Overview
It’s estimated that about 1-2% of people worldwide suffer from chronic migraine. Migraine is more common in women than in men. Research by the World Health Organisation has established migraine as the 6th highest cause of years lost to disability. The onset peaks between the ages of 35 - 45 years. The natural history of headache is to improve. Unfortunately, individuals with migraine will experience periods of time when they are more susceptible to headache. We do not know the exact cause of migraine, but researchers believe that the answer lies in genetics, with migraines tending to run in families. Women are about three times as likely as men to experience migraines, most probably due to hormonal factors. Women might experience a migraine just before, or just after, the start of their period; find that oral contraception (the pill) can trigger or help migraines; changes of headache in pregnancy; experience migraines as they approach the menopause, or hormone replacement therapy (HRT) triggers migraines. In many, but not all patients it is possible to identify triggers. It may be difficult to identify triggers as they differ between sufferers, and it is often a combination of factors that act together to trigger an attack.
Symptoms & Diagnosis
Each migraine can follow a different pattern and this can change over the course of a lifetime. There are several phases of a migraine. Before an attack starts people may feel tired or yawn more, some may have more energy or experience craving, or find they need to pass urine more. This is known as the premonitory phase. These can start several hours of days before the migraine attack. The next phase is the Aura which is described below. This is experienced in 20-25% of those with migraines. The headache phase follows this with the symptoms described above. The final phase is the postdrome/recovery phase . At this stage the headache has gone but is left the person feeling tired and washed out. People commonly feel tired for up to two or three days after a migraine.
The pain of migraine headaches can be severe, throbbing and is often accompanied by excessive sensitivity to light (photophobia), loud sounds (phonophobia), or smells/odours, as well as nausea and/or vomiting. Migraines commonly last between 4-72 hours and can be made worse by movement. People who have fewer than 15 attacks per month, each one lasting between four and 72 hours, have episodic migraines. These are the most common sorts of migraines. Every year, about 2.5% of migraine sufferers progress from episodic attacks to chronic ones. Chronic migraine is when someone has 15 days or more of headaches with at least 8 of those being migraines. Although migraines are not life-threatening they can have a significant impact on the quality of people’s lives, including their family and social life and employment. Some patients also experience aura. Aura is the name given to part of the migraine made up of a range of temporary neurological symptoms including visual changes (flashes of lights, loss of vision, zigzag patterns), tingling sensations, speech problems, dizziness, weakness on one side of the body and, very rarely, loss of consciousness. Theses symptoms usually begin in one place and move over time allowing us to distinguish from the symptoms of a stroke which typically have a sudden, abrupt onset. Auras can last from five to 60 minutes, and usually happens before the headache. It is also possible to have the aura without the migraine (acephalic/silent migraine). Imaging of the head, neck and balance centres may be requested by the consultant as part of the diagnostic work up.
Around 40% of migraine sufferers will experience significant vestibular symptoms (vertigo, balance disturbance) before their attack or as a main symptoms. Those who experience balance disturbance, room spinning (vertigo), motion intolerance and other more common migraines symptoms are likely to have vestibular migraines. The underlying mechanisms are unclear but it is thought to be another manifestation for migraine aura. Management of this involves a multidisciplinary approach, working closely with neuro-otology colleagues and vestibular rehabilitation physiotherapists.
Treatments & Key Areas We Specialise In
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