What is Migraine?
Migraine is a genetic neurological disease that affects 1 billion people worldwide. Migraine includes a severe, throbbing or solid, intense headache, typically on one side of the head that lasts from 4–72 hours, is made worse by any movement or physical exertion, and is often accompanied by nausea, vomiting, light and sound sensitivity. There are many other migraine symptoms listed below which vary from patient to patient.
Although the cause of migraine is not fully understood it is now believed that migraine attacks originate in the brainstem and involve the hyper-excitability of the peripheral and central nervous system. Basically, neurons misfire and unleash an electrocheminal reaction that sends pain signals to the cortex and cause other migraine symptoms. We know that the trigeminal nerve plays a key role in this process.
Migraine is a spectrum disorder, each patient has a very different experience. Each attack can vary in duration, intensity and symptoms. These are the classes of migraine by frequency:
⟐ Episodic = 0–8 migraine days per month
⟐ High Episodic = 9–14 migraine days per month
⟐ Chronic = 15 or more migraine days per month
Migraine Symptoms
Migraine is a sensory processing disorder which means that all of the five senses can be affected. Migraine symptoms vary from person to person in their intensity and impact on daily function. In addition many patients are also affected by their comorbid illnesses. The range of symptoms include:
⟐ Intense head pain on one side or sometimes both sides of the head. The pain can be throbbing, pulsing, or continuous.
⟐ Sound Sensitivity (phonophobia)
⟐ Light Sensitivity (photophobia)
⟐ Nausea
⟐ Vomiting
⟐ Brain fog (cognitive impairment)
⟐ Fatigue
⟐ Smell Sensitivity (ospmophobia)
⟐ Touch Sensitivity and Pain (allodynia)
⟐ Neck pain (this can be a symptom or, for some people, a comorbid condition)
⟐ Jaw pain (this can be a symptom, or TMJ, a comorbid condition)
⟐ Joint pain and stiffness
⟐ Dizziness and Vertigo (especially in people with Vestibular Migraine)
⟐ Visual disturbances (blind spots, jagged lines, flashing lights, blurred vision)
⟐ Problems with speech (transient aphasia)
⟐ Problems with muscle control and coordination (episodic ataxia)
⟐ Numbness, tingling
⟐ Puffy eyelid
⟐ Diarrhea or constipation
⟐ Sinus pain and pressure
⟐ Runny eyes or nose
⟐ Cold hands, feet, or nose
⟐ Mood changes
⟐ Hot flashes and chills
⟐ Allodynia (pain from non-painful stimuli) can be themal, mechanical or tactile
Migraine Triggers
Migraine triggers are anything that set off the chain reaction of a migraine attack. Remember, triggers are NOT causes. The cause of migraine disease is genetic. Migraine triggers are far-ranging. Each patient is different and has a different set of triggers. Our sensitivity to each trigger can also be vastly different. In many cases Trigger Stacking is at play. This suggests that each patient has a “bucket” in which each trigger is placed. It is often the accumulation of multiple triggers that causes the person to spill over the threshold resulting in a migraine attack. In general, the migraine brain craves stability. Most triggers are physical, emotional, dietary or environmental.
The best way to identify and track our triggers is through a Migraine Diary. I suggest Canadian Migraine Tracker and Migraine Buddy. The range of migraine triggers include:
⟐ Stress (this can be an increase OR decrease in stress)
⟐ Hormonal Fluctuations (onset of puberty, menstruation, ovulation, menopause, birth control pills etc.)
⟐ Weather (barometric pressure changes, humidity, sun, heat, cool air, wind etc.)
⟐ Food (tyramine sensitivities, histamine sensitivities, skipped meals, MSG, aged cheese, fermented foods, citrus)
⟐ Caffeine and alcohol
⟐ Dehydration
⟐ Light (bright lights, fluorescent lights, computer screens, night-driving)
⟐ Smells (perfume, smoke, chemicals)
⟐ Noise (loud noises, thumping, drilling etc.)
⟐ Physical exertion (exercise, increase in blood pressure, sex)
⟐ Posture (especially for people with comorbid arthritis or muscle pain)
⟐ Medications (vasodilators, birth control pills, MOH — medication overuse headache)
⟐ Sleep disturbances (changes in sleep schedule, insomnia, sleep apnea)