Different kinds of migraines and what they mean
Posted on 18 April 2019
More than one in seven people suffer migraines, which are considered the third most common health condition in the world. Painful and debilitating, they often lead to absenteeism, anxiety and even depression. Dr Zafar Iqbal, a neurologist at Mediclinic Muelmed, describes the different kinds of migraines and what they mean.
Migraine can be defined as a penetratingly painful headache that is often accompanied by nausea and vomiting and sensory disturbance like sensitivity to light and noise. Often, but not always, the headaches affect one half of the head, they throb, and can last anything between four and 72 hours.
For years it was thought migraines were caused by pressure changes in blood vessels that supply the brain. It is now thought that migraines have a strong genetic link, and that if a genetically-primed brain cell is triggered by a change in the external environment, such as atmospheric pressure, or the internal environment, such as sudden hormonal changes, it makes it electrochemically unstable and triggers a migraine.
Dr Iqbal explains how symptoms of migraine vary between people, and that sufferers (or migraineurs) can experience different symptoms each time they have a migraine.
“There are often, but not always, four phases to a migraine. The first is the prodromal phase. This usually occurs one or two days prior to the attack, when you might experience irritability, drowsiness, food cravings and hyperactivity. The second phase is the aura – a sensory disturbance that can temporarily affect your sight or cause numbness or tingling in your body. This can last up to an hour and happens before or during the headache. The third phase is the headache attack itself, which can last up to three days. The final phase, postdrome, is when the headache is over and the sufferer is left feeling exhausted,” Dr Iqbal explains.
Types of migraine
There are two main categories of migraine:
- Migraine without aura (common migraine)
This is the most common amongst migraineurs – 70% to 90% of sufferers experience this type of migraine, which can occur as infrequently as once a year or as often as several times a week. A menstrual migraine is one example in this category. Up to 60% of female migraineurs experience this before, during or after their menstrual periods.
- Migraine with aura (classic migraine)
Far less common, this type of migraine is preceded by a visual experience (seeing coloured spots, blind spots, flashing lights, tunnel vision or temporary blindness) or a sensory feeling (numbness or tingling, pins and needles in the arms and legs, weakness on one side of the body, dizziness or a feeling of vertigo).“Auras often alert the patient to the approaching migraine attack, and measures can be taken to avoid it in time before the headache starts,” Dr Iqbal says.
There are subcategories of migraine with aura, including:
– migraine with typical aura
– migraine with brainstem aura (such as ataxia, dizziness and double-vision)
– hemiplegic aura, where the headache is preceded or accompanied by temporary weakness on one side of the body
– retinal migraine, which involves defects in sight that can last up to an hour
– abdominal migraine, abdominal symptoms which accompany the headache (this is more common in child migraineurs)
While there are many factors that trigger migraines, some common ones include:
- caffeine (coffee, carbonated drinks and energy drinks)
- diet, particularly dairy products
- hormonal changes (women are three times more likely to suffer from a migraine because of hormonal changes; 60% of female migraineurs experience menstrual migraine)
- changes in weather and barometric pressure, dehydration, exposure to excessive light, changes in sleep schedule, and increased stress levels
For migraine sufferers, Dr Iqbal says keeping mindful of your typical triggers can help avoid the migraine attack. Make specific lifestyle changes, and consider the following shortlist:
- avoid caffeine, chocolate, cheese, tobacco and skipping meals
- take good care of your sleep hygiene (make every effort not to compromise on quality sleep)
- exercise regularly (but build up gently, as fatigue can also precipitate a migraine attack)
- if you’re taking prophylactic treatment for migraines, avoid skipping your medications
- keeping a headache diary will help your doctor understand the pattern of your headaches
- in the case of family planning, seek advice from a gynaecologist for treatment with a low oestrogen component