Migrain

According to diagnostic criteria established by the International Headache Society, to be diagnosed with migraine disease, patients must have had at least 5 headache attacks that lasted 4–72 hours and the attacks must have had at least 2 of the following characteristics:

  • Unilateral location
  • Pulsating quality
  • Moderate or severe pain intensity
  • Aggravation by or causing avoidance of routine physical activity

In addition, during the headache the patient must have had at least 1 of the following:

  • Nausea and/or vomiting
  • Photophobia and phonophobia

We think it is imperative to view migraine as a full-body disorder.

While this is the typical classification for migraine disease, we at AMD recognize that migraine is a complex neurological disease with symptoms well beyond a headache. Migraine can impact the entire nervous system. This means people may experience symptoms in various parts of their body. One may think these widespread symptoms are not related but in fact, migraine could be the underlying cause. Here are some common migraine symptoms that aren’t often associated with migraine:

  • Imbalance
  • Difficulty finding words
  • Ear and sinus pressure
  • Sleeping poorly
  • Feeling anxious

We choose to highlight the spectrum of migraine manifestations.

Migraine Phases

Migraine attacks can progress through several phases, each with characteristic symptoms, varying in severity and duration. While this graph shows it as 4 distinct phases, the symptoms actually overlap significantly. Not all individuals experience all 4 phases and each person’s attack can vary from one to the next.

A unique aspect of a migraine attack is the prodrome and postdrome phases. While a person may not be having a headache in this phase, that may not be feeling or functioning well for hours or days.

Many migraine patients describe their prodrome as the onset of yawning or the feelings of depression, slow thinking or fatigue.

A fifth phase that occurs between cycles is called the interictal phase. It can be an unpredictable length of time and therefore some people struggle with the anxiety of not knowing when to expect their next attack.

Migraine With Aura

Two main types of migraine have been recognized: migraine with and without aura.
An aura is a temporary sensory disturbance before or during the headache. Common auras are the illusion of changes in vision, an unpleasant phantom smell or confused thinking.

While patients often describe an aura where they feel a numbness that starts in an extremity and moves centrally, visual auras are FAR the most common. The “classic” visual aura is a scintillating scotoma  – that is, a small central area of temporary blindness followed by brightly colored, shimmering light.

It is helpful to remember that an aura does not have to occur with every headache and about 5% of those with aura never have a headache. The most common of these painless migraine events is an ophthalmic, or ocular, migraine. People often mistake this for a transient ischemic attack or stroke.