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More precisely, migraines are recurrent headaches separated by symptom-free intervals and accompanied by nausea and light sensitivity. Migraines are often accompanied by visual symptoms and are relieved by sleep; furthermore there is usually a throbbing quality.
More often than not there is a family history of migraine. Migraine is a “committee” diagnosis – -meaning that a izometh of people got together somewhere and decided what they were going to call a “migraine”.
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Modern genetics has established that there are a large number of genes that contribute slightly to the probability that someone will be diagnosed with “migraine”. In other words, we are not dealing with a “disease here” – we have a group of symptoms that are subcategorized by a committee that was set up prior to us knowing modern genetics. There are several other “committee” diagnoses relevant to vertigo — including Meniere’s disease. For “committee” diagnoses, “ruling out everything else” is usually required by the diagnostic process.
Some disorders that we deal with commonly in dizzy persons, such as ” cervical vertigo “, don’t have a committee, and being undefined, are less studied than disorders fortunate enough to have their own committee. On the other hand, if one needs a committee to define something, it means that the “somethings” very existence is subject to negotiation.
Accordingly, Formal criteria for migraine, have been defined by the IHS international headache society in a very long document. Because headaches are common and because the IHS criteria include nearly anything you can imagine, migraine is a very “inclusive” disorder. It is to be hoped that eventually a blood test or genetic test will be developed. So far, there seem to be many genes. If one attempts to distill out the most useful parts of the IHS document, migraine usually involves a combination of headache and sensory sensitivity.
Concerning sensitivity, there are various types of sensory inputs which may trigger migraine headache — light photophobiasound sonophobiasmells such as perfumeand motion — persons with migraine are often prone to become isomeh. They are more sensitive to medications than most people, and they often have symptoms triggered by weather changes.
Psychological testing shows unsurprisingly that people with an active migraine headache don’t think as well as usual Meyer JS et al, Although migraines are usually episodic, they can be chronic too. Each year, about 2. Although migraine headache is usually unilateral, opposite sides of the head are characteristically affected during different attacks. Migraine auras usually last 5 to 60 diichlor.
Visual auras begin in central field of vision and move to the periphery. Another common visual aura is a scotoma black spot. There is apa; genre of art called ” migraine art aap, based on migraine aura. There are also sensory auras — they often move from hand to arm to face and ipsilateral tongue.
Presumably, any part of the brain might have an aura. The possibilities are endless!
Spap are numerous defined variants of migraine in the very long IHS document. Tension headaches are presently thought by many neurologists to be a milder type of migraine.
They are usually described as a dull ache in the back of the head, over the ears, in the forehead or in a tight band round the neck. Like migraines as well as nearly any medical problem, tension headaches are made worse by stress.
Sinus headache is generally overdiagnosed and operated upon. Schreiber et al, Neck related headaches are extremely common, and are usually recognized by their association with posterior pain and aggravation by neck movement.
Altitude sickness headaches are of course associated with high altitudes. Their mechanism is probably not migraine. Other medical problems such as brain tumors or aneurysms are rare in people with headache, but need to be considered, especially in headaches of recent onset.
There have been some HUGE studies of migraine, perhaps because one can “diagnose” migraine from a survey. The main problem with this statistic is that there is no biomarker for migraineand one must wonder what exactly these survey studies are finding — perhaps they are showing that lots of people have bad headaches from time to time.
As ofit is obvious that “migraine” is not a single disorder, even though we have a substantial medical infrastructure built up around the idea that “migraine” is a disease.
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This is a common problem with “committee” diagnosesthat have no biomarker, and similar criticism can reasonably me leveled against the process of “diagnosing” many other illnesses for example, most of psychiatry. We can only hope that as molecular genetics and biology progresses, we will be able to “split” up these conditions into more meaningful groups.
Well anyway, women are especially likely to get migraine 3: Women probably get more migraine than men because of hormonal fluctuations, and the incidence appears to be increasing in women Rozen et al, Women who have recently transitioned into menopause have more migraine.
Children have migraines too. See this page for more about migraine in children. Because migraine is so broad, there may actually be many causal variants. It seems unlikely that there could be so many “causes” in a single disorder.
