People who don’t know about migraines usually think it’s a poor excuse. Like this: The madam has migraine, that is, she does not like to get up. Or: Colleague X is sleeping off his drunkenness (and we have to go along with the work). Those who know her suffer from it, from her and from the assessment they receive from the others.
Symptoms and course of the disease of migraine
Migraine starts out of the blue – sometimes after precursors – with a violent headache that increases over the course of hours and reaches a penetrating peak under nausea. In fact, migraine is a tormenting condition, which does not exclude its occasional use as an excuse. It starts out of the blue – sometimes after precursors – with a violent headache that increases over the course of hours and reaches a penetrating peak under nausea. Then the attack subsides. Mostly the whole thing takes place in one day. After weeks, sometimes after a few days, the next attack may begin. This attack-like course is the main characteristic of migraine. A typical feature is also the half-sidedness of the pain. This symptom has given the condition its name (hemicrania = half-sided headache). The side changes, usually one predominates, in the attack the side does not change, but the pain spreads to the other. If these course and localization characteristics are not clearly present, the migraine can betray itself through accompanying symptoms. Usually the nausea increases with the pain until vomiting. Visual disturbances are also very characteristic: Light shyness and flickering light appear with reduced vision. Therefore, a dark room is often visited during the attack. But also in other sensory areas there can be irritation and failure symptoms. It is important that all symptoms disappear completely with the seizure.
Mirgain as a functional disorder
Can this peculiar mixture of symptoms be explained and reduced to a common denominator? Their volatility and the fact that no pathological changes are found in the nervous system or in other organs suggest that a “functional condition” is present. Between healthy life processes and diseases caused by damage to organs or tissues, there is, after all, the broad intermediate area of functional disorders. For example, nerve cells need, among other things, a certain amount of oxygen in a unit of time for their proper activity. If this quantity is not reached, the function is disturbed. If the carotid artery is throttled for a few seconds, fainting occurs. Yet the nerve cells remain perfectly viable; they resume their activity as soon as the oxygen supply is guaranteed. Not all functional disorders arise in this way, but in migraine this is apparently the case. Certain areas of the head suffer temporarily from a lack of oxygen and therefore function poorly or not at all. This explains the transient failures, for example, of vision. The pain is unexplained, and above all it remains unclear how the lack of oxygen occurs. There are also studies that think that the migraine itself causes the lack of oxygen in the brain. Let’s deal with the second part of the question first. All nutrients, including oxygen, require a means of transport to get to the organs. This is the main function of blood. The blood demand of the organs changes depending on their performance. So the inflow must be constantly regulated. This is accomplished by muscle fibers woven into the walls of the vessels. They can widen and narrow the free opening. Good, symptom-free activity of the organism from this point of view means: fine tuning of the right amount of blood flow for all organs, correct regulation of the width of all blood vessels. Now we can define migraine as a misregulation of head blood flow.
Headache and migraine
Now to the pain. As varied as the problems of pain are, we know for certain that the main cause of organ pain is lack of oxygen. The heart pain attack starts as soon as the blood supply for the heart muscle falls below a certain limit. So we have found a common cause for dysfunction and pain. By the way, the headache is not a brain pain. Even gross damage to the brain does not hurt. But the envelopes, the periosteum and the large blood vessels, are “sensitive”.This is where the migraine pain is located, triggered by an incorrect dosage of blood supply to the head and many other factors. If one now goes further and asks how such a regulation disturbance comes about, one is faced with a problem that is still insufficiently clarified. Certainly the “constitution” plays a role. There are diseases to which practically every human being is subject, if only he has been exposed to the damaging causes long and intensively enough. However, most people have never known a migraine in their entire lives, while others, living under the same conditions and stresses, suffer attack after attack. Some women have had migraines since their first menstrual period and lose them with their last, or have been afflicted with them since early school days. It is not uncommon for the mother to have suffered from similar pain. The triggering of many attacks can be related to hypersensitivity, and often there is a relationship to nervous overload and to sleep. But there is not the simple relation: sleep deprivation – migraine attack. It is often observed that it is precisely prolonged sleep, such as on Sunday morning, that is followed by an attack.
Treatment
Thus, a whole series of factors can be compiled, with which the migraine or the individual attack can be associated. However, this does not identify a single cause. In other words: We know something about the mechanism of the attack and some of the triggering factors, but nothing reliable about the origin, the core of the condition. Thus, our treatment is also primarily directed against the symptoms and against the seizure-triggering factors. At least, quite good successes are achieved with this. However, there is still no remedy that can eliminate migraine with certainty and in every case forever. The science of migraine cannot reach the level that has been achieved with various infectious diseases, for example, through antibiotic treatment. We have some drugs that are characterized by pronounced effectiveness on the blood vessels of the head and can prevent most attacks if taken at the first signs. With curative treatment, the tendency to seizures also decreases. In this way, and by a number of other measures that depend on the individual characteristics of each patient, the experienced specialist can help decisively in most cases.
Differential diagnoses
Now, not every migraine-like headache has to be a true migraine. One does well to distinguish between “true” and “symptomatic” migraine, because quite different considerations may arise for treatment. For example, a vascular malformation in the skull capsule not infrequently presents with seizure-like headache and visual disturbances. Surgical intervention is a possible treatment. Or an accident leads to fine displacements in the structure of the cervical spine: the same symptoms, and yet other measures are required to eliminate them. It is not the purpose here to give a complete overview of the possible causes of migraine-like headaches. It should be said to the sufferer, who from experience does not always seek specialist care, that in the case of certain symptoms a specialist in nervous disorders should determine whether there is not an unusual cause for the complaints, from which special diagnostic and therapeutic measures arise. These symptoms include: seizure-like headaches that begin relatively quickly in middle age or later, or those that begin only a few times over the course of many years but then become extraordinarily severe or are associated with disturbances of consciousness, severe neck pain, paralysis, and double vision, exclusively unilateral pain, vomiting that occurs independently of the headache attack and of justified stomach upset, migraine symptoms that persist beyond the attack, pain that is dependent on position and head movement, and other deviations from what has been presented here as “typical migraine.”
