Things You Don’t Know About Migraine

The stats are startling: More than 39 million Americans live with migraine and it affects more than 1 billion people worldwide, making migraine the third most prevalent disease on earth. Even more alarming: It is believed that up to 50% of people with migraine are undiagnosed, so the actual number of cases could be even higher. (Chronic migraine, defined as having 15 or more headaches a month, is a subset of that number.) The World Health Organization considers a severe migraine attack to be one of the top 10 most disabling conditions.

Migraine disease is a complex neurological condition with a host of symptoms (some of which can be severe), that can impact the entire body. While headaches are one of the main symptoms of chronic migraine, it can also come with other symptoms that affect different parts of your body. Some people may experience pain around the eyes, temples, sinuses, jaw or neck, a sensitivity to light, noise, and odors, nausea and vomiting, loss of appetite, tiredness, dizziness, or blurred vision.

For some people, migraine attacks occur in specific phases—though they may experience just one or two of these. First, there’s the prodrone phase, which happens one to three days before the head pain appears and can last for hours or several days. Symptoms may include constipation or diarrhea, changes in mood like anxiety, depression, or irritability, muscle stiffness and/or cramping, particularly in the neck and shoulders, fatigue, confusion and/or difficulty concentrating, urinary frequency, and sensitivity to light and sound.

Next comes the aura stage. Auras are neurological symptoms and general visual “disturbances” such as sparks, bright dots, and zig zags. They may also bring symptoms like an inability to understand and use language or phantom smells (smelling something that isn’t actually there). Then comes the head pain itself, which often goes from one side of the head to the other and ranges from mild to severe. Finally, there’s the postdrome stage, which feels like a hangover and can include symptoms like difficulty concentrating, extreme fatigue, body aches, and confusion.

Chronic migraine affects different people in very different ways. So the way you experience your symptoms can be completely different from your best friend’s experience, which can make the disease hard to properly diagnose, says Melissa Calise, director of communications for the Association of Migraine Disorders in North Kingstown, RI. Making things more complicated, there are different types of migraine. With a vestibular migraine, you may experience dizziness, vertigo, loss of balance, or motion intolerance. Someone with hemiplegic migraine could have symptoms that look more like a stroke: one-sided weakness or paralysis, says Calise.

Adults aren’t the only demographic where chronic migraine strikes: According to the American Academy of Pediatrics, about 10% of children ages 5 to 15 and up to 28% of teens are affected. What’s more, among those people who get chronic migraine, about half have their first attack before the age of 12. Even babies aren’t immune. Migraine has been reported in children as young as 18 months. For kids, the impact can be detrimental to daily life. Children who suffer from migraine miss twice as many school days as their classmates.

Wacky but true: There is actually such a thing as silent migraine, known technically as acephalgic migraine, which occurs without a headache. For chronic migraine sufferers, this may be a more welcome form, however it usually also comes with an aura (thank you very much) and all of its disruptive symptoms like visual disturbances. This type of migraine is shorter and typically lasts from a few minutes up to an hour—and typically occurs in older adults.

Women experience migraine three times more often than men, and of those, 60% to 70% report a connection between their period and their migraine attacks, according to the Cleveland Clinic in Ohio. The reason? Hormones. “Right before the onset of menstruation, a hormone known as estradiol, as well as progesterone, drops,” says Kylie Petrarca, a registered nurse with the Association of Migraine Disorders. “Together, the sudden decrease in these hormones can trigger a headache during menstruation.”

If you are susceptible to menstrual migraine, it typically starts up to three days before your period. The symptoms mirror those of regular chronic migraine—head pain that ranges from a dull ache to a severe throb, sweating or chills, sensitivity to light, noise, and smells, tender scalp, loss of appetite, dizziness and blurred vision, feeling tired, nausea, and vomiting. One silver lining: During pregnancy, estrogen levels rise quickly early on and remain high throughout pregnancy, which also means chronic migraine attacks can improve or even disappear completely during this time.