Migraine Fundamentals

Migraine Fundamentals

Calling a migraine a bad headache is like calling a tsunami a big wave.

A big wave in the surf may wipe out a few surfers, but a tsunami can travel right up the beach, down the street and inland for miles destroying everything and everyone in its path.

The difference between a tsunami and a typical wave is the same difference between a migraine and a headache. One is very common, not serious and easily treated. The other is devastating and destructive.

But what do we really know about migraines? What happens when a migraine hits? More importantly, why is it happening to you?

What are migraine attacks?

Migraines are often described as “a common primary headache disorder”.(1) For those without a MD or DR next to their name that doesn’t mean much. A more detailed explanation would help.

“Disorder” can be defined  in a medical context as “a physical or psychical (mental) malfunction”.

Put simply… migraines are a brain malfunction

For many people migraine is more than just a painful headache. A really painful headache.

Common migraine symptoms include(2):

  • disturbed vision
  • light sensitivity
  • sensitivity to smell
  • sensitivity to sound
  • nausea and vomiting

As you can imagine, the first experience of a migraine attack can be very frightening. You may need to lie still for several hours in a dark room with no noise, sound or movement and try to fall asleep. That is a common migraine treatment.

The symptoms of migraines can vary from person to person and you may even have different symptoms during different attacks. Individual attacks can differ in length, frequency and severity. Some people for instance only experience nausea which is common in children. Others may only experience the aura without any head pain.

Migraines can last anywhere from a few hours to a few days, in more severe cases, they can last longer.

How common is migraine?

It’s more common than you think. The World Health Organization (WHO) ranks migraine and headache as one of the most common health conditions worldwide. It is estimated that around 1 in 7 people will experience migraine at some point in their life. Which is equivalent to around 1 billion people.(3)

Migraine is more common in women, with approximately 18% of women and 6% of men experiencing migraine. (4) Why more women than men? It is thought that more women suffer migraine due to hormonal factors. It is common for women to experience a menstrual migraine each month which is not a risk factor for men.

How serious is migraine?

In many cases migraine is episodic and does not occur frequently in patients. On the otherhand they can be disabling and debilitating. In some cases, depending on the frequency and severity of the attacks, the migraine disorder can affect a person’s job, relationships and quality of life.

WHO ranks migraines in the top 10 among all diseases worldwide causing disability. They also rate a severe migraine attack as among the most disabling illnesses, comparable to dementia, quadriplegia and active psychosis.(5)

Just over half of those with migraine experience one or more attacks per month, and 13% claim one or more per week.(6)

Migraine peaks between the ages of 35 and 45 in both males and females and declines thereafter. In many instances, this can be due to failure to diagnose and/or poor management of the condition, both of which are common.

Migraine can be complicated by medication overuse which can lead to more frequent attacks and further deterioration until the migraines eventually fade away by themselves.

Most people who suffer migraine, haven’t been diagnosed

Cephalalgia, a peer-reviewed medical journal from the International Headache Society (the leading global headache body), quote at least 50% of patients are undiagnosed or undertreated for migraine.(7)

That’s worth repeating.

50% of migraine patients are underdiagnosed or undertreated.

This underscores the effort required by all of us to help ourselves and others by getting the right information and seeing a doctor if in doubt.

Curious as to what Cephalalgia means? It’s a medical term for pain in the region of the head or neck.

Why do I have migraine?

Why do you have migraine happen to you and not other people? Surprisingly, no one has figured out exactly what causes migraines and what happens during them. Nor has a universal cure for migraine been developed.

Previously scientists believed migraine were linked to the dilation and constriction of the blood vessels in the head. But most medical scientists now believe migraine is due to a combination of genetic and enviromental factors… So you can thank your parents. (8)

Read more about the causes and triggers of migraine here.

