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Migraine Definition – Symptoms – Genetics – Complications – Migraine in Children and Women
Migraine Definition and Symptoms
Migraine is not “just a headache”. Migraine sufferers know that there is a “migraine” and there is a “headache”. Head pain is only one of migraine symptoms and sometimes not the worst one. Mathematically speaking: Migraine = Headache + Associated Symptoms.
Migraine is an inherited disorder of episodic hypersensitivity. Brains of migraine sufferers process normal sensory information differently from the brains of non-migraineurs. It is especially evident during migraine attacks. Normal levels of lighting and noise are perceived as irritating.
There is a hypersensitivity to everything during the attack. Irritability, difficulty concentrating, low energy level, nausea and vomiting are very common. Dizziness, or sensation of unsteadiness as if being on a boat, is a frequent migraine attack associate.
Headache intensity is usually moderate, or it might be severe and debilitating. Pain is often, but not necessarily, throbbing in quality. Head movements commonly bring up throbbing quality of pain. Most of the time normal activity is impossible during migraine attacks.
Some migraine symptoms persist during headache free periods. Migraineurs commonly have excessive motion sensitivity. They are sensitive to large visual displays, complex visual patterns, such as supermarket shelves, 3D movies, or a transportation.
Migraine attack frequency and severity is very individual – from once in a blue moon to multiple per week. Life style and some other factors may increase the attack frequency. They are called “triggers”. In about 25% migraine is triggered by aura. Some of the attacks appear to be triggered by excessive sleep, relief after stress, or long breaks between meals. Most of migraine attacks occur spontaneously without any provocation. Despite common believes, specific foods and weather pattern likely have nothing to do with migraine triggers.
Migraine Epidemiology and Genetics
Multiple studies consistently report that around 18% of females and 6% of males have migraines at least at some point of their lives. Migraine attack frequency peaks in 30s and declines during 50s. Migraine is the least common in Asians, slightly more common in African Americans and the most common in whites.
Migraine is typically inherited without specific pattern. Majority of migraineurs have first degree relatives with migraine. Studies in identical twins were confusing about the mode of inheritance. It appears that development of migraine depends on both genetic predisposition and environmental factors.
Patients with migraine have low magnesium level in the brain, which is involved in the natural mechanism of migraine attack control. Effectiveness of migraine treatment with magnesium supplementation is doubtful, however.
Why Do We Need Migraine?
It is not a rhetorical question!
Any genetic trait highly prevalent in any given population is beneficial. Considering 18% affected females, migraine is definitely needed for one reason or the other. Maybe it is not the migraine itself but rather something associated with it is beneficial. I don’t have the answer.
Migraine in Women
Migraine is 3 to 4 times more common in women than in men, which appears to be influenced by female hormones. Before puberty migraine frequency is pretty much equal in both genders. Migraine attacks frequency and severity are heavily affected by menstrual cycle, pregnancy, and birth control pills.
It is common to have migraine attacks in the particular part of the menstrual cycle. Migraine associated with menses is called menstrual migraine. About 60% of female migraineurs have migraine attacks around menses and 14% have migraine exclusively during this part of the menstrual cycle. Estrogen level fall during menses triggers migraine attacks in sensitive women.
Hormonal contraception may affect migraine severity in either direction. Birth control pills may bring up the first migraine attack in women with family history of migraine, or they may make the existing migraine uncontrollable. In some women migraine may become less severe on hormonal contraception. Overall, migraine is rather worse on birth comtol pills.
Net effect of pregnancy on migraine severity is positive. Migraine tends to be worse in the first trimester, while the second and the third trimesters bring some relief from migraine attacks.
Migraine carries a two-fold risk of stroke compared with general population. Birth control pills (in migraine with aura) increase the chance of stroke more than 10-fold. Combination of migraine with aura, oral contraceptives, and smoking boosts the chance of stroke even further. Oral contraceptives should be avoided in women suffering migraines with aura.
Migraine tends to improve in the second half of life. In about half of women menopause does not change the migraine pattern. The rest will experience worsening migraines during hormonal instability of perimenopause with improvement later on.
Migraine in Children
Migraine affects about 10% of girls and 5% of boys. Headache attacks might not have typical migraine features. Light and noise sensitivity often does not develop until after age 12. Migraine attacks tend to be shorter (up to an hour), pain is more common on both sides of the head, and it is often relieved by sleep. Occipital headache caused by migraine is rear in children.
Children often have very bizarre auras. “Alice in Wonderland” type of aura is especially remarkable. Objects appear either small or large, or they may have distorted proportions.
Exotic forms of migraine, such as abdominal migraine, paroxysmal vertigo and cyclic vomiting, are much more common in children than in adults. Younger children have difficulty expressing their sensations, so the correct diagnosis could be challenging.
Migraine Association with Other Disorders
Patent foramen ovale (hole between the upper chambers of the heart) is two times more common in migraineurs than in general population. The reason for this association is not clear. Closing of the opening does not affect migraine frequency and severity.
There is a strong association of migraine with Meniere disease and positional vertigo. The latter has a reasonable explanation (see vestibular migraine).
The other associated disorders are epilepsy, anxiety, depression, mitral valve prolapse, hypo- and hypertension, asthma and allergies. Migraine is a complex disorder with largely unknown cause, so the reasons for the association are not clear.
Chronic or transformed migraine is the most common issue. Repetitive insults of migraine attacks on the brain pain processing system leads to the pain processing system malfunction.
Allodynia (pain produced by simple touch or temperature change) results from abnormal activity in the pain processing system. Multiple attacks lead to some permanent changes, which is expressed as a constant or very frequent pain in the head. Scalp and upper body become sensitive to simple touch. This pain is different from the attack related pain. There is scientific evidence of wear and tear in the in the pain suppressing regions of the brain. Iron deposition was found in the periaqueductal gray matter of the midbrain.
Vertigo and dizziness are common accompaniments of migraine attacks, which cause some temporary circulation changes in the labyrinth. Repeated attacks seem to cause alterations in the balance system. Migraine produced vestibulopathy is responsible for chronic sense of dizziness and disequilibrium in some migraineurs. Migraine may sometimes be responsible for chronic subjective dizziness syndrome.
Do Migraines Cause Brain Damage?
The answer depends on what you call “damage”. Migraine does not appear to be causing any cognitive decline or memory loss, but there are some changes on the brain MRI due to small vessel disease. Clinical significance of these findings is questionable. Similar, but more extensive, small vessel disease is seen in diabetes and high blood pressure. Both conditions cause, so called, lacunar strokes.
Migraine is associated with strokes. It means that both, strokes and migraines are caused by the same mechanisms. The headache, however, does damage the brain in a very peculiar way. Frequent pain attacks damage the pain processing system as it is described in “chronic migraine” paragraph.
Can Migraine Be Cured?
There is no known cure for migraines at this point. Migraine is a complex disease of hypersensitivity with unknown cause.
Life style adjustments, such as a regular sleep pattern and moderate exercise, do decrease attack frequency and severity. These measures would not control headaches completely.
In most cases, migraine can be either fully or partially controlled by complex approach, which includes preventive treatment with medications.