Migraine is classified as a neurological disorder. A migraine attack is characterised by moderate to severe, pulsating headache (often one sided – unilateral). It may be accompanied by nausea and vomiting and an intolerance to bright lights (photophobia) and/or loud noises (phonophobia). The attack may last from a few hours to three days and in a third of people may be preceded by an aura.
Migraine is relatively common. Figures vary but it is believed that about 6% of men and 18% of women have had at least one attack in the last year. Attacks are often so severe that the sufferers are unable to work and will retreat to a quiet, darkened room. This can have a major effect on the sufferers quality of life.
The nature of migraine is often unpredictable with various treatment having different success rates in the same person at different times. Even the site of the pain can vary enormously from different parts of the head to different parts of the body (there may be no headache at all).
The latest evidence suggests that migraine is influenced by the serotogenic control system – a neuro transmitter and hormone. There seem to genetic influences indicated by twin studies whilst some are caused by diseases or injuries to the hormonal organ system. A third to three quarters of sufferers are female but pre pubertal females are affected at the same rate as boys. It has been suggested that a correlation exists between the falling of hormones and the reduction intestinal serotonin the may then go on to cross the blood brain barrier.
Although migraine is often considered to be a vascular headache there is increasing evidence pointing to ‘cortical spreading depression’ where neurological activity over the cortex becomes depressed leading to inflammatory mediators irritated the cranial nerves especially the Trigeminal Nerve (CN V).
The signs and symptoms of migraine vary enormously between patients and in the same patient at different times. There do seem to be four phases.
The prodrome precedes the painful stage and is characterised by irritability, mood change, euphoria or depression, fatigue and yawning, sleepiness, stiffness (especially neck stiffness), food cravings, constipation or diarrhoea. This phase may appear hours or days before the attack and the sufferer often knows that a migraine is looming.
About a quarter of sufferers experience an aura. This may be experienced as visual, auditory or motor changes. Visual effects are the most common and may be flashes of light, zig zagged lines or blurred vision. There may be auditory hallucinations, pins and needles in the body especially around the face and lips or vertigo.
The typical migraine headache is moderate to severe, one sided (unilateral) throbbing. The headache grows slowly after the prodrome and aura and may last up to three days. There is often nausea and/or vomiting and intolerance to bright lights (photophobia) and/or loud noise (phonophobia) leading the sufferer to retreat to a quiet, dark room. The re may be increased urination (polyuria), sweating, pallor, neck stiffness and mood disturbance.
After an attack the sufferer may feel exhausted irritable. The mood may vary from depression to slight euphoria. Some minor symptoms of the pain phase may persist.
This are any factors that seem to precipitate a migraine which the sufferer may be exposed to or separated from. They may be infectious, environmental, chemical, hormonal, behavioural or dietary. Some of the more common triggers are
The obvious treatment is to avoid the particular triggers significant to the sufferer. Keep stress levels low and learning relaxation techniques. Reducing muscular stiffness especially neck pain with gentle stretch and exercises can be helpful. Desk Therapy can produce exercises for neck pain and stiffness along with exercises for eye strain and fatigue.
Heat or cold applied directly to the head may help. Ice held in the mouth seems to help some people by directly cooling the hypothalamus.
Paracetamol, codeine and anti inflammatory medication may relieve some headache. Serotonin agonists or trepans like Imigram or ergot based drugs are often used successfully.
Manual therapy like osteopathy, massage, physiotherapy and chiropractic have been shown to help. These combined with stretching regimes like those found on Desk Therapy which reduce muscle tension in the neck and upper back.
Diet, visualisation, cognitive behavioural approaches to pain and self hypnosis are all worth investigating.
All in all a comprehensive approach to reduce stress levels and promote relaxation, keeping fitness levels up, adhering to a good diet and ensuring adequate sleep can reduce the frequency of migraine.
Desk Therapy exercise software can help. Please visit our Home Page to see how Desk Therapy can create an exercise programme designed specifically for you