Some feel good facts

If you have migraine and you’re thinking this is all bad, don’t be put down. Take some comfort out of the following:

  • The fact that you’re here reading this puts you way ahead of the majority of people suffering from migraine. Many don’t even realize they are suffering from migraine attacks, let alone educating themselves with referenced articles or learning how to manage them.
  • Research and technology today is better than it was five or even two years ago. The availability and access of information to research and studies means that there has never been a better collaboration, access to scientific findings, DNA research and the promise of a solution, even a potential cure.
  • Focus on what you can control. You may not be able to control the fact that you experience migraine, but you can control what you know about migraine, your triggers and its impact on your life.
  • Be proactive in your management. If you don’t manage your migraine, they will manage you. It is possible to control your migraine. It takes time, learning, patience and a little discipline.

Getting the right information, equipping yourself with the right tools and surrounding yourself with supportive and helpful people (including a great doctor) is vital.

Stay positive and put a smile on your face for your own health. (9) There is great hope for a brighter future.

Article References
  1. World Health Organisation & Lifting the Burden. “ATLAS of Headache Disorders And Resources in the World 2011”. Report, 2011.
  2. International Headache Society “ICHD – II:Diagnostic criteria for Migraine”
  3. Steiner TJ et al.  ‘Migraine: the seventh disabler’.  The Journal of Headache and Pain 2013, 14:1.
  4. Who And How Many? Migraine Statistics. http://www.relieve-migraine-headache.com/migraine-statistics.html
  5. Shapiro, RE. Goadsby, PJ. “The Long Drought: The Dearth Of Public Funding For Headache Research”. Cephalalgia, Sept 2007.
  6. Steiner et al. “The Prevalence And Disability Burden Of Adult Migraine In England And Their Relationships To Age, Gender And Ethnicity”. Cephalalgia, Sept 2003.
  7. Pavone E. et.al. “Patterns Of Triptans Use: A Study Based On The Records Of A Community Pharmaceutical Department”. Cephalalgia, Sept 2007.
  8. Dodick DW, Gargus JJ. “Why Migraines Strike”. Scientific American, Aug 2008.
  9. Professor James Lance. “Migraine and Other Headaches”. 1999.
  10. World Health Organization. “The Global Burden Of Disease: 2004 update”. WHO Report 2008.

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About The Author

Carl Cincinnato

Carl stopped taking his health for granted at an early age due to migraine. He has had migraine for 26 years. Over this time health has become central throughout his life and work. Today, he works with charities, foundations, and organizations to help lift the global burden of migraine including Headache Australia, the Brain Foundation, the Coalition of Headache and Migraine Patients, and the European Migraine and Headache Alliance. He is a member of the International Headache Society, he acts on several advisory boards and he also is the author of MigrainePal and co-host for the Migraine World Summit. Carl is a public and passionate patient advocate for migraine. He has spoken nationally and internationally about migraine and the need to increase research funding, reduce stigma, increase patient support and education. He has been featured in national TV, print and radio stations.

6 Comments

  1. Sarah Cummings

    I couldn’t imagine how hard it is to have a migraine. ‘Cause a simple headache causes a lot of pain. 😦 Thanks for the info! 🙂

    Reply
  2. Martha

    I have had migraine for 35 years. During the last few years I discovered amitryptaline which helped a bit and triptans which work well. But for 2 years now I have been getting a sore head when lying down. At first I thought my pillow was too hard and was hurting my head, so I kept getting new softer pillows. Eventually I realized that it was just lying down that was hurting my head. This sore head lying down also started to trigger a migraine, so I would wake up with a migraine or a sore head every day or not be able to sleep at all. I often slept on an armchair and became anxious about lying down. It has been awful and has affected my health and wellbeing so badly. My GP said the problem is in my neck and said that the amitryptaline should solve it but it only worked a bit and if I increased the dose I was just dizzy during the day and it also gave me terrible nightmares so if I slept I woke up with a bad feeling anyhow from the nightmares. Then the GP put me on beta blockers which do help a bit but make me so tired and I still get the migraines, currently around 5 a week. I am constantly using triptans and ibuprofen and that’s not good. The whole thing is really getting me down and depressed. I was put on the waiting list for the neurologist and after 8 months was finally seen, except it wasn’t even a neurologist but a GP with a special interest in headaches. He moved my neck and head about and said that the problem wasn’t my neck but that the whole thing was just migraine. So basically he is saying that my sore head lying down is a migraine which is also triggering a migraine – except I explained to him that the sore head lying down isn’t exactly a headache – it’s a sore head which to me there is a difference. He said that if amitryptiline doesn’t suit me or a beta blocker then so be it and i would just have to suffer it. I had a brain scan anyhow and have now waited 2 months for the results. The NHS here in the UK really hasn’t proven very good for all this and I don’t feel I am listened to or taken seriously. It is good for other things but not this. My GP says the results hadn’t come through for the brain scan – although the breast clinic doctor could see the test results online really easily by just looking at my medical records. She said there is nothing alarming on it anyhow. I don’t feel cared for at all or listened to by my GP and have now I have resorted to looking for answers on the internet and buying books because I don’t feel my doctor will help.. I feel that I am going to suffer from a sore head every night and be woken by a migraine in the middle of the night or early in the morning and to be honest I don’t think I can cope. My quality of life has plummeted and I am becoming a shadow of my former self and have been to my GP so many times that I don’t feel I can go back.

