What Migraine Is, for Those Not Paying Attention

For this post I am going to try and tackle, again, what migraine is, because some people aren't paying very close attention to the subject when they should be.  And no, I am not necessarily talking about everyone in my life, however, there are a few of you who don't quite seem to understand, nor do you even try - though you seem to want to be in on what's going on.  This post, admittedly, might come across as passive-aggressive on my part, but after being misunderstood for almost 6 years now while people trounce about asking stupid questions without bothering to read the information that is easily and readily available to them, I think I have a right to feel this way.  I'm tired of it.  I speak but I am not heard.  I am ill, but I am not believed by the people who should count the most.  I'm not talking about people I work with, I am not talking about friends, but I am talking about people who are would-be caretakers.  And if the casual layperson learns something here today as well, then my job has been only half-way successful, because, yes, there are some people who would be close that need to open up their eyes and look, and learn, and internalize...But on my side right now, there is a greater need for me to be personally understood.

OK, so, since that is out of my system, here we go.  Ready?

At its very basic, migraine can be defined as a "genetic neurological disorder," in which trigger events precipitate an attack that is similar in origin in the brain to epileptic attacks.  A migraine is not a headache.  Let me repeat that so it can sink in.  Migraine is NOT a headache.  To say migraine is a headache is to be ignorant of the physiological processes behind the disorder - the very thing we are fighting against in our advocacy efforts.  It is, however, adequate to say that migraine is a "headache disorder."  Migraine is a neurological "storm," if you will, the stages of which can course itself over days' long periods.  The initial phase alone, prodrome, can occur 24-72 hours before the second phase, aura.  Prodrome can be accompanied by excessive yawning, thirst, food cravings, excessive urination, intense fatigue, and in some cases the opposite - insomnia and a heightened sense of well-being and hyperactivity.  Sufferers may notice an increase in neck and shoulder stiffness/pain.  Aura generally lasts from 20 minutes to an hour before the third phase, and causes reversible neurological phenomena such as scintillating scotoma and blindness, olfactory hallucinations, auditory hallucinations, numbness and tingling, difficulty speaking/remembering words (aphasia), among many others.  The third stage is the head pain stage - the stage most recognized among the general public and the stage from which migraine is mistakenly identified as a "headache."  This stage is accompanied by head pain, neck pain, shoulder pain, and in some cases nausea, vomiting and/or diarrhea.  Recent studies suggest that neck and shoulder pain is more prominent during this stage than nausea may be.  This stage will also be accompanied by one or more of the following:  Light sensitivity, olfactory sensitivity, or auditory sensitivity, in that these sensations coming into the sufferer's brain may cause prolonged pain.  The final stage of the migraine attack is postdrome, or the refractory phase.  During this stage the sufferer may have residual head/neck pain, great fatigue, or again, a sense of well-being and clarity.  They might want to sleep for a long time.

A migraineur can skip any one of these stages during an attack.  Not all stages must be present on order to have a migraine.  A migraine attack can proceed without the pain phase, in which is is termed silent, or aphasic migraine.  A migraineur who has aura is considered rare - about 3-5% of the overall migraine population, which, in the United States alone, extends into the 37 millions.  It is important to note that not everyone who has a headache is having a migraine.  

For the sake of space, I will not be pursuing migraine variants in this article.

Migraine attacks are the result of the interplay between several different systems - genetic predisposition, environment, and other biological factors which we are just coming to understand.  A migraine attack is the result of the over-stimulation of the nerves of the brain in the individual predisposed to migraine through genetics.  An individual with migraine has a central nervous system that is highly attuned to change in the environment and the brain may perceive change on a level far below and easier than that of an individual not predisposed to migraine.  The brain may also perceive this change before the individual is even consciously aware of it.  In my case, my brain perceives the light spectrum much differently than those around me - one like me does not have to be consciously aware of a flickering light bulb in order for the brain to pick the message up and send it along neural pathways that will, in turn, influence a migraine attack.  Most of us are highly attuned to our triggers, however, so we know what to avoid if we can.  The migraine brain is also resistant to change - the slightest change in sleep schedule or eating schedule may throw the body into an attack.  The migraine brain is also susceptible to stress - though there are arguments on whether stress itself is a trigger event or something which lowers the threshold to other triggers, such as it does with a virus.

Migraine is not a response to repressed emotional feelings, though it is linked to clinical depression, anxiety, and Bipolar Disorder.  The appearance of migraine may also signal cues as to the physical health of the sufferer as well - the migraine population is at higher risk for heart disease, strokes, Factor-V Leiden, diabetes, and co-morbidities such as chronic pain syndromes like fibromyalgia, and a host of auto-immune disorders.  In some individuals, such as myself, migraine with aura may suggest a common heart defect called a Patent Foramen Ovale (PFO).

For some few, lucky individuals (chronic sufferers), migraine may be a progressive brain disease.  Silent infarcts, similar as can be seen on stroke or MS victims, may show up during MRI examinations.  Current studies do not suggest that these infarcts cause any external or internal signs of lasting damage, but it can be scary to know they are there nonetheless.

Chronic, intractable migraine is often seen as a "learned" behavior for those of us who are lucky enough to suffer on a near-daily basis.  Once the migraine brain goes chronic, it can be very difficult to slow those over-excited neurons down back to the nature of having episodic attacks.  The brain is "plastic", and as with any repetitive task in which practice sustains the skill, such as reading, math, drawing, programming, etc., it "learns" the behavior of migraine as the new "normal" and becomes even more hyper-sensitized to the environment around it, making it easier to trigger into the next attack.  One attack piggybacks to the beginning of the next attack with very short or non-existent refractory phases.  In these cases, is necessary for the sufferer to treat the attacks with daily preventive medications as well as treat the individual attacks with an abortive.  However, rebound migraines may occur as a result of overuse of these abortive treatments, so it is not suggested to take more than 2-3 of these medications per week and to avoid over-the-counter medications such as Excedrin, Aleve, acetaminophen, etc, which is why it is important for the chronic sufferer to seek a knowledgeable doctor who will listen and treat the attacks appropriately, sometimes incorporating other treatment avenues as well, including alternative therapies, physical therapy, medicinal therapies, etc.  The downside to treating chronic migraine is that we all want an immediate cessation of migraine, but it can take years to find the right combination of medications in order to knock the attacks back to episodic status because not every migraineur responds to the same treatments in the same way and it's a "guess and go" puzzle.  Generally the problem here is that people who have gone chronic have probably left their migraines professionally untreated for years (mistakenly thinking they are just having "headaches" and treating with OTCs multiple times weekly or even daily), so the brain is stubborn in that it wants to keep on doing what it's done so well for so long - trigger into migraine attacks that are debilitating and reduce the quality of life of the sufferer.  Isn't it nice to know your chronic, migraine brain is very skilled at migraine?

In order to see how powerfully migraine affects the sufferer's quality of life, I urge you again to read Kelly's ongoing suicide series this week, and get a sense of how invisible illnesses can harm an individual, even if they have a strong support system:  Fly With Hope.

Thus concludes my newest post on general information about migraine.  Pretty soon I'll link up some articles and journals with my information.  I just wanted to get this pounded out (HA!) and put up.