Migraine

Migraine is a condition that has many manifestations. It can produce many kinds of visual or neurological symptoms, as well as headaches. The symptoms of migraine are caused by transient inflammation of vessels, dilation of blood vessels, and abnormal firing of nerve cells in the brain.

Some people know “it will be a migraine day” because of tiredness, excessive energy, mood changes, yawning, or food cravings. In about 20 percent of people, a migraine starts with visual or neurological symptoms. The next phase is the headache. Some people experience all phases, and some only one—it is not necessary to have headaches to have migraine.

Migraine is very common; approximately 15-20 percent of the population is affected (18 percent of women, 6 percent of men and children). After puberty, it is three times more common in women than men. Migraine often runs in families, and knowing about other family members’ headaches is often helpful for the diagnosis and treatment of migraine.

Many migraine sufferers are also prone to motion sickness. There is also an association between some medical conditions and migraine, such as Raynaud’s phenomenon, depression, anxiety, bipolar disorder, asthma, epilepsy, and fibromyalgia.

Evaluation

If your symptoms are typical for migraine and the neurological exam is normal, usually no tests are needed, particularly if there is a family history of migraine. If the symptoms are not typical, or the headaches develop later in life, a brain scan may be recommended.

Sometimes migrainous visual loss can be confused with attacks of visual loss caused by vascular disease or blood clots from the neck or heart. In this case, other tests will be recommended to be sure that migraine is the cause.

Symptoms

Headaches
Headaches are the best-known features of migraine, although it is possible to have migraine without having headaches. The headaches usually start as a mild ache, often on one side of the head. The pain gradually increases in intensity and becomes throbbing or pounding in nature. Many people also experience nausea, vomiting, diarrhea, inability to eat, blurred vision, or sensitivity to light, noise, and odors. Activity usually makes them worse, so most people prefer to lie down in a dark, quiet room, and can often get relief with sleep. Migraine headaches usually last for hours, but sometimes last for days. Migraine in young children is briefer, usually lasting less than two hours.
Neurological
Neurological manifestations of migraine include weakness, numbness, dizziness, speech difficulty, confusion, or loss of conscious- ness. A progressive “march” of symptoms can occur (for example, numbness on the face that resolves, then weakness of the arm that resolves, then flashing lights). The visual or neurological symptoms can last between seconds and hours, but usually last less than 45 minutes. Occasionally they are permanent.
Visual
Migraine can cause visual loss in one or both eyes. Visual loss in one eye may resemble a “mini stroke,” and in patients over age 50 without previous migraines, investigations for other causes of stroke may be recommended. The most common visual symptoms are “positive” visual phenomena, such as flashing lights, zig-zag lines, “heat waves,” stars, or other disturbances of vision. Some people experience loss of one side of the vision, tunnel vision, or complete loss of vision. The visual symptoms often begin gradually and fade away. Double vision occurs infrequently. A dilated pupil without any other symptoms has been described with migraine.