    Reply
    • Carl Cincinnato

      Hi Martha, I’m sorry to hear about your frustrating and disappointing experience with getting quality medical care and support. A couple of points to note. This is very common and often it is up to us, the patient, to take our own care into our own hands by demanding access to an expert or specialist from our GP. A GP with a special interest in headache may likely be better than many neurologists and unfortunately some neurologists do not know much about headache either!

      Migraine can change over time. Especially the symptoms of migraine. Many people have neck pain as the first sign of an attack. The neck may stiff, sore or irritated but often scans will show up completely fine in the neck. If your symptoms have changed it may be worth reading around high and low pressure headaches. These are often misdiagnosed as chronic migraine and hard anyone except a headache specialist to uncover. There was an excellent presentation on this from Dr. Friedman this year at the Migraine World Summit. You can preview her talk here: https://www.migraineworldsummit.com/2019-deborah-friedman/

      Reply
  3. Jan S

    I too get soreness where my vertebrae join to my head. It use to happen in the final stages of a migraine (my migraines began with peri menopause and I am now 65) but now it is frequent, with or without a migraine. The area feels sore, sensitive and ‘mushy.’ I have cervical spinal stenosis. I undertook a comprehensive vitamin and supplement regime for a year and headaches stopped. I don’t know what worked, but I stopped because most of my hair on my head fell out. After stopping, headaches resumed, but now they feel like a sinus headache, but are sometime accompanied with nausea, vomiting and diarrhea. In these cases the sumatriptan I take has a delayed effect or no effect. I feel as though my sinuses are overreacting to everything although I had a negative allergy test. I had a horrible sinus infection over a year ago and it lasted for over 6 months. One ENT says it’s TMJ, one says it’s migraine, my PCP says I have fluid in my ear. I have recently experienced documented hearing loss, followed by tinnitus then dizziness. It seems like everything from the neck up is malfunctioning and I’m frustrated and confused. I don’t know where to start.

    Reply
    • Carl Cincinnato

      Hi Jan,

      It’s very understandable to be confused and frustrated because it is confusing and it is frustrating. Migraine can mimic other issues like sinus pain, sinus infection, ear fullness and it’s associated with tinnitus. There are several experts who discuss these issues in more detail at the Migraine World Summit. This expert from Harvard talks about TMJ (https://www.migraineworldsummit.com/public-2018-paul-mathew/), this ENT expert talks about migraine and the ear(https://www.migraineworldsummit.com/2019-michael-teixido/).

      These links will show a short preview of the interview to give you an idea. It can all be related because there are brain functions which overlap. It is also possible that one stimulus like your neck could be sending irritating signals to the brain that help trigger migraine. It is really worth investigating it from multiple angels and I’ve found that unless you have someone that really knows about migraine and these other areas, you are often left frustrated. The Migraine World Summit interviewed these experts 2018 and 2019. You’ll certainly find more answers there but otherwise you can read up on some of the research in Google Scholar.

      Reply

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