This is a debilitating neurological condition, which affects 1 in 7 of the population. Women are affected more than men. The fairly ubiquitous symptom associated with all of the different migraine types is headache. Frequently there is a prodrome or aura that precedes the headache or neurological symptoms. Examples of aura include tingling in the limbs, stiffness, tiredness and difficulty concentrating. The range of symptoms, the order in which they occur, and the severity, is diverse amongst sufferers. The exact cause of migraine is poorly understood but related to serotonin (a nerve transmitter) levels in the brain. There are some well-known triggers such as caffeine, chocolate, stress and lack of sleep.
There are two main types of migraine:
Prodromal symptoms, pounding headache, no visual symptoms. There may be nausea and vomiting. There may be sensitivity to light (photophobia), sound (phonophobia) or smell (osmophobia) during the headache.
Visual aura consisting of bright or dark patches, zig zag lines, shimmering, tunnel vision, fortification spectrum which consists of an enlarging zig zag patch, often of diverse colour which ultimately breaks up and disappears. These symptoms may rarely occur in the absence of headache, a so-called acephalgic variant.
Less Common forms of Migraine
This typically affects men in late middle age. The headache, which can be disabling, occurs for short periods throughout the day and night and occurs in clusters over a few weeks and then disappears, often for many years. Headache is characteristically on one side. They are usually associated with watery eye, nasal congestion or facial sweating. There is no visual aura.
This is typically a monocular variant, lasts for a shorter duration. Vasospasm of the retinal arteries has been observed in this group.
If you have suffered with migraines for years, this does not warrant investigation. If headache and neurological symptoms are a new phenomenon, a neurological examination and imaging of the brain is required to exclude another pathology.
If vision loss is not typical or lasts more than a few minutes you should seek medical advice immediately.
With the start of an attack, paracetomol, aspirin or non-steroidal anti-inflammatory drugs and ergotamine are useful. Anti emetics may be required.
Prophylaxis with beta-blockers, calcium channel antagonists, pizotifen, methysergide and aproclonidine may be helpful. You will need to seek the advice of an expert in the field (usually a neurologist) to tailor the best prevention and treatment strategy for your needs.
Botox® has been helpful for some forms of chronic migraine headache resistant to other therapies.
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