Nearly 90 percent of the people who are susceptible to migraines have a family history of the condition. A good time to gain a more complete understanding of these intense headaches, which affect 15 to 33 percent of adult women and anywhere from 6 to 15 percent of adult men, is Migraine and Headache Awareness Month is observed, June of each year. Although migraines can begin at any age, most people who experience them report their first attack before age 40. Among women, migraines either improve or do not occur during the later stages of pregnancy and generally improve after menopause. Symptoms of a migraine vary according to type.
Sorting It Out
Migraine headaches fall into general types. The most common is a pulsating or throbbing headache that occurs on one side of the head and has no accompanying aura. Its close cousin, the so-called "classic migraine," is marked by a similar severe headache with additional perceptual disturbances, such as visual, sensory, and speech alterations occurring before the headache descends. Migraines with an aura have a stronger familial genetic link; the probability of occurence of migraines with an aura in a person with a family history of the condition is about three times greater than migraines without an aura.
Abdominal migraines mostly affects children and is also known as "periodic syndrome." Such attacks are characterized by periodic bouts of moderate to severe midline abdominal pain lasting anywhere from one to 72 hours. Along with the abdominal, pain patients may endure other symptoms, such as nausea, vomiting, flushing, and pallor.
Basilar migraines, common in young adults, are a rare form with aura symptoms originating in the brainstem and affecting both sides of the brain. Symptoms can include dizziness, double vision, loss of balance, confusion, slurred speech, hearing changes, and tingling on both sides of the body. During an attack, some people lose consciousness or pass out, and have been mistaken for someone experiencing an epileptic seizure or drug overdose.
Patients with cyclic migraines usually experience 10 or more long-lasting attacks per month. Nocturnal migraines affect patients during the middle of the night or early morning hours. And ophthalmoplegic migraines are brought on by a rare condition caused by weakness of the muscles surrounding the eye; pain surrounds the eyeball and lasts from a few days to a months.
Familial hemiplegic migraine (FHM) is a form of migraine headache that runs in families. An aura precedes the familial hemiplegic migraine; along with the most common symptoms — temporary blind spots known as scotomas, flashing lights, zig-zagging lines, and double vision. Auras are also characterized by temporary numbness or weakness, often affecting one side of the body, called hemiparesis. Additional features of an aura can include difficulty with speech, confusion, and drowsiness. An aura typically lasts about an hour. Unusually severe migraine episodes have been reported by some sufferers of FHM, with fever, seizures, prolonged weakness, coma, and, on rare occasions, death. Neurological symptoms such as memory loss and problems with attention can last for weeks or months after the end of the migraine. About 20 percent of people with this condition develop ataxia, a mild but permanent difficulty coordinating movements ataxia, which may worsen with time, and rapid, involuntary eye movements called nystagmus. Researchers have identified three forms of familial hemiplegic migraine known as FHM1, FHM2, and FHM3. Each of the three types is caused by mutations in a different gene.
How to Help Yourself
Because migraines have no cure, sufferers work to manage their condition either alone or with a doctor's help, depending on the severity of the headaches. Many patients recommend keeping a migraine notebook to better understand their triggers, the idiosyncratic and individual cause of their headaches. Remember that your personal migraine prompts may not affect anyone else — and vice versa. Nevertheless, the most commonly cited triggers are hormonal changes, such as those resulting from menstruation, oral contraceptives, or hormone replacement therapy. Specific foods, such as chocolate, cheese, alcohol, and food additives, including sulfites, nitrates and MSG, are also often identified as triggers by patients. Missing meals, general stress, and windy humid weather have frequently been mentioned as precedents as well. The hope in keeping a notebook is that you will be able to identify triggers and then avoid anything that might ignite a migraine.
Among the factors you will want to jot down in a notebook each and every time you experience a migraine are:
- Date and time. When and where did the migraine begin, and when did it end?
- Describe the pain. Is the pain shifting from one side of the head to the other, or does it affect the whole head? Is it pounding or throbbing? On a scale of one to 10 (10 being the worst), how painful is the headache?
- Food. Many people believe certain foods, such as chocolate or shellfish, trigger their headaches. What did you eat before the migraine?
- Sleep. What were your patterns of sleep preceding the attack?
- Weather changes. Was it especially hot or humid before your headache started? Or particularly cold and dry?
- Physical activity. Were you running around when the migraine began? Were you lying down?
- Unusual symptoms. Many people experience symptoms (also called an aura) up to 48 hours before a migraine starts. These may include nausea; drowsiness; irritability; sensitivity to light, sounds, or motion; and visual disturbances such as seeing zigzag patterns or flashing lights.
- Treatments. List every type of treatment you may have tried, including over-the-counter medications, and include whether the treatment helped and/or how much it helped.
"Current thinking is that migraine headaches are caused by a genetically inherited abnormality," says Dr. Naziyath Vijayan, a neurologist with UC Davis Medical Center in Sacramento. "For an attack to occur, something triggers a change in the brain, which excites serotonin-containing nerve cells and causes them to transmit impulses to the blood vessels. The inflammation and dilation of blood vessels cause the throbbing, pulsing pain."
Many patients self-treat their migraines with over-the-counter medications. Excedrin Migraine, Advil Migraine, and Motrin Migraine Pain have been recommended by sufferers. For the past 50 years, doctors have also prescribed ergotamine for the acute treatment of migraine as well as triptans, a newer class of compounds developed for the treatment of headaches and approved by the Federal Drug Administration more than 20 years ago. Many doctors rely on combinations of different drugs and then add in additional medications to address nausea and vomiting when such symptoms co-exist with a migraine. Medications that can be administered by nasal spray, holding under the tongue, injection, or rectal suppository are often faster acting and the recommended choice for those whose headaches descend rapidly or those who vomit during attacks.
Current research suggests a complexity of genetic factors, rather than a single gene, in addition to environmental causes contribute to the onset of migraine headaches. With the investigation of migraines in families as well as twin studies, results suggest that half the time it is inherited genetic factors that are responsible for migraines. Although specific genetic alleles have not yet been isolated, several susceptibility locations have been located in genome-wide screens and candidate studies. A recent study found that mutations on a single gene appear to increase the risk for both an unusual sleep disorder and migraines. Researchers hope this knowledge will lead to either new treatments or prevention.
Sources: Chillemi S. This way in: weather-related migraines. Neurology Now. 2013.
Nash VR, Pestka EL. Decoding Genetics: Genetic aspects of migraine headaches. The American Journal of Primary Healthcare. 2013.