The symptoms of migraine vary from person to person and can include not only headaches, but also nausea, vomiting, and dizziness, as well as sensitivity to touch, smells, and light. In a few people, numbness and difficulties with speech can occur. The headache pain in migraine is usually on only one side of the head.
Estimates vary, but up to 39 million Americans live with migraine. The condition often starts in childhood; in fact, half of all people with migraine had their first attack before age 12, and children as young as 18 months have been known to have migraine.
Episodic or Chronic?
Most people with migraine have an attack every few months or less often; this is episodic migraine. But some people have attacks much more frequently. When migraine episodes occur 15 or more days per month, for three months or more, the condition is known as chronic migraine.
Episodic and chronic migraine are not two separate illnesses, explains Robert Pearlman, MD, associate professor of neurology at University of Alabama at Birmingham Hospital. “Migraine is there all the time,” he says, “but people with chronic migraine have more attacks.”
According to Juliette Preston, MD, director of the headache center at Oregon Health & Science University in Portland, over time people with episodic migraine may develop more and more headaches for various reasons, including changes in hormones, increased stress, illness, or simply using pain medications more often. Having more headaches decreases the threshold for new headaches, and the condition can become chronic and less responsive to medications.
The Origins of Migraine
Both genetics and environment play roles in who gets migraine. Up to 90 percent of people who live with migraine have a family history of the illness. If one of your parents has migraine, you have a 50 percent chance of having it as well. If both parents do, your risk is 75 percent.
Various foods, certain medications, stress, and changes in weather or routines can trigger attacks. Note that a trigger isn’t the same as a cause; a trigger is simply something that is likely to set off a migraine attack. Triggers vary greatly from person to person and can even vary for the same individual—something that triggers a migraine episode one day might not have that effect on another day.
The cause of migraine is something else entirely, and in some ways, more mysterious. “No one knows for sure exactly what causes migraine,” explains Dr. Pearlman, “but changes in the levels of serotonin and other neurochemicals are definitely involved. This affects the trigeminal nerve system, a constellation of nerves in the face and head. The thinking now is that patients with migraine have some basic neurological problem that manifests as migraine headaches.”
Both men and women get migraine. Prior to puberty, boys are more likely to experience attacks than girls, but overall, women are three times more likely to have the condition than men. It is not entirely clear why.
Many women find that they are more likely to have attacks just before or during their menstrual periods, and often migraine improves for women after menopause. This suggests that hormones (probably estrogen) are involved. However, the situation is likely more complex than that, says Dr. Preston. “Estrogen is a trigger for some women, but not all,” she says. “Some women find that their headaches lessen after menopause, but others, unfortunately, do not.”
The Migraine Millstone
It is hard to overestimate the costs, both personal and economic, of migraine. When you have a migraine attack, it is difficult, if not impossible, to work, study, or conduct any of the routine activities of daily life. Add to that the fact that attacks typically last between four and 72 hours (and in some cases a week or longer), it’s not surprising that migraine is ranked the second most disabling disease in the world, according to the Global Burden of Disease Study, which estimates the prevalence of disease and the relative harm it causes.
“If you have chronic migraine, it can be very difficult to maintain employment or keep up in school. It really changes daily life,” says Dr. Pearlman. “When you’re experiencing an attack, you’re just miserable; you’re unable to do much of anything.”
The good news is that complications from migraine are rare. “Generally, there is no long-term issue,” says Dr. Pearlman, “though there is a slight increase in the risk of stroke for some people with migraine.”
Chronic migraine is a challenging illness. Unfortunately, there is no cure; it is a condition that you need to learn to manage. But thanks to new medications and various lifestyle measures, such as avoiding triggers, it is possible to live a full and productive life with the condition.
What Is Aura?
Chronic migraine and episodic migraine typically share similar symptoms. And migraine attacks in both types are sometimes preceded by a phenomenon known as aura. The term refers to transitory symptoms that may commence approximately 30 minutes or so before a migraine headache begins. Neurotransmitters in the brain are thought to cause them.
The symptoms of aura are usually visual and may include such disturbances as seeing flashing lights or wavy lines, or losing part or all of your vision for a short period of time. Aura can sometimes include verbal disruptions; sensory disturbances such as mild hallucinations; vertigo and dizziness; or motor problems such as tingling, weakness, or numbness in the extremities.
Migraine with aura is less common than migraine without; the former is probably experienced by about 25 percent of people who have migraine. Treatment for migraine with aura is usually the same as treatment for migraine without. It’s also possible to experience aura without having a headache or any other symptoms afterward; this situation becomes more common as people get older.