A migraine is one of the most intensely painful and disorienting of
all common ailments, and can severely disrupt the lives of regular
sufferers. As yet, medical science has no complete answer to the
A migraine attack can strike almost anyone, though women are far more
often affected than men, and young and middle-aged adults tend to be
more susceptible than young children or elderly people. There are
several types of migraine, and symptoms vary both between individuals
and between attacks, but characteristic features help distinguish
migraine from any other form of headache. The pain is severe and
concentrated on one side of the head, usually behind or above an eye.
Sufferers feel nauseated, and may vomit; sudden movement or intense
stimulation, especially by bright lights or noise, intensify the pain.
WHAT CAUSES MIGRAINE?
Although the causes of migraine are not fully understood, it is thought
to be the result of the blood vessels in the head narrowing, then
expanding. This affects the blood supply to the brain, which in turn
triggers the symptoms of migraine.
Research has suggested that a migraine attack is related to changes
in the amounts of naturally occurring substances, called amines, in the
body. The level of certain amines in the tissues may be raised by
consuming certain types of foods, by stress or by low blood sugar caused
by too long a period between meals. One amine, serotonin, is increased
by 'positive ions', electrically-charged particles found in the air in
stuffy, smoky rooms, hot, dry winds and thundery weather, all of which
can trigger attacks in susceptible people.
Migraine sufferers may also be deficient in enzymes responsible for
breaking down the amines. This may explain why sufferers may be affected
by hormonal changes associated with menstruation and the contraceptive
pill, though other factors are also involved.
When the salt and water
content of body tissues is raised -- which most commonly occurs in women
before and during periods -- attacks are more likely. People who have
already shown a tendency to migraine will have more severe and more
frequent attacks if they get high blood pressure.
Some, but by no means all,
attacks are preceded by an 'aura', more common in younger than older
sufferers. The visual field may be broken up, with flashing lights and
stars appearing, and there is a detached, other-worldly, even euphoric
feeling similar to that experienced in cases of shock or under the
influence of certain hallucinogenic drugs. This feeling rarely lasts
more than a few minutes or so.
Some migraine symptoms, such
as the pain and occasional loss of vision, can be very frightening,
especially when first experienced, but attacks are not permanently
damaging or fatal, though sufferers should not drive or do anything else
requiring accurate hand and eye co-ordination during an attack.
People who have never before had migraines and suddenly begin to
experience recurrent severe head pain should always consult their doctor
to check that the problem is not something rare, but more serious, such
as a blood clot or tumour in the brain.
The best treatment for migraine is to discover the triggers that
cause it and as far as possible remove them from your life. To this end,
regular sufferers are strongly recommended to keep a migraine diary to
marry up attacks with possible causes.
LIVING WITH MIGRAINE
For various reasons, it is
not always possible to cut out all migraine triggers. Generally
speaking, sufferers need to accept that they may be more sensitive than
other people; they need to rest adequately, eat regularly and well, and
take life at a gentle pace.
Stress at home, at work and in personal relationships can contribute
to the severity of a migraine; sufferers should learn not to 'drive'
themselves, and explore various stress-lowering techniques, including
meditation and regular, gentle exercise. So-called 'talking cures' for
emotional problems can also prove useful.
There are all sorts of drugs for migraine. As a preventative measure,
some doctors prescribe sedatives and anti-depressants, such as
tricyclics, to keep stress at bay, but this is rarely a long-term
solution. Others prescribe drugs to control the nervous impulses
affecting blood vessel diameter or to counter the potentially harmful
effects of too much serotonin.
Other long-term treatments include regular doses of pizotifen or
propanol, which cut down the frequency of attacks, but these drugs may
have unpleasant, though not dangerous, side-effects.
Simple, short-term painkillers such as aspirin, paracetamol or codeine
are rarely effective against migraine, as the stomach becomes inactive
early in an attack; the drugs are not absorbed well and may be vomited
back. For this reason, anti-nausea drugs may be taken first.
There is a range of specific anti-migraine drugs, such as the new
'wonder' drug sumatriptan and ergotamine, that constrict swollen blood
vessels. These can be very effective if taken early in an attack, but
there are risks and special precautions attached to their use.
Sufferers should lie flat on a bed, preferably without a pillow, in a
quiet, darkened room. A damp towel over the eyes helps some people, but
not everyone. In the early stages, gentle massage may help to loosen
tension at the neck and the base of the skull, on the back and
shoulders, and on the stomach. Some sufferers, however, find any kind of
touch almost as difficult to take as a loud noise or a scouringly bright
Finger pressure on the bridge of the nose, or on the pulse points at
the temple and behind the ear, may bring temporary relief from pain.
Going to sleep early in the attack often helps to shorten it; trying to
fight it off usually makes it worse.