Migraine is a complex neurological condition which is classified by the World Health Organisation as the 7th most disabling disease worldwide, the 4th for women. Global Burden of Disease Study 2013. Vos et al. The Lancet, Volume 386, Issue 9995, Pages 743 – 800, 22 August 2015
Migraine is the most common neurological condition in the world, affecting about 12 – 15% of people. It is three times more common in women than it is in men and is usually inherited. It is a very individual condition. Some people experience only one or two attacks per year while others suffer on a weekly basis. An attack can last from 4 to 72 hours.
The Migraine Association of Ireland’s goal is to provide relief for sufferers of Migraine through support, self education, information and resources for Healthcare professionals.
Migraine generally features a one-sided throbbing headache which is episodic and lasts hours or even days with total freedom between attacks. The headache is normally worsened by movement or routine physical activity. Migraine has been likened to a power cut, as the whole body seems to shut down until the attack is over. The headache is of course just one of the symptoms, albeit the most well-known.
An attack of migraine can be very frightening. The onset of classical Migraine (Migraine with Aura) may be signalled by visual disturbances in what is called the “aura” stage. This affects about 20% of migraineurs.
Common Migraine (or Migraine without aura) and classical migraine may be accompanied by nausea, vomiting, diarrhoea, confusion and, in rare cases, temporary paralysis and loss of speech. Sensitivity to light, noise and strong smells is also frequently reported.
Data suggests that between 12-15% of Irish people suffer from migraine – this means that roughly half a million people suffer from migraine in Ireland. It is estimated that migraine costs Irish businesses €252 million every year as a result of lost productivity with the average migraineur missing between 1.5 and 4.5 days from work annually. Despite these staggering figures migraine remains a misunderstood and under managed condition.
All age groups suffer. Children as young as twelve months have been diagnosed. Three times more women than men suffer mainly due to hormonal changes. People who are subject to migraine come in a large variety of shapes, ages, temperaments and personalities. Migraine is hereditary in approximately 60% of cases.
The majority of migraine sufferers have Migraine without Aura. The most common symptoms of Migraine without Aura are: Intense throbbing headache, usually on one side of the head, worsened by movement and lasting from 4-72 hours.
The most common symptoms of Migraine without Aura are:
If you experience two or more of these symptoms, and if they prevent you from continuing with normal daily activities, then you may be suffering from migraine without aura.
Migraine with Aura refers to a range of neurological disturbances that occur before the headache begins, usually lasting about 20-60 minutes. About 20% of people with migraine experience ‘aura’ in addition to some or all of the symptoms
of ‘Migraine Without Aura’.
The disturbances are usually visual e.g.
Aura can also present in other ways:
The other symptoms of migraine will usually follow the migraine aura. These are:
If you experience two or more of these symptoms in addition to the aura symptoms and if they prevent you from continuing with normal daily activities, then you may be suffering from migraine with aura.
Migraine aura can also present as:
Hemiplegic Migraine is a rare form of migraine where the person experiences many of the usual migraine symptoms, but may also suffer from temporary numbness, weakness or even paralysis on one side of their body!
The word Hemiplegia comes from the Greek – ‘Hemi’ meaning ‘half’ and ‘Plegia’ from either ‘plēgē’ meaning ‘stroke’ or ‘plēssein’ meaning ‘to strike’.
Unlike a stroke, the symptoms of Hemiplegic Migraine begin slowly and build up as the migraine progresses. Weakness and numbness usually go away within 24 hours, but may last a few days.
Hemiplegic migraine can be one of the more difficult types of migraine to diagnose as many of the symptoms can mimic stroke, seizures or other conditions. MRIs, CT scans and other neurological tests, as well as a full review of your medical history are usually done to rule out other more sinister causes of the symptoms.
Hemiplegic Migraine, like most other types of migraine can be triggered by many things, including food, weather, stress, lack of sleep, skipping meals, dehydration. The best way to figure out your triggers and when you might be in danger of an attack is to keep a diary, or even to use a migraine app like Migraine Buddy or Curelator. They will track your attacks and will hopefully help you to live as normal a life as possible while coping with this condition.
Due to the nature or Hemiplegic Migraine, finding the right treatment can be difficult. Unlike other migraine types, Triptans are contraindicated for Hemiplegic Migraine as they constrict the blood vessels. This constriction may happen during the attack itself, thereby increasing the constriction and heightening the possibility of stroke so Triptans are rarely prescribed.
Acute medications used include the normal NSAIDs such as Ibuprofen or Diclofenac (Difene), along with an antiemetic (anti-nausea) medication such as Domperidone or Metoclopromide to ease the nausea, but also to aid in the faster absorption of other medication.
Many people with Hemiplegic Migraine often find going to a specialist physiotherapist can help them, especially with exercises for movement during or after the attack on affected limbs. Physiotherapy can also help with pain management.
Lifestyle can be an important factor in treating or coping with Hemiplegic Migraine. Making sure that you do the following can help immensely;
We also have a Migraine ID card which can be handy for people who lose the ability to communicate during an attack. It lets others know that it is a migraine attack and not a stroke, so you shouldn’t end up in A & E. It can also show the medications needed, and that the attack is temporary. It also has our Information and Support Line number on it. If you would like one, please contact us and we’ll be happy to send one out.
How do you treat Vestibular Migraine?
Experts believe that the most effective way of treating someone with Vestibular Migraine is with a combination of medication, vestibular rehabilitation and lifestyle modifications.
At the moment, the medication used for treating Vestibular Migraine is the same as that used for other migraine disorders; beta blockers, e.g. Propranolol, tricyclic anti-depressants, e.g. Amitriptyline, calcium channel blockers, e.g. Flunarizine, anti-convulsants e.g. Topiramate, and anti-emetics e.g. Domperidone. Some medications may have a bonus effect on the vestibular symptoms as well as the migraine, however, you may need something a little more specific to target that end of things. Like all medication some work better for some people than for others so it’s very important to get the right medication for you. Over the counter analgesics and anti-inflammatories are thought to have little effect on vestibular symptoms, but can help with pain.
It is important to speak to your GP or Specialist about ANY medication you intend to try to make sure it does not interact badly with other medication you may be on, or other conditions you may suffer from.
Vestibular Rehabilitation is a specific form of physiotherapy that involves exercise and movement to reduce the symptoms associated with a vestibular disorder. The idea of the therapy is to retrain your brain and your vestibular system to recognise and process the signals coming from your eyes, body and the vestibular organs, then to increase coordination and return balance. It is important to see a specially trained physiotherapist for this therapy.
Lifestyle Modification:
It’s a daunting concept sometimes having to change your lifestyle to accommodate an illness, but it can be done, and for the greater good. Sometimes it means changing small things, like sticking to a routine of bed and food at the same time everyday, other times it can be a big change, like giving up something you enjoy doing so as to avoid your migraine. By making the few small changes you may avoid not only the migraine, but having to make those big changes after all.
Using a migraine diary can help you find out exactly what triggers your migraine. It can also show you a pattern so you can pinpoint times when you may be in danger of an attack.
