Many of us may have heard either our friends or ura relatives’ distressful tale of the agonising headache called migraine. Those who suffer from migraine can only tell you how awful migraine attacks are and why they are forced to keep an eagle eye on their daily routine in order to avoid the dreadful headache. Migraine attacks can be very frightening and can make the sufferer almost disappear into grim darkness for quite a long time until the attack subsides.

Every sufferer has his/her own symptom of migraine and the triggers can also vary from person to person. Therefore for a migraineur, it is essential to understand what migraine is and what the triggers are that can bring about a migraine attack. Moreover being able to differentiate between migraine headaches from other forms of headache is also important because a migraine headache may look like another form of headache, but in reality there is a huge difference between a bad headache and a migraine.

What is migraine?

Migraine is a condition that is characterized by bouts of severe, throbbing and pulsating headaches, usually on one side of the head or in rare cases both sides. Unlike a general headache, migraine headaches are often accompanied by sensory disturbances such as extreme sensitivity to light, sound or smell. Vomiting and nausea is also strongly experienced by many migraine sufferers. Some migrainuers even complain of a migraine aura, which is formation of hazy spots in the centre of vision immediately prior to commencement of migraine attack. However this is one of the stages of migraine and not everyone suffer from this stage.

Stages of Migraine:

Premonitory stage: Also known as Prodrome or pre-headache stage is just the beginning or warning phase of an upcoming migraine episode. In this stage, the sufferer slowly starts to experience physical and mental changes such as feeling tired, thirsty or sleepy, diarrhoea, nausea, photophobia, repetitive yawning etc. Some may experience light-headedness and neck stiffness while others may observe mood changes and irritability1. This stage can last anywhere between 1 hour to 24 hours.

Symptoms of Premonitory stage1:

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  • Light headache
  • Difficulty in concentrating
  • Aversion to food, sound and light
  • Difficulty falling asleep
  • Fatigue and tiredness
  • Irritation and anxiety

The Aura Stage: This stage is not commonly experienced by all with hardly 5% migraineurs suffering from an aura2. The person experiences strong visual disturbances such as seeing flashing lights or hazy spots in the centre of vision. Just as the prodrome stage, the aura stage also serves as a warning phase, which sometimes allows the migraineur to take appropriate action and medication to abort the upcoming migraine attack. In rare cases, patients experience the aura stage without the subsequent headache, and this phenomenon is known as “Silent Migraine” or “Acephalgic Migraine”. An Aura stage can last between 5 to 60 minutes.

Symptoms of Aura Stage2:

  • Visual symptoms include flashing lights and hazy spots
  • Blurry vision or partial blindness
  • Hallucinating weird sound and smell which is not present
  • Other symptoms such as confusion, dizziness, difficulty in speech, and nausea.

The Headache or Attack Stage: This is the main attack stage and the most debilitating part of migraine, which is characterised by the throbbing one sided headache, usually experienced above an eyebrow. Sometimes, the migraine attack can be so strong that pain is not just confined to the head but experienced throughout the body. This pain is so intense that it is difficult for a non-migraineur to ever imagine or realize what a migraineur feels. This phase can last anywhere between 4-72 hours and can put the sufferer out-of-action for the whole time. If migraine headache is experienced over 72 hours, then this is called status Migrainous and immediate medical help should be sought3. Researchers have noticed that avoiding harsh lights, loud sounds and strong odors during this phase can help calm the nerves of the migraineur and help them cope up better with the attack. Also keeping oneself well hydrated can help in easy sailing through the migraine attack better as dehydration is commonly accompanied with migraine attacks.

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Symptoms of Attack stage4:

  • 11A unilateral headache
  • Neck pain or body pain
  • Fatigue and extreme weakness
  • Anxiety and depression
  • Nausea and vomiting
  • Extreme sensitivity to sound light and smells
  • Diarrhoea or dehydration, depending on how body reacts
  • Hot flashes and dizziness

Recovery or Postdromeor Post-Headache stage: this is the final stage of the migraine episode where the migraineur experiences a gradual relief from the migraine headache. In rare cases, patients overcome the migraine headache, but the migraine attack may or may not be yet completely over. Many migraine patients have described this phase as feeling “hung-over” or “drowsy”. In some cases relief can be instantly achieved by vomiting.

Symptoms of Postdrome stage5:

  • Fatigue and tiredness
  • Cognitive impairment
  • Vomiting
  • Difficulty in concentrating and focusing on daily tasks.  

With the help of the above mentioned stages, one can distinguish between a bad headache and migraine.

Even though migraine is a widespread condition affecting millions of people worldwide, it is one of the highly under-diagnosed conditions. Many people confuse migraine with a sinus headache or general headache and pop over-the-counter available headache pills. Doctors are strongly of the opinion that consuming these pills can do more harm than good.

Migraine headache is physically, mentally and emotionally tiresome and hence if you suspect you or your loved ones frequent bout of headache to be migraine, then consulting a doctor at the earliest is a good choice. Migraine is a treatable condition and with proper diagnosis and medication one may no longer have to confine themselves away from the social order and suffer the agonising pain in darkness and silence.

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Refs:

  1. Neurology. 2003 Mar 25;60(6):935-40.
  2. Cephalalgia. 1992 Aug;12(4):221-8
  3. Headache. 2006 Nov-Dec;46(10):1480-6.
  4. J Neurosci. 2015 Apr 29;35(17):6619-29.
  5. Headache. 2011 Jan;51(1):105-17.