret Browning, Alexander Pope, Alexander Graham Bell, Alfred Nobel, Kareem Abduhl Jabar, Immanual Kant, Friedrich Nietsche, Sigmund Freud, Linnaeus, Blaise Pascal (Source: _Migraine: Winning the Fight of Your Life_ by Charles Theisler)
I've been told that migraines are a psychological disease. Is this true?
No. Previously, migraines were thought to occur mostly in people who fit a specific psychological profile. Migraine sufferers were said to be neurotic, obsessive, compulsive, rigid, and to suffer from repressed hostility. Research done in the last 15 years has shown that migraine sufferers, in fact, have psychological profiles no different from anyone else. Many physicians, however, still cling to the old stereotype. Hopefully, this is changing with the new research being done on the causes of migraine.
What do I do if I have a doctor who won't listen to me?
Try quietly and calmly, but stubbornly, insisting on what you need. Educate yourself about your problem (you're doing it now!) and possible remedies. If these tactics fail, try finding a better doctor.
David Meldrum writes:
I find it very sad to see patients describing a long history of headache investigations, neurologist after neurologist, all with MRI, CT, followed by ENT specialist, and then a long list of drugs, all of which have failed. Such patients have never had their problems addressed, and to me such stories represent a failure of the medical services. The solution as I see it, is to find a physician who specialises in headache, and since nearly all headaches are multifactorial, preferably works in a multidisciplinary clinic. If the patient can trust th physician/ clinic, then stay with them through the inevitable ups and downs. Do not go from neurologist toneurologist in the forlorn hope of finding the one drug that will work. It almost certainly does not exist.
Please note the word *RARE* in this section heading.
Abdominal Migraine
Symptoms may include stomach pain (which can be severe), bloating, nausea, vomiting (sometimes vomiting a bile-like substance) or diarrhea. This type of migraine is seen more often in children. The above symptoms may or may not be accompanied by a headache.
"Ice Pick" headaches
These headaches have been defined as short lived (only seconds in duration) pain that feels as if an ice-pick has been stabbed through part of the head. They can recur over and over throughout the day. Migraine sufferers are more likely to experience them than non- migraine sufferers, but they tend to occur between migraine headaches, rather than as a migraine accompaniment.
Chronic daily headache (aka. transitional, transformational, or combination headaches)
Combination headaches have symptoms of both chronic tension and migraine headaches. They are characterized by dull, continuous, bilateral pain that worsens as the day goes on and is usually associated with migrainous symptoms such as photophobia, phonophobia and nausea. This pain can be interspersed with severe or acute migraines. To be classified as having chronic headache, a person must suffer from them at least 15 days a month for at least 6 months. One study has found that most people with chronic daily headache started out as migraine sufferers whose headaches gradually evolved into the chronic daily type over a number of years. Standard migraine therapy is, in fact, often the most effective way to treat these headaches.
People who suffer from combination headaches frequently end up chronically overusing analgesics or ergotamines, which, paradoxically, can trigger rebound headaches. People suffering from chronic daily headache typically have a family history of headache, and it has been suggested that many also suffer from depression, anxiety, and sleep disturbances.
Combination headaches are typically difficult to diagnose and treat. You may need to try several types or combinations of prophylactic and abortive medications before you find something that works. You may also have painful withdrawal from accustomed use of analgesics or other medications. Above all, see your doctor. The first line of defense is a continuous relationship with a trusted physician. (Text originally submitted by Peggy Parker, who thanks Dr. Kent England for working with her so compassionately to control her headaches)
Occipital Neuralgia (excerpted from NHF newsletter)
Symptoms: Headache that is localized or following a "ram's horn" pattern on the side of the head, often starting in the upper neck or base of the skull; scalp that is tender to the touch, often hypersensitive.; pain at the base of the skull; reduced ability to rotate or flex the neck; shoulder pain; pain or pressure behind the eyes; eyes are very sensitive to light, especially when the headache is present.
The headaches almost never stop. Various medications help a little for a while, but it seems the best way to reduce the pain is to have someone rub the back of your head and neck. Occipital neuralgia is used to describe a cycle of pain-spasm-pain originating from the suboccipital area (base) of the skull that often radiates to the back, front, and side of the head, as well as behind the eyes. Occipital neuralgia occurs more often in women than men. Commonly the nerves are inflamed and sensitive because they are trapped within the muscles through which they pass. Muscle spasm and pain are often associated with nerve entrapment, which causes localized pain, spasm and muscle cramping.
Hemiplegic Migraine
Sufferers experience a motor deficit on one side of their body that outlasts the headache phase. Sensory deficits also frequently accompany the motor problems.
Basilar Artery Migraine
This is more common in women than men, and more common in teen-agers than other age groups. This type of migraine includes at least some of the following symptoms, as well as the headache, which may precede or accompany the pain: ringing of the ears, hearing loss (sometimes fluctuating), vertigo, disturbance of gait, bilateral numbness or tingling in the limbs, loss of consciousness. The headache is almost always bilateral, and is usually located at the back of the head.
Dysphrenic Migraine
Many migraine sufferers experience some disturbance of mental functioning during an attack. People who suffer from dysphrenic migraine experience severe disturbance of it. Symptoms include: loss of memory (amnesia), severe disorientation, confusion, agitation, with or without accompanying headache.
Exertional Headaches
This type of headache is a migraine, usually of relatively short duration, which is brought on by physical activity, such as running, weight-lifting, or even sex. It can also sometimes be triggered by coughing or sneezing. This type of headache occurs more commonly in people that suffer from other types of migraine as well.
Hemicrania Continua
Rare one-sided headaches which last from 5-60 minutes and include dull, throbbing or severe pain, which is pulsating with several minutes of intense "ice pick" type pain. They occur up to five times in a 24-hour period. Alcohol and exercise often increase the pain, and sufferers may have other symptoms of migraine, such as light sensitivity and nausea.
Chronic Paroxysmal Hemicrania
This condition is characterized by frequent headaches in any one day, as many as 10 to 30. These headaches are brief and very severe, and seem to only respond to indomethicin (Indocin).
Reflex Sympathetic Dystrophy (from NHF newsletter):
"Sympathetically maintained pain (caused when the sympathetic nervous system is abnormally activated) can occur after trauma, such as an invasive or soft tissue injury. Patients may develop a syndrome marked by burning and aching pain and by exquisite hypersensitivity, causing coldness of the hands, rashes on certain parts of the body, and pitting of the nail beds. The proper diagnosis of the patient is often established by history and presenting symptoms. The disorder is commonly mistreated, causing additional pain and suffering."
If you have web access and are looking for additional informationabout migraine headaches, we recommend the following:
(NOTE: this list is not intended to be comprehensive. Sites dealing exclusively with treatment, especially only one form of treatment, are not represented.)
Depending on your circumstances, newsgroups of interest might be:
alt.support.headaches.migraine
alt.folklore.herbs
alt.recovery
alt.support.chronic-pain
alt.support.depression
rec.food.recipes
Headache Hotline: 1-800-843-2256