In fact, one might even question whether the term “migraine” is useful one at all, given the huge heterogeneity in symptoms and genetics. The current consensus is that migraines are caused by abnormality in the brain which represents a combination of familial tendency, trigger factors such as stress, sleep disturbance, hormonal fluctuations, and certain foods. While in the past migraine was felt to be related to vasospasm, presently it is thought that the blood flow changes are not primary.
Instead, it is felt that migraine is related to abnormal sensitivity to sensory inputs Goadsby PJ, Nevertheless, there is reasonable evidence in the other direction — for example, some forms of migraine are associated with a mutation in a gene that controls a potent vasoconstrictor Tzourio et al,and there is also evidence for vascular muscle dysfunction in migraine Napoli et al, ; Asghar et al, Really there is evidence for almost everything in migraine sadly.
Our most effective medications for migraine headache ergots, triptans manipulate a blood chemical called serotonin. Medications that manipulate another neurotransmitter dopamineare also often effective treatments for migraine although they have side effects and abnormal dopamine is unlikely to the core central problem Mascia et al, Another neurotransmitter called CGRP — calcitonin gene-related peptide also appears to be important to migraine.
CGRP causes cranial vasodilation and facilitates pain reception.
During a migraine attack, trigeminal activation results in release of CGRP. CGRP is increased in persons with chronic migraine. The neurology field is currently hoping for drugs that antagonize CGRP.
Lets hope that they are not prohibitively expensive. Migraine does not appear to be strongly related to allergy or immune disturbances in most instances. However, histamine released in allergy may trigger migraine. The diagnosis is made through identification of characteristic features of the headache and examination. The features that one looks for are on the list of symptoms defined by the international headache society.
Patients with migraine typically are required to have sensory amplification symptoms In our practicewhich largely contains persons with dizziness and headaches, we have also observed that many patients with “migraine” are very sensitive to changes in barometric pressure, and also that they are more sensitive to medication.
Migraine shares central allodynia with fibromyalgia, which interestingly enough, is often treated with a similar repertoire of centrally acting medications e. Fibromyalgia is reported in Fibromyalgia, like migraine, is another symptom collection, and given recent genetic developments in migraine, perhaps the two are just variants determined by a particular subset of genetic and environmental risk factors.
There are also a few with smell intolerance. All of these central sensitivities also have other causes — photophobia in particular was recently reviewed by Digre and Brennanwho point out that dry eyes is a common cause too.
If one pursues the idea that there are multiple genes that are associated with “migraine”, one might also think that perhaps subsets of these genes also accounts for these limited sensory syndromes, lacking headache.
Interestingly, patients with “migraine” are “wired differently” and have thicker sensory cortex than patients without migraine DaSilva et al, They are more “sensitive” to pain Lipton et al, Patients with migraine have visual cortex that is more excitable than normal during migraine attacks Denuelle et al, As migraine is a ” committee diagnosis “, tests are used to exclude other entities rather than to make a positive diagnosis.
No X-rays or blood tests are available to make the diagnosis, but in persons with severe and recent headaches, neurological findings, or complicated medical histories, the physician may recommend an MRI or CT scan Silberstein, Imaging is generally not necessary if the examination is normal and the headache pattern is unchanged.
Lumbar punctures are obtained when subarachnoid hemorrhage or meningitis is suspected. We have collected together some of the papers on vestibular and hearing testing in migraine here.
As a general comment, none of them are sensitive to migraine. Migraine headaches are often misdiagnosed by patients themselves as sinus headaches. What this study really said was that they didn’t have sinus inflammation. Migraine, being so broad, accepts headaches left over from other conditions that are defined with greater specificity. In other words, migraine is often a “catch all”.
MRI scans may reveal white matter lesions in young persons with migraine. These can and often are confused with white matter lesions due to multiple sclerosis or white matter lesions that occur in older people periventricular white matter lesions. For more information, see this link: MR angiography can be used to diagnose vascular malformations. MR venography can be used for sagittal sinus thrombosis. MR also may detect low-pressure type headachestumors, as well as the Chiari malformation.
Fortunately all of these are rare. However, this is a low-yield endeavor, and headaches are not significantly associated with lupus Mitsikostas et al, It would seem likely to us that tests of high sensory reactivity, or inability to block out unwanted distractors, would be a reasonable method of screening for Migraine.
Perhaps there is room for more research?