Just about everyone has headaches. But Migraine differs from other types of headaches. It is often described as a severe recurring headache with an intense throbbing pain on one side of the head, although l/3 of the attacks can affect both sides. Attacks last between 4 and 72 hours and are often, but not always, accompanied by: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound and light, and tingling or numbness in the extremities or face. In 15-20% of cases, neurological symptoms occur in advance of the actual headache. These symptoms, which last 20-60 minutes, are referred to as the aura phase of the headache. 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 it presents in many different ways, Migraine is often misdiagnosed or even undiagnosed.
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 conducting medical tests and using specific medical criteria. Diagnosis is not always easy, however. It is often a matter of eliminating other causes for the headache and analyzing the reported symptoms. 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 REAL ILLNESS
Many people fail to realize that Migraine is a real illness, like asthma or diabetes. 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 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, suffer from Migraine. Nearly 1 in 4 U.S. households include 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, care for their families, or meet social obligations. While most sufferers experience attacks once or twice a month, about 4% of the population, or 12 million people, experience attacks on a near-daily basis.
About 18% of American women and 6% of men suffer from Migraine. This translates to approximately 30 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 and 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.
The illness often goes undiagnosed in children because their attacks can follow a different pattern than those in adults. In childhood Migraine, head pain is often less dramatic or severe than other symptoms, such as unexplained nausea or vomiting, abdominal pain, or severe vertigo. Moreover, it is not uncommon for attacks to occur with only minor or even no head pain, making it even harder to diagnose. Motion sickness is an early warning of the predisposition to childhood Migraine, perhaps revealing a special vulnerability to dizziness and vertigo (spinning) attacks. In childhood, the non-headache symptoms are often referred to as Migraine equivalents.
While symptoms of childhood Migraine may be different from those typically found in adults, children are just as disabled. Such children lose an average of 7.8 days of school each year, compared to 3.7 days lost for children without Migraine.
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WOMEN AND MIGRAINE
Approximately 22 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.
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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 brain 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, but not always, 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; although in some patients, life-style changes, biofeedback and other complementary treatments can help avoid the triggering or provocation of attacks. Complementary treatment, which does not use drugs, includes biofeedback, relaxation techniques, exercise, and proper rest and diet.
Even with the correct diagnosis, treating Migraine can be very difficult. There are well over 100 drugs 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.
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For about 4% of the population, the illness progresses to Chronic Migraine when attacks come nearly daily and are severe. 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.
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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, the individual sufferer. MRF was established to raise funds for research to understand the causes and mechanisms of Migraine, to develop improvements in treatment, and to find the cure. Read more about the cutting edge research we support and join our efforts to end the debilitating pain of Migraine.
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American Council for Headache Education www.achenet.org
American Headache Society www.americanheadachesociety.org
Migraine and Other Headache Disorders, R. Lipton and M. Bigal, eds. (Taylor and Francis Group 2006)
National Headache Foundation www.headaches.org
National Institute of Neurological Disorders and Stroke www.ninds.nih.gov
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DISCLAIMER 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.
Headache pain artwork reprinted with permission from the American Headache Society.