Migraine Awareness Week is an annual initiative by The Migraine Trust that sets out to “raise general awareness of migraine as a serious public health issue and to reduce stigma”. According to The Migraine Trust, one in seven people suffer from migraines. In the UK alone, that translates to over eight million people, with approximately 190,000 attacks occurring every day. Migraines are therefore more common than diabetes, epilepsy, and asthma combined. The World Health Organisation recognises migraine as among the most disabling of all lifetime conditions. Despite this, many people seem to view migraines as nothing more than particularly strong headaches. I know people who have phoned in sick to work, claiming to have a migraine. The next day they’ll admit, candidly and sheepishly, that they were merely hungover. A migraine is much more than a strong headache – it’s a condition that can be so painfully debilitating that it can make even the most punishing of hangovers feel like a day at the spa. And given that, every year, an estimated 25 million days are lost from work or school because of migraines, what’s bad for the sufferer is also bad for the economy. It’s for these reasons that The Migraine Trust holds annual awareness weeks. The 2015 Migraine Awareness Week takes place 6 – 12 September. As a means of raising awareness, we thought we’d take a look at the science behind migraines. Hopefully, when you know a little bit more about migraines, you might stop thinking of them as just “bad headaches”. What’s the Difference between a Migraine and a Headache? “Headache” is a vague, all-encompassing term that can be used to describe any pain felt in the head. A headache can be caused by anything, from stress to dehydration. A migraine, though, is something more specific, yet widely misunderstood. Migraine is the most common neurological disease in the developed world. It’s generally characterised by recurrent pulsating headaches combined with a number of autonomic nervous system symptoms. Migraines typically affect one half of the head. Indeed, the term “migraine” derives from the Greek hemikrania, meaning “pain on one side of the head.” The headaches can be moderate to severe, which can make it almost impossible for the sufferer to blank out the pain. Associated symptoms will vary from sufferer to sufferer, but they can include nausea, vomiting, and sensitivity to light, sound, and smell. Migraines can last from two to 72 hours, and physical activity generally makes the pain even worse. But what causes migraines? The truth is, we still don’t know for sure. The Causes of Migraines – Theories and Statistics Though the specific underlying causes of migraines remain unknown, they are believed to be related to a range of environmental and genetic factors. In around two-thirds of cases, they run in families, although they rarely occur due to a single gene defect. Before puberty, migraines affect slightly more boys than girls. But given that, among adults, migraines affect up to three times more women than men, some believe that changing hormonal levels might play a role in causing the condition. This theory is supported by the fact that the risk of migraines tends to decrease during pregnancy. Beyond the theoretical underlying genetic causes, certain things might trigger migraines in sufferers. Again, triggers will vary from person to person, but they can include stress, hunger, fatigue, menstruation, and certain foods and drinks. When it comes to the dietary triggers, though, the evidence is largely based on self-reports, and is thus not nearly rigorous enough to act as hard proof. The notion that environmental aspects such as the quality of the air or light can act as a trigger is similarly lacking in hard evidence. Finally, there’s evidence that migraines are neurovascular disorders that start at the brain and spread to the blood vessels. There’s disagreement over which system plays the greatest role in causing migraines – the neuronal mechanisms, the blood vessels, or both – but high levels of the neurotransmitter serotonin are thought to be involved. And yet, the precise mechanism of the head pain that occurs during a migraine remains unknown. The Four Stages of Migraines All sufferers experience migraines differently. There are four possible stages, though not all are necessarily experienced, and the precise symptoms are highly variable: 1. The Prodrome Phase – Experienced by around 60% of sufferers, the premonitory symptoms can be experienced as far as two days before the onset of the pain, and can include irritability, euphoria, depression, fatigue, and food cravings. 2. The Aura Phase – This stage is perhaps the hardest for non-sufferers to grasp. Up to a third of sufferers perceive some kind of aura that signifies the onset of a migraine. It can be a transient visual, sensory, linguistic, or motor disturbance. Visual disturbances are the most common, and can include blurring, partial alteration of the field of vision, and even the appearance of coloured lines. 3. The Pain Phase – Self-explanatory, but to further differentiate how a migraine differs from a regular headache, it’s worth reiterating just how the pain is experienced: it’s moderate to severe in intensity, throbbing, and it’s almost exclusively felt in one half of the head. The pain is accompanied by a range of unpleasant symptoms including nausea, sensitivity to light, irritability, confusion, and a sense that the world is spinning. For children, the pain phase can last for less than an hour. For adults, it typically spans between four hours and 72 hours. In some cases, it can last even longer. 4. The Postdrome Phase – Even the shortest of pain phases might induce lingering effects for days afterwards. The affected area might remain sore, and it might take a while before the sufferer’s mental and physical faculties return to 100%. On the other hand, some sufferers feel a sense of refreshed euphoria after an attack. How to Treat a Migraine Some people experience migraines more frequently than others. In particularly severe cases, such as for those who experience them more than two days a week, doctors may advise preventative measures such as medication, nutritional supplements, lifestyle changes, and even surgery. However, for many sufferers, migraines cannot be cured or prevented – they can only be managed. Ibuprofen and paracetamol can be taken for the headaches, and antiemetics can be taken for the nausea, but beyond this, there’s little that can be done beyond avoiding triggers and waiting for the pain to pass. Physical activity can make things worse, and many sufferers become sensitive to bright lights and loud noises, so for a lot of migraine sufferers, treatment involves lying down in darkened rooms for as long as is required. But of course, just like the symptoms differ from person to person, so too might the treatment. Many sufferers will have products or techniques that they claim work for them, but which, for others, may worsen symptoms. For example, some might insist that listening to soft music helps them to take their mind off the pain. But for others, all music, no matter how soft, might be intolerable. Why We Need Migraine Awareness Week So to sum up – we’re not quite sure what causes migraines, and the way they’re felt tends to vary dramatically from person to person. It’s no wonder, then, that the condition is so misunderstood. Also, migraine remains undiagnosed and undertreated in at least 50% of patients, and hardly any sufferers even think of consulting a physician. It’s because of this that we can appreciate the vital importance of initiatives such as Migraine Awareness Week. Click here to make a donation to The Migraine Trust. Otherwise, take it upon yourself to do as we’ve just done, and spread awareness, in any way you can, about this much misunderstood lifelong disability.