Headaches are one of the most common symptoms that patients report to their doctors, but their causes and manifestations vary so much that a diagnosis does little to help.
From the Greek hemi (“half”) and kranion (“skull”), migraine is associated with severe, throbbing, unilateral pain; an aversion to light and sound; and nausea and vomiting, all of which is aggravated by movement. But migraine may include or trigger many other symptoms. An attack may be announced by sudden exhaustion, food cravings, a foul mood, or what is called an aura, a neurological phenomenon that disrupts a migraineur’s vision with silvery squiggles and zigzags.
For some, a migraine might include extreme sensitivity to touch, partial blindness, vertigo, or the inability to speak. There are also vestibular migraines – attacks associated primarily with dizziness – and abdominal migraines, when pain is instead felt in the stomach. Both of these may occur without head pain and can be bewildering to patients seeking a diagnosis. After an attack – which may last up to four days – many migraineurs suffer from a “post-drome”, when they might feel listless, agitated, or depressed.
Although migraine symptoms have been described since antiquity, doctors still struggle to understand their cause. For much of the early 20th century, migraine was thought to be a vascular condition, something that could be treated by restricting blood vessels. Now, most neurologists argue that migraine is a disorder of the trigeminal nerve system, where overactive cells in the face and head respond to benign input (light, sound, smell) by releasing chemicals that transmit pain. But doctors still can’t offer reliable relief.
The best treatment available is prevention, so my doctor tells me about possible triggers – stress, menstruation, sleeping too much, sleeping too little. Beyond that, treatment is a process of trial and error.
The Guardian: Long Reads
The Health-Care Survivor’s Comment
I have suffered from migraines since childhood, and this is the best general description of migraines I have ever found. Although this article was not written for the benefit of the medical profession, I am sure that many nurses and clinicians of all kinds could learn something from Altman’s experience.