If you’ve ever suffered a migraine attack, you’ll know how debilitating they can be, but people often don’t realise there’s so much more to a migraine attack than a splitting headache.
Almost 6 million people in the UK suffer from migraines, with symptoms varying from person to person. Far from being ‘just a headache’, some people experience flashes in vision, while others suffer from stomach aches and nausea.
“Migraine is a fascinating, misunderstood, stigmatised and disabling condition,” says Dr Katy Munro, migraine expert and author of Managing Your Migraine.“It needs to be understood by sufferers and non-sufferers alike so it’s taken more seriously as a condition. Saying it’s ‘just a headache’ is a myth.”
With that in mind, here are six fascinating facts that you may not know about the condition.
There are four stages of a migraine attack
“It’s helpful to think about migraine as a spectrum condition,” explains Dr Munro. “Rather than focusing just on the days you are in pain – if you experience pain – I’d rather ask my patients what the impact of the migraine attack is like. Most people aren’t just impacted the day of the migraine itself, but also the days before and afterwards.”
According to charity The National Migraine Centre there can be up to four stages of a migraine attack – although not all sufferers will experience all four.
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The prodrome stage
This is the start of symptoms and when you might experience warning signs, which you may come to recognise over time. “The prodromal stage can last up to 48 hours before a migraine attack,” explains Dr Munro. “It can encompass yawning, fatigue and food cravings, for example. Your brain craving fuel in the form of carbohydrates and chocolate has been shown to be a prodromal indicator that you’re getting a migraine.
“It’s important to recognise that these are not triggers, but the very early symptoms of attack.”
The aura stage
“Only about a third of people with migraine will get aura,” explains Dr Munro. “So the majority of people won’t experience visual symptoms. It’s a myth that you will always get aura with a migraine attack.”
Aura tends to occur directly before any headache and may last up to an hour, although typically it will last 15 to 30 minutes. According to the National Migraine Centre, aura can involve visual disturbances (90% of auras) as well as numbness, dizziness, paralysis, speech difficulty and memory loss. “Visual aura normally begins off-centre in both eyes and gradually enlarges with blackness, zigzags, lights or patterns that can affect half or all the vision. It can be helpful to cover or close one then the other eye to check if vision from both eyes is affected.”
The pain stage
Pain will typically be the last manifestation of the migraine attack and may feel like pressure in the neck or head. It’s frequently severe and thumping, and it can last hours or days.
If head pain is mild or absent, diagnosis of migraine can be difficult – for example, in cases of vestibular migraine, which predominantly involve vertigo and dizziness.
Recovery from a migraine attack can take a few days, even once symptoms have subsided. You’re likely to feel generally unwell and you may suffer from brain fog and find it hard to concentrate or find simple tasks take longer to complete.
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Triggers can include poor sleep, low blood sugar or Covid
“It’s important to remember that migraine as a condition is genetic,” advises Dr Munro. “You have a genetic set-up that makes your brain more vulnerable to change. The thing that activates this vulnerability of the brain will vary from person to person, and throughout life.
“As experts, we believe that when a number of changes are added together, brain irritability is pushed to a certain threshold where you will experience a migraine attack.”
While triggers vary, common ones include lack of sleep, low blood sugar, a Covid infection or a head injury.
They’re so much more than a headache
There are several different types of migraine attack, which can have different triggers. The two you’re most likely to experience are:
Migraine without aura
According to charity The Migraine Trust, migraine without aura is the most common type of migraine, and is characterised by an intense headache, along with nausea and/or vomiting and sensitivity to light, sounds and/or smell. In contrast, it’s possible to experience migraine with aura without any pain.
According to The Migraine Trust, more than half of women with migraine report their periods are a migraine trigger. Menstrual migraines are caused by fluctuations in hormone levels, and in particular a drop in oestrogen.
Your stomach ache could be a migraine
“Migraine is a complex neurological condition that results in migraine attacks, which have many different expressions in different people at different times of their lives,” explains Dr Munro. “There are a whole range of symptoms that migraine can create within the attack that it causes.”
Symptoms may include headache, visual disturbances, stomach aches, dizziness and nausea, among others. Abdominal migraines are common in children, and are often misdiagnosed as other stomach conditions.
You can treat migraines with a can of cola
“You can absolutely prevent a migraine attack occurring,” advises Dr Munro. “People are often advised to wait until their migraine is really bad before they treat it with medication, but this is completely the wrong advice. The sooner you treat an attack, the better.”
Treatment will depend on the type of migraine attack, but for people who experience aura, like me, this includes carrying a can of cola (full fat only) and three soluble aspirin at all times.
“The minute you start to experience symptoms, pop the aspirin in the cola and swig it down,” says Dr Munro. “The magic of this is threefold: the fizziness of the drink dissolves the aspirin over a larger surface area so it’s rapidly absorbed by the gut. Secondly, sugar is crucial, as we know that low blood sugar is a trigger for many people – having too long between meals or intermittent fasting can cause an attack. And lastly, caffeine works to boost the painkilling effect of the aspirin.”
If you’re highly sensitive or anxious, you’re more likely to suffer
“Migraine and anxiety are closely linked – they share similar clinical features and presentation and both are episodic in nature,” explains chartered psychologist Catherine Hallissey . “They have a bidirectional relationship, where each increases the risk of the other. Psychosocial stress is a common trigger for migraine attacks, similar to anxiety disorders.
“Both migraine and anxiety have a significant impact on quality of life, and reducing the frequency of headaches through medication, lifestyle changes and managing triggers is crucial to reducing the likelihood of developing an anxiety disorder. Stress reduction and anxiety management strategies along with personal therapy should also be part of the treatment plan.”
But the experts are clear: you don’t have to suffer in silence. If migraine attacks are impacting your life, visit your GP. You can also check out the resources at The National Migraine Centre for more information.
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