What is a migraine?
Migraine is the most common form of headache, affecting about 1 in 5 people. About 1 in 5 women, and 1 in 16 men have migraine. There are several forms of migraine; some are more common, and others are rare. The most common form is migraine without aura, and up to 20% people have it with aura. Migraine is a complex brain disorder that is, in part, genetically determined.
Migraine begins as an episodic headache; but can be transformed into a chronic migraine with time. Migraine is manifested by recurrent, stereotyped, most of the time but not always involving half of the head, that can be alternating. Attacks can affect either the right or the left side of the head predominantly.
The pain is usually throbbing, pulsating and most of the time is of moderate to severe intensity affecting the daily life activities forcing the suffering patient to miss a university class or absenteeism from work. Frequent migraines expose the individual to serious professional conflicts. Migraine commonly begins during puberty or young adulthood and ends around menopause.
Migraine frequency varies within the same patient and from one patient to another. Some patients might have rare attacks, a few per year; others can have several days per month. A patient having 15 migraine days per month or more for at least three months is considered to have a chronic migraine.
One migraine attack, if untreated, may last up to three days. When a migraine attack lasts more than three days, it is called “ status migrainosus.” Many patients need to rest in a dark room or sleep during an attack as movements increase the pain. In most patients, migraine is associated with nausea, vomiting, and intolerance to light and sounds. In some patients, the headache is preceded by transient visual symptoms like white or black spots, colorful lines typically in zigzag, or even a blurry vision in a part of the visual field; others more rarely might have sensory, motor, or speech transient symptoms. The aura can last between 15 to 60 minutes.
Many patients have identified “migraine triggering” factors as menstruation, exposure to light, smell, stress, lack of sleep, hunger, dehydration, alcohol, monosodium glutamate found in Chinese food, aged cheese or fermented food rich in tyramine and some processed meat. Some patients can have their migraine triggered by weather and barometric pressure change. It can happen that a patient with migraine also has another cause of headache, such as a tension-type headache, sinusitis, or neck pain. Those co-morbidities need to be identified and appropriately managed.
Although there is no definite cure for migraine, it can be managed successfully. Treating migraine requires a treatment to abort the attacks and preventive treatment to lower the frequency and intensity of attacks, not to forget to address the triggering factors and lifestyle changes.