Migraine is an incurable, largely genetic disease that affects up to 1 in 5 people. It is a spectrum disorder, rendering some completely disabled, while others are able to live fairly normal lives with only the occasional attack. It is an invisible disability, not a temporary condition, nor something that will go away.
Typical or common migraine is characterised by a pulsating or throbbing headache, usually only on one side of the head, which lasts between 4 and 72 hours, with some warning symptoms before, and a ‘migraine hangover’ afterwards. However, migraine is a very individual disease: some people get the other symptoms of migraine and no headache at all, others have migraine attacks that last for months.
The research around migraine is a rapidly changing landscape, with significant breakthroughs in recent years. The current understanding of migraine is that it is a neurovascular disease – that is, it involves both the neurological and vascular systems. There is a series of events, usually beginning with a ‘trigger’, which cascades into a migraine attack.
Migraine physiology is complex, and unfortunately not well understood, but there are three things we know are going on: pain nerves in the head and the neck are irritated; blood vessels in the head spasm; and, there is inflammation going on in the affected part of the brain. It’s the combination of these three that usually results in the severe and disabling headache.
There are four phases of a migraine attack.
The first is the Prodrome – the ramp up to the attack. This is a bit like the migraine equivalent of PMS: you may be irritable, depressed, crave food, and many other symptoms that can leave you feeling ‘not quite right’. It is also possible to feel euphoric and have difficulty sitting still or sleeping. Most people living with migraine will notice their own warning signs that come with the prodrome.
The second stage is the Aura. Only a minority of people with migraine get aura, but if they do, it is significant, and sometimes more significant than the headache. The most common aura is visual disturbances, followed by numbness and tingling in parts of the body. Aura can also be abdominal pains, weakness, disturbances in the senses like smelling strange things or not being able to taste anything, and loss of balance. There are a range of rarer types of migraine that more accurately describe these symptoms.
The third stage is Attack, also called the acute or headache phase. Not all people with migraine get headache, but it is a common symptom. During this stage any combination of throbbing headache, sensitivity to light, smell and sound, and/or nausea is expected. Vomiting, light-headedness, pain elsewhere in the body, or mood shifts are also possible. This third stage is the part that typically lasts 4-72 hours.
The final stage is Postdrome – otherwise known as the migraine hangover. For some, this is worse than the headache stage, with depression and headache common, as well as significant fatigue, dizzyness and confusion.
Both the pro- and postdrome can last for days or weeks. For some who get severe migraine attacks, there can be no or little respite from one migraine attack to the next.
People who live with migraine also are at risk of medication overuse headache. This is when overuse of common pain and migraine medications causes rebound headaches, and transforms migraine attacks into constant, unrelenting headache. It is believed this only affects those with migraine.