Attacks of unilateral (one-sided), throbbing head pain with sensitivity to movement, light, auditory (photophobia and phonophobia), and other outside stimuli typically describe what a migraine can feel and act like. This simplistic description, even though correct, doesn’t really describe what a migraine is, feels like, and the many other aspects associated with a migraine. When most of us think of a migraine it is an event that can be disabling, severe pain, light/sound sensitivities, and where we may not want to interact or do anything at all. However, a migraine can start up to 72hours before any head pain and the stages that follow are just as important. The 4 stages that we need to be more familiar with when dealing with migraine are Premonitory, Aura, Headache, and Postdrome. It is the understanding of these stages that can help us or others understand why it is that migraine acts the way it does.
The Premonitory Stage is the first stage of a migraine. It can start as early as 72 hours before any head pain occurs. Some of the symptoms with this stage can include-
fatigue, stiff neck, increases in yawning, food cravings, changes in mood/ activity, and the start of light/sound sensitivities.
This is very important because this is the first example of how migraine is different than a headache. We have and will keep talking about a migraine being a more neurological condition and it can be seen here. This is also a key stage because if someone can know when these triggers are about to occur they can immediately take action to start to decrease the migraine.
Migraine vs. Headache- Premonitory Stage
Symptoms like food cravings, yawning, and neck stiffness can let us know that the brain isn’t regulating different processes well. Take food cravings for example. A headache, even a severe headache, doesn’t cause food cravings. This tells us that there is a more hormonal and neurological consequence to migraine and isn’t just from a stiff neck. Speaking of the stiff neck we know that a stiff neck can be from a migraine and headache but are they different? In this stage of a migraine, the stiff neck is telling us that the part(s) of the brain that helps with posture and muscle activation (vestibulospinal tract and cerebro-cerebellar tract) is starting to fail and the brain is locking that system down to prevent injury. The same pathway can be for a headache but it is usually from increases in stress or we went to the gym and worked out too hard and pulled a muscle.
About 1/3-migraine patients will have an aura associated with their migraine. An aura is a transient (comes and goes) neurological event that can include anything from vision changes, seeing lights, speech issues, and sensory deficits. About 90% of the auras are in the visual cortex of the brain so vision changes are usually the most common. These auras can last anywhere from 5 min to a couple of hours at a time. This is where our conversation about cortical spreading comes into play from what we discussed last week. It isn’t fully understood but most of the research suggests that the auras start in the visual cortex of the brain and spreads to different parts of the brain, like a thunderstorm, giving us the visual, sensory, or motor auras. This also can help explain what we talked about as far as hyper-excitability. Once the spreading occurs it overexcites that part of the brain and can give us aura and to some extent the premonitory phase (sensitivities to light and sound).
Migraine vs. Headache
A headache doesn’t involve an aura stage. This also again shows us that a migraine is a more neurological condition and can involve the entire brain.
The headache part of a migraine is defined as a headache that lasts about 4-72 hours, unilateral, and involves some form of nausea and light/sound sensitivities. This stage can be as little as 1x a year to a more chronic issue that is at least 15x a MONTH. This is the stage that most of us are familiar with and can be the most debilitating as well. At this point in migraine, a person may want to just be left alone, go to a quiet place, and turn all of the lights off. This makes sense, especially with what we have talked about so far because different parts of the brain are firing too much and we just want to get away from all of the noise, sounds, and anything that may excite the brain.
Migraine vs. Headache
One of the big distinctions that separate migraine from headache is it being unilateral. However, we can get a headache on just one side as well, but most headaches involve both sides of the head. Also, a headache may be unilateral but won’t have the other associated symptoms such as light or sound sensitivities. If we have a really bad headache sound or light may make it worse but we can usually stay in the area without it really bothering us, whereas with a migraine if that same person stays in the area the headache will get so bad they may get sick or just want to scream.
This is the last stage of migraine and one that most people aren’t familiar with and needs more research on. This stage is after the headache is gone, but we may feel more tired neck tightness or trouble with concentrating. In people that take medication, this can be referred to as the rebound effect. This rebound effect is when the headache is gone but we seem to rebound from that to immediate concentration issues, tiredness, or neck issues. The brain has been trying to fight off this migraine for hours or days sometimes and after the “battle” the brain and body need to heal itself. If we were fighting a battle for hours or days at a time it would make sense that we would be more tired than usual and our concentration would be affecting as well.
When we put all of this together we can see that migraine is more involved and complex than we might have previously thought. It is important to know these stages if we are going through a migraine or know someone that is. Knowing won’t necessarily directly help alleviate the different stages but now that we have more information about them we can be better prepared and just have a better appreciation for our brain(s). A migraine isn’t something that should just be ignored or treated like other conditions, like a headache. There need to be very specific treatments for a person with a migraine and that person needs to know why their brain is acting the way it is. That patient may benefit from the same therapies that can help with headache, but I think we can see that it is a little more involved and may need to be more specific in nature to help someone with a migraine or dealing with different stages of a migraine.
Next week will be a very interesting blog because we will be going over some treatment options for migraine and talking a little about medication associated with migraine as well!