What is Migraine?
Just about everyone has headaches. But migraine is not just a bad headache. It is an extremely debilitating collection of neurological symptoms that usually includes a severe recurring intense throbbing pain on one side of the head (although in 1/3 of migraine attacks, both sides are affected). Attacks last between 4 and 72 hours and are often accompanied by one or more of the following: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face. Of course, everyone is different, and symptoms vary by person and sometimes by attack.
Migraine is a syndrome, a collection of symptoms which arise from a common cause. A syndrome may occur in a complete form, with all of the typical symptoms, in a less complete form, with some symptoms, or in specific groupings of symptoms. Migraine is classified according to the grouping of its symptoms. Since symptoms vary widely, migraine is often misdiagnosed.
Many people who suffer from migraine begin by treating themselves with over-the-counter medications. Sufferers sometimes consult their doctor as symptoms become more severe and disabling. Doctors diagnose migraine by analyzing the symptoms, conducting medical tests and eliminating other possible causes of the headache. Diagnosis is not always easy, however. Migraine is a moving target: symptoms are hard to evaluate and can change from one attack to the next.
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Migraine is a Neurological Disease
Many people fail to realize that migraine is a neurological disease, like epilepsy. Every 10 seconds, someone in the United States goes to the emergency room with a headache or migraine. Migraine sufferers visit the emergency room because of the severity of the pain or the fear of unremitting pain, drug reactions or side effects from headache medications, severe nausea or vomiting, dehydration, and/or stroke-like neurological symptoms that might accompany the headache.
Migraine ranks in the top 20 of the world's most disabling medical illnesses. Amazingly, over 10% of the population, including children, suffers from migraine. Nearly 1 in 4 U.S. households includes someone with migraine. In addition to the attack-related disability, many sufferers live in fear knowing that at any time an attack could disrupt their ability to work or go to school, care for their families, or enjoy social activities. More than 90% of sufferers are unable to work or function normally during their migraine attacks. While most sufferers experience attacks once or twice a month, about 14 million people experience headaches on a near-daily basis.
About 18% of American women and 6% of men suffer from migraine. This translates to about 36 million people in the United States alone! American employers lose more than $13 billion each year as a result of 113 million lost work days.
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Children and Migraine
Unfortunately, migraine is also very common in children. It has been reported in children as young as 18 months old. About 10% of school-age children suffer from migraine. Half of all migraine sufferers have their first attack before the age of 12. Before puberty, boys suffer from migraine more often than girls. As adolescence approaches, the incidence increases more rapidly in girls than in boys.
Migraine often goes undiagnosed in children and adolescents. In childhood migraine, head pain is often less dramatic or severe than other symptoms, such as unexplained nausea or vomiting, abdominal pain, or dizziness. Moreover, it is not uncommon for attacks to occur with only minor or even no head pain, making it hard to diagnose. Motion sickness is an early warning of the predisposition to childhood migraine. In childhood, the non-headache symptoms are often referred to as migraine equivalents.
While symptoms of childhood and adolescent migraine may be different from those typically found in adults, children are just as disabled. Children who suffer from migraine are absent from school twice as often as children without migraine. Treatment for childhood and adolescent migraine depends on the age of the child and the frequency and severity of the attacks. Although there are well over 100 drugs used to prevent or treat migraine symptoms, none has been approved for use in children. However, they have been studied by researchers and are prescribed. Expert help from migraine doctors or centers specializing in migraine may be indicated for children for whom diagnosis is difficult or who don’t respond to typical first-line treatments.
For a list of Children's Headache Centers, click here.
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Women and Migraine
Over 27 million women are affected by migraine in the United States today. Three times as many women as men suffer from migraine in adulthood. In childhood, boys are affected more than girls, but after adolescence, when estrogen influence begins in young girls, the risk of migraine and its severity rises in females.
Estrogen adversely influences the brain receptors that play a role in migraine development. About half of affected women have more than one attack each month, and a quarter experience 4 or more severe attacks per month. More severe and more frequent attacks often result from fluctuations in estrogen levels.
10-14% of American women get menstrual migraine. The vast majority of these women also have migraine at other times of the month. Menstrual migraine is an attack that occurs up to 2 days before and up to 3 days after menstrual onset. It is usually more severe and harder to control than other types of migraine.
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Migraine treatment has changed dramatically over the years. In the past, doctors often diagnosed patients with disabling head pain as neurotic and dismissed their complaints as psychiatric in nature. Later, researchers believed that the dilation and constriction of blood vessels in the head were the primary source of the pain. Early migraine medications focused on the blood vessels as the principal target for treatment. The current theory of the source of migraine pain reflects the advances in technology that help us understand how the brain works. Researchers now believe that migraine is a disorder involving nerve pathways and brain chemicals. There is also evidence that links a number of genes to migraine, so that genetics is undoubtedly involved.
