Understanding the types of migraine

By Dr. Michelle Cooper

Published 07/07/2015 | 00:00

Migraine is common. About 1 in 4 women and about 1 in 12 men develop migraine at some point in their lives. It most commonly starts in childhood years or in early adult life. Some people suffer from frequent attacks - sometimes several attacks per week. Others suffer from infrequent attacks only occurring now and then and some may go for years between attacks. In some people, the migraine attacks stop in later adult life. However, in some cases the attacks continue (persist) throughout life.

TYPES OF MIGRAINE

Migraine without aura: This is the most common type of migraine. Symptoms include: headache which is usually on one side of the head, typically at the front or side although sometimes on both sides of the head. Sometimes it starts on one side, and then spreads all over the head. The pain is moderate or severe and is often described as throbbing or pulsating. Movements of the head may make the headache worse. It often begins in the morning, but may begin at any time of the day or night. Typically, it gradually gets worse and peaks after 2-12 hours, then gradually eases off. However, it can last from 4 to 72 hours.

Other migraine symptoms are as follows: feeling sick (nausea); being sick (vomiting); not liking bright lights or loud noises. Other symptoms that sometimes occur: Being off food; Blurred vision Poor concentration; Stuffy nose; Hunger Diarrhoea Tummy (abdominal) pain Passing lots of urine Going pale; Sweating Scalp tenderness; ;Sensations of heat or cold.

Migraine with aura: About 1 in 4 people with migraine have migraine with aura. The symptoms are the same as those described above (migraine without aura), but also include a warning sign (known as an aura) before the headache begins.

- Visual aura is the most common type of aura. Examples include a temporary loss of part of one's vision, flashes of light as well as objects which may seem to rotate, shake, or boil within ones visual field.

- Numbness and pins and needles are the second most common type of aura. Numbness usually starts in the hand, travels up the arm, then involves the face, lips, and tongue. The leg is sometimes involved.

- Problems with speech are the third most common type of aura.

- Other types of aura include an odd smell, food cravings and a feeling of well-being.

One of the above auras may develop, or several may occur one after another. Each aura usually lasts a few minutes before passing and usually passes before the headache begins. The headache usually develops within 60 minutes of the end of the aura, but it may develop a lot sooner than that - often straight afterwards. Sometimes, just the aura occurs and no headache follows. Most people who have migraine with aura also have episodes of migraine without aura.

DIAGNOSIS

Migraine is usually diagnosed by your GP based on symptoms alone. There is no test to confirm migraine. A doctor can usually be confident that you have migraine if you have typical symptoms and by an examining you. However, some people with migraine have non-typical headaches. Therefore, sometimes tests are done to rule out other causes of headaches. Remember, if you have migraine, you do not have symptoms between attacks. It is the episodic nature of the symptoms (that is, they come and then go) that is typical of migraine. A headache that does not go, or other symptoms that do not go, are not due to migraine.

TREATMENT OPTIONS

Painkillers: Paracetamol or aspirin works well for many migraine attacks. (Note: children aged under 16 should not take aspirin for any condition.) Take a dose as early as possible after symptoms begin. Take the full dose of painkiller and repeat the dose in four hours if necessary. Soluble tablets are probably best as they are absorbed more quickly than solid tablets.

Anti-sickness medication: Migraine attacks may cause a feeling of sickness (nausea) which can cause poor absorption of tablets into your body. If you take painkillers, they may remain in your stomach and not work well if you feel sick. Anti-sickness medication is important, therefore, and can be taken with with painkillers. Like painkillers, they work best when taken as soon as possible after symptoms begin.

Triptan medications: Triptans are a good alternative if painkillers do not help. They work by interfering with a brain chemical called 5HT. An alteration in this chemical is thought to be involved in migraine. Triptans will often reduce or put an end to a migraine attack. Some triptans work in some people and not in others. Therefore, if one triptan does not work, a different one may work well. Triptans should not be taken too early in an attack of migraine. (This is unlike painkillers described above which should be taken as early as possible.) You should take the first dose when the headache (pain) is just beginning to develop, but not before this stage. Triptans probably work much less well if taken too early on in an attack.

Preventing migraine attacks

A medicine to prevent migraine attacks is an option if you have frequent or severe attacks. It may not stop all attacks, but their number and severity are often reduced. Medicines to prevent migraine are taken every day. They are not painkillers, and are different to those used to treat each migraine attack. Your GP can advise on the various medicines available.

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