Mind Over Matter, Except When it Comes to a Migraine

Despite being the third most common disease in the world, migraine remains misunderstood and often mis- or undiagnosed.

Among the most common misunderstandings is that a migraine is simply an awful headache. But the truth is more complicated than that as migraine is a neurological disease with no cure. And yes, headaches are a common symptom, but the disease is actually a complex group of symptoms that occur in phases (prodrome, aura, headache, and postdrome) over a period of time that can last from 4 to 72 hours. However, not everyone will experience the same symptoms, which may include: 

► Fatigue or difficulty sleeping

► Depressed mood or changes in mood

► Visual disturbances or even loss of sight

► Severe headache

► Vomiting

► Sensitivity to light, sound, and smells

► Dizziness or vertigo

It is important to recognize that experiencing one—or even two—of these symptoms does not mean you have migraine.

In order to be properly diagnosed with a migraine, the following criteria must be met:

1. At least five attacks fulfilling criteria B-D
2. Headache attacks lasting 4 – 72 hours
3. Headache has at least 2 of the following four characteristics:
   1. Unilateral location (meaning one side of the head) 
   2. Pulsating quality
   3. Moderate or severe pain intensity
   4. Aggravation by or causing avoidance of routine physical activity
4. During headache, has at least one of the following:
   1. Nausea and/or vomiting
   2. Photophobia (light sensitivity) and Hyperacusis (sound sensitivity)
5. Not better accounted for by another ICHD-3 diagnosis as defined by the International Classification of Headache Disorders (ICHD-3). 

Experienced migraine sufferers often learn to recognize the onset phases of a migraine attack and can prepare themselves hours, or even days, before the debilitating headache phase kicks in.

Phases of a Migraine Attack

SOURCE: AmericanMigraineFoundation.org

In the same way there is no cure, there is also no test for a migraine. However, that should not keep you from seeking medical advice, especially if frequent or severe migraine is interfering with daily life.

If you suspect you may have a migraine, it is important to keep a timeline of symptoms, including notes about environmental elements and personal health issues, which may trigger an attack. Here is a look at some common triggers:

• Stress
• Changes in weather
• Strong smells
• Bright light
• Certain medications
• Alcohol
• Caffeine
• Changes to your sleep
• Skipping a meal

This information, along with your personal and family health history, will help your healthcare provider assess your condition and develop a treatment plan. In some cases, they may recommend imaging of the head to rule out other potential conditions.

Common treatment options include:

• Acute medications to stop or alleviate migraine attacks
• Preventive medications to reduce the frequency and severity of attacks
• Lifestyle modifications and trigger management

NOTE: It is important to distinguish migraine from other types of headaches, as the treatment and management strategies may differ.

While most migraines can be managed at home, there are certain situations when seeking immediate medical care is crucial:

• Sudden, severe headache (thunderclap headache) that comes on within seconds
• Headache accompanied by fever, stiff neck, confusion, seizures, or neurological deficits
• Headache following a head injury or trauma
• Headache that worsens with coughing, bending, or physical activity
• Intractable migraine lasting more than 72 hours without relief
• New or different headache pattern, especially if over 50 years old

These symptoms may indicate a more serious underlying condition, such as a stroke, aneurysm, or meningitis, and require prompt evaluation and treatment.

Jennie Smyth is a PA with the neurology department of Southwestern Vermont Medical Center