Migraine can often be managed with proper diagnosis and treatment. There are three principle approaches to treatment: acute, preventive, and complementary. Acute treatment uses drugs to relieve the symptoms of attacks when they occur. Preventive treatment uses drugs taken daily to reduce the number of attacks and lessen the intensity of pain. Complementary treatment, which does not use drugs and is mostly used for prevention, includes biofeedback, relaxation techniques, acupuncture, exercise, and proper rest and diet. In some patients, life-style changes and other non-drug treatments can help avoid the triggering of attacks.
Click here for a list of non-drug treatments.
Even with the correct diagnosis, treating migraine can be very difficult. There are well over 100 drugs, surgical treatments and devices used to prevent or treat migraine symptoms and choosing one or a combination that might work is time consuming and frequently requires expert help from doctors or centers specializing in the treatment of migraine.
For a list of doctors certified in headache medicine, click here.
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Chronic Migraine and Chronic Daily Headache
About 4% of the U.S. population, around 14 million people, suffers from Chronic Daily Headache, which is when headaches occur on 15 or more days per month. Chronic daily headache is an umbrella category that consists of four different types of headaches: chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Approximately 2% of the population suffers from chronic migraine, which is when migraines occur on 15 or more days per month.
Those who suffer from chronic migraine use a combination of acute, preventive, and complementary treatments to try to control or lessen the disabling pain. Depression, anxiety, and sleep disturbances are common for those with chronic migraine. These sufferers are often significantly disabled, and their overall quality of life is greatly diminished.
Although there are many contributing factors to the progression from episodic migraine to chronic migraine, medication overuse is the most common. Over-the-counter as well as prescription drugs can cause overuse headaches. Overuse is defined as using pain killers, triptans, or certain other medications more than 2-3 days per week, week after week and month after month. This can create a headache-worsening pattern that results in more headaches and the resulting need to take more medicine. Not only is the pattern itself harmful, but while in this cycle, other effective treatments often do not work. The only way out of this cycle is to stop the pattern of overuse, which should be done under a doctor’s care. Researchers are currently investigating the role of opiates and pain-killers in the progression to chronic migraine.
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Exercise and Migraine
Exercise programs are frequently recommended to promote health, control weight, and prevent disease. But migraine sufferers typically are less physically active than those who don’t suffer. They often avoid exercise, worrying that the exercise itself will aggravate or trigger a migraine.
Sufferers who follow certain common-sense guidelines can improve their quality of life and increase their aerobic endurance and flexibility without aggravating or triggering their migraines. Here are some tips:
- Keep your exercise low-impact. Use equipment like stationary bikes or ellipticals that minimize pounding movements. Try yoga, isometric or band exercises.
- When using a treadmill, increase the incline rather than the speed to minimize pounding movements.
- Stretching and weight-bearing exercises are fine, but be careful of the neck area. This is a very tender and vulnerable spot that directly affects migraines.
- Drink water and stay hydrated. Dehydration is a very common migraine trigger.
- Take it slowly. Work up to longer and more intense exercise as your body gets stronger.
- Listen to your body – if an exercise aggravates your migraines, don’t do it! But don’t abandon exercise. Consult a trainer or physical therapist for alternatives.
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Migraine remains poorly understood and frequently mistreated. Researchers still do not understand many things about the causes of migraine, the role of genetics, the nature of pain, and the reasons why medications work only on some people and in some situations. As a result, sufferers often endure a lengthy process of trial and error to discover an effective treatment. Once a treatment is determined, it may not alleviate every attack, and it may prove ineffective over time. Some people suffer from several different types of migraine, making diagnosis and treatment that much more difficult.
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Role of the Migraine Research Foundation
Migraine is an enormous public health problem that has an impact on society, business, families, and, most importantly, on the individual sufferer. MRF raises funds for research to further the understanding of the causes of migraine, to develop improvements in treatment, and to find the cure. Read more about the cutting edge research we support.
Join our efforts to end the debilitating pain of migraine. Donate now
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The information provided here should not be used for the diagnosis, treatment, or evaluation of any medical condition. The Migraine Research Foundation has made every effort to ensure that the information is accurate; however, we cannot warranty its reliability, completeness, or timeliness.
All headache pain artwork ©1991 Novartis Pharmaceuticals Corporation. All rights reserved. Reprinted with permission from the American Headache Society.
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