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David Baxter

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Anatomy of a Migraine
By Teri Robert

When many people think ?Migraine,? they think only of the pain of Migraine. In reality, a Migraine (often called a "Migraine attack") consists of far more. The typical Migraine attack actually consists of four parts, referred to as phases or components. It's important to note that not every Migraineur (a person with Migraine disease) experiences all four phases. Also, attacks can vary with different phases experienced during different attacks. The four phases of a Migraine attack are:

  • Prodrome
  • Aura
  • Headache
  • Postdrome
The Prodrome
The prodrome (sometimes called preheadache or premonitory phase) may be experienced hours or even days before a Migraine attack. The prodrome may be considered to be the Migraineur's ?yellow light,? a warning that a Migraine is imminent. For the 30 to 40% of Migraineurs who experience prodrome, it can actually be very helpful because, in some cases, it gives opportunity to abort the attack. For Migraineurs who experience prodrome, it makes a solid case for keeping a Migraine diary and being aware of one's body. Symptoms typical of the prodrome are:

  • food cravings
  • constipation or diarrhea
  • mood changes ? depression, irritability, etc.
  • muscle stiffness, especially in the neck
  • fatigue
  • increased frequency of urination
  • yawning
The Aura
The aura is perhaps the most talked about of the phases. The symptoms and effects of the aura vary widely. Some can be quite terrifying, especially when experienced for the first time. Some of the visual distortions can be exotic and bizarre. It's interesting to note that Migraine aura symptoms are thought to have influenced some famous pieces of art and literary works. One of the better know is Lewis Carroll's Alice in Wonderland. While most people probably think of aura as being strictly visual, auras can have a wide range of symptoms, including:

  • visual ? flashing lights, wavy lines, spots, partial loss of sight, blurry vision
  • olfactory hallucinations ? smelling odors that aren't there
  • tingling or numbness of the face or extremities on the side where the headache develops.
  • difficult finding words and/or speaking (aphasia)
  • confusion
  • dizziness
  • partial paralysis (only in hemiplegic Migraine)
  • auditory hallucinations ? hearing things that aren't really there
  • decrease in or loss of hearing
  • reduced sensation
  • hypersensitivity to feel and touch (allodynia)
  • brief flashes of light that streak across the visual field (phosphenes)
Approximately 20% of Migraineurs experience aura. As with the prodrome, Migraine aura, when the Migraineur is aware of it, can serve as a warning, and sometimes allows the use of medications to abort the attack before the headache phase begins. As noted earlier, not all Migraine attacks include all phases. Although not the majority of attacks, there are some Migraine attacks in which Migraineurs experience aura but no headache. There are several terms used for this experience, including "silent Migraine," and "acephalgic Migraine."

The Headache
The headache phase is generally the most debilitating part of a Migraine attack. It's effects are not limited to the head only, but affect the entire body. The pain of the headache can range from mild to severe. It can be so intense that it is difficult to comprehend by those who have not experienced it. Characteristics of the headache phase may include:

  • headache pain that is often unilateral ? on one side. This pain can shift to the other side or become bilateral.
  • Although Migraine pain can occur at any time of day, statistics have shown the most common time to be 6 a.m. It is not uncommon for Migraineurs to be awakened by the pain.
  • This phase usually lasts from one to 72 hours. In less common cases where it lasts longer than 72 hours, it is termed "status migrainosus," and medical attention should be sought.
  • The pain is worsened by any physical activity.
  • phonophobia ? sensitivity to sound
  • photophobia ? sensitivity to light
  • nausea and vomiting
  • diarrhea or constipation
  • nasal congestion and/or runny nose
  • depression, severe anxiety
  • hot flashes and chills
  • dizziness
  • confusion
  • dehydration or fluid retention, depending on the individual body's reactions
The Postdrome
Once the headache is over, the Migraine attack may or may not be over. The postdrome (sometimes called postheadache) follows immediately afterward. The majority of Migraineurs take hours to fully recover; some take days. Many people describe postdrome as feeling ?like a zombie? or ?hung-over.? These feelings are often attributed to medications taken to treat the Migraine, but may well be caused by the Migraine itself. Postdromal symptoms have been shown to be accompanied and possibly caused by abnormal cerebral blood flow for up to 24 hours after the end of the headache stage. In cases where prodrome and/or aura are experienced without the headache phase, the postdrome may still occur. The symptoms of prodrome may include:

  • lowered mood levels, especially depression
  • or feelings of well-being and euphoria
  • fatigue
  • poor concentration and comprehension
  • lowered intellect levels
Summary
As we've seen, there's far more to an attack than just the headache phase. Not all Migraineurs experience all phases, and those who do don't necessarily experience them with each attack. If it all sounds unpredictable ? it is. For those who suffer from Migraine, there can be great advantage to learning about these phases of a Migraine and how to recognize them. Once we know about them and learn to listen to our bodies, if we experience prodrome or aura symptoms, we have a better chance of avoiding the headache phase. In addition, there's always an emotional comfort factor to knowing what is causing us to feel depressed or have other symptoms. Once we learn to recognize these symptoms and use them in our Migraine management, we gain a bit more control over Migraine. Any time we can do that, it's a positive move.
 

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What an informative overview of the dynamics of Migraine. As one who has experienced Migraine most of my life, it is a subject that has interests me greatly.

In another Psychlinks posting, we discussed Migraine Triggers

Anyone who suspects they experience Migraine, which of course is different from headaches most people regularly experience. A headache at the back of the neck or across the back of the shoulders may not be a Migraine.

Migraines are usually described as a one sided headache, often concentrated in one eye, and feels like a searing spike in that eye.

Migraines are also usually accompanied by sensitivity to light, sound and odor where all these seem to be exxagerated.

Sometimes Migraine does not even include a headache, which is a special type of Migraine.

Migraine is a nuerological event, and should be evaluated by a specialist, specifically a Neurologist.

There are effective treatement options available to treat Migraine that can be discussed with the doctor. The newer Migraine treatements, referred to as triptans target neurotransmitters thought to be associated with Migraine. The effectiveness in treating Migraine has been very encouraging in recent years.
 

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