What is migraine, exactly? Is there a real difference between migraine versus headache?
Let’s begin with what migraine is not. It isn’t “just a headache.”
Migraine is a neurological disease. Living with migraine puts you in a members-only club you never asked to join, and few outside that club truly understand the toll it takes. It’s a complicated condition of wide-ranging severity, frequency, and symptoms, all of which combine in ways that are unique to each person. More than 38 million Americans experience debilitating migraine attacks every year, and yet no one experiences it in the exact same way.
Maybe migraine’s complexity has something to do with the fact that it stems from our most complex organ: the brain.
The (Overly) Vigilant Brain
If you could peek inside the “migraine brain,” you’d see that the brains of people with migraine behave differently than the brains of those without migraine. Scientists suspect that a migraine attack is set off by multiple factors coming together:
- The migraine brain is hypervigilant, meaning it’s always on high alert. That makes it more sensitive to sensory information (i.e., sound, vision, touch) than a neurotypical brain.
- This extra sensitivity leads the brain to overreact to certain kinds of sensory information or environmental changes.
- The brain’s hypervigilant response may be due to an inability to control the electrical activity in the brain, spinal cord, and sensory ganglia.
- The brainstem may then respond inappropriately by sending pain signals to the trigeminal nerve, a big cranial nerve that transmits information to the face and the brain covering. This process is the likely cause of migraine pain.
A Wide Range Of Symptoms
Migraine expresses itself through a huge variety of symptoms and patterns, which often creates difficulties in finding the right diagnosis. Here are a few of the ways in which migraine varies from person to person:
Symptoms: The most common migraine symptoms are excruciating head pain, nausea, and vomiting, but that’s not nearly all. Other symptoms may include dizziness, sinus pressure, brain fog, sensitivity to light, sound or smell, abdominal pain, diarrhea, motion sickness, fatigue, eye pain, slurred words, scalp sensitivity, and even fainting.
Variability: Migraine symptoms often change throughout a person’s lifetime. If at age 30 your primary complaint was head pain, at age 50 you might be coping with aura, dizziness, and gastrointestinal issues.
Pain severity: For some, the pain of a migraine attack can be excruciating. Others may suffer aura-only attacks which, while debilitating, don’t register as pain at all.
Frequency: Some people suffer migraine attacks every so often — twice a year, or twice a month — which is called an “episodic” migraine. Others experience migraine 15 or more days a month, a condition classified as “chronic.” Some people may have a constant, 24/7 headache with fluctuations in pain and other symptoms.
The Four Phases Of Migraine
As varied as migraine attacks can be, most people experience four phases of migraine: prodrome, aura, headache, and postdrome.
Phase One: Prodrome
The opening act of a migraine attack is called “prodrome.” It’s an early signal that migraine is coming, and can last for hours or even days before a headache. Prodrome symptoms include:
- Psychological: depression, drowsiness, euphoria, hyperactivity, irritability, restlessness, talkativeness
- Constitutional: loss of appetite, chill, diarrhea or constipation, fluid retention, food cravings, sluggishness, stiff neck, thirst, and urinary frequency
- Neurological: difficulty concentrating, inability to generate normal speech, heightened sense of smell, light and sound sensitivity, yawning, aura
Phase Two: Aura
Migraine aura is a sensory disturbance that can occur before or during the headache. It is experienced by 25 to 30 percent of people with migraine. Auras can take many forms, including physical sensations like numbness and tingling, vertigo, difficulty speaking, weakness, and confusion. Disturbances of vision are most common: Some people see explosions of light and flashes, others develop a sudden blind spot, while still others describe shapes and mosaics floating across the visual field.
Phase Three: Headache
When the headache comes, it often occurs on one side of the head — in fact, the word “migraine” derives from the Greek words for “half” and “skull” — although head pain can also be bilateral. The pain can manifest as throbbing, pounding, pulsating, pressure, vice-like, sharp, or dull. It typically lasts anywhere from four to 72 hours for adults. Because physical activity tends to exacerbate pain, most people prefer to lie down in a quiet, dark room.
Besides the headache itself, this phase is often accompanied by symptoms that create greater disability, including:
- Scalp sensitivity
- Light sensitivity (photophobia)
- Sound sensitivity (phonophobia)
- Sensitivity to smell (osmophobia)
- Visual disturbance
- Dizziness, lightheadedness or vertigo
- Neck pain
- Congestion, nasal secretions and tearing eyes
The symptoms that signaled the onset of the attack often stick around throughout the headache phase.
Phase Four: Postdrome
After the head pain subsides, symptoms linger in the postdrome phase, including difficulty concentrating, fatigue, irritability, muscle aches, and loss of appetite. Some lucky people actually feel refreshed and euphoric in postdrome; they’re enveloped by a clarity of mind, leading to great productivity. Regardless of your postdrome symptoms, rest assured that the end of your migraine attack is in sight.