Most people have suffered from a headache at some time in their lives. Usually, the pain is mild and a couple of painkillers is often enough to block out the pain so that normal life can resume. However, migraine headaches are quite different. Sufferers quite often have to stop what they are doing and hide away in a darkened room until the worst of the episode passes.
The pain from a migraine can feel like the temples are going to explode. some people say the pain is like a garden rake scraping over their eyes and head. Some have said that their head feels like a balloon that is overfilled with air and is about to burst.
Many migraine sufferers get a feeling of being washed out and drained of energy after an attack, looking pale and feeling tired for a day or two after an episode.
Migraine has been recognised as a medical condition for centuries. Unfortunately, it is a complex disorder and medical science is not able to offer definitive reasons why some people suffer from the condition. We know that as many as 20% of the population are affected, with women three times more likely to experience migraine than men.
Thankfully, migraine attacks are not life threatening, although to many sufferers the condition can seem like the end of the world. One of the biggest problems with migraine is that you can never really predict when an attack will occur. A person could be driving, going off on holiday, about to pick up the kids from school or about to go our for a meal with friends when the dreaded migraine strikes.
The sequence of events
Research has helped us to understand what happens during a typical migraine. Some people notice that they yawn a lot more in the hours leading up to an episode while others say they have lots of energy. Some crave certain foods. These unusual signs may be experienced a few hours before a migraine comes on, or they can be experienced a day before.
Migraine headaches can be classed in two different ways; with aura and without aura. The ‘classic’ migraine usually starts with some sort of visual disturbance, referred to as an ‘aura’. About 25% of sufferers know that a migraine is starting because they notice a disturbance in their vision. Many of my patients say their ‘eyes go funny and out of focus’ or they see ‘zig-zag lines’ that move across their eyes. Some people say they have blind spots in their vision.
The aura stage of migraine can last from a few minutes to an hour or more. This stage is usually followed by the first signs of pain in the head.
The ‘common migraine’ is when there is no aura. The attack starts with a headache, which quickly develops into a thumping pain in the right or left side of the head.
Most people experience other symptoms during the early stages of a migraine. Speech many be affected, with difficulty forming words. Some people have a tingling sensation in their fingertips, which often spreads up their arms. Many people experience tingling in their tongue.
One of my patients told me that he suffers from about five migraines each year and they all follow exactly the same pattern. They start with a visual disturbance that lasts about 20 minutes, followed by difficulty speaking. He gets tingling in his fingers and tongue and then the headache starts, mild at first but it quickly develops into a thumping pain in either his left or right temple. He feels completely drained for the next 24 hours.
Similar symptoms to a stroke
Some of the symptoms of migraine can be frightening, particularly the speech problem. Often referred to as ‘migraine babble’, this part of the migraine cycle is one of the most noticeable signs that a person is experiencing something untoward. Speech problems, or transient aphasia, probably occurs when blood vessels over-dilate, which is thought to be the main cause of migraines. Different parts of the brain are affected by over-dilation, which partly explains why many people get these unusual symptoms.
Understandably, some people are afraid that their migraine is a symptom of a stroke. The good news is that there is little evidence to suggest that a stroke is more likely to occur during a migraine. A stroke is when a blood vessel in the brain in either blocked so that oxygen is prevented from getting to brain tissue, or that a blood vessel bursts inside the brain. Migraine is neither of these two things.
Trigeminovascular theory of migraine
So what causes a migraine?
The answer to this question is not an easy one. For many years, it was believed that over-dilation of blood vessels in the brain caused migraine pain. However, over-dilation doesn’t quite explain why the attack occurs.
Research has shown that electrical changes that go across the brain are linked to the early stages of migraine, particularly the aura effect. This wave of electrical activity is quickly followed by what is called ‘spreading cortical depression’ and it is during this phase that constriction of blood vessels occurs. Studies have shown that as the waves of spreading depression pass over the brain there is a drop in oxygenation of that segment of the brain. Thankfully, the drop in oxygen levels doesn’t last long, only until the wave of electrical energy passes over. This could explain why some of the symptoms that migraine sufferers experience are similar to those of a stroke victim.
There is also evidence of brainstem activation at the beginning of a migraine, and there is strong evidence that migraine is linked with abnormally excitable neurons in the trigeminal nerve. In summary, something may trigger abnormally excitable neurons to fire, which causes a wave of electrical energy to pass over the brain, resulting in constriction of blood vessels and a drop in oxygenation.
What excites the neurons?
So, what causes the over-excitement of these neurons? Various things can do this, including low magnesium, abnormal calcium channels or inherited brain chemical abnormalities.
Regardless of the scientific pathology, it is generally accepted that migraines are started by ‘triggers’. Some people are more susceptible to certain triggers than others. But the story about triggers is complex too. A person exposed to one of their known triggers might not be enough to start a migraine. For example, red wine is thought to be a common trigger. A person who is susceptible to red wine may drink a glass every day for a year and never have a migraine. We know that more than one trigger is usually needed.
I often talk about ‘tipping the balance’. Imagine if red wine is one of your triggers. You might drink a glass with no effect. However, if you had a glass of red wine on an empty stomach after driving a long journey following a few days of lack of sleep or sleep disturbance, you may have tipped the balance and, hey presto, a migraine is triggered.
All of those things mentioned above can be triggers. I classify triggers in nine categories: lack of food, specific foods, sleep disturbance, stress and anxiety, exercise (not enough or sudden bursts), long travel journeys, changes in the environment (lighting, noise), neck pain, and hormonal changes in women.
Three or four of the above occurring together may be the root cause of a person’s migraine. That is why it is such a good idea to keep a migraine diary. Whenever I have a patient who needs treatment for migraine, I always ask them to keep a diary so that we can discuss their habits and lifestyle at their first appointment.
Can migraine be treated?
Some people are prescribed preventative medication by their GPs. These can have varying degrees of success. Beta-blokers, serotonin antagonists and tricyclic antidepressants are common drugs that are known to help migraine sufferers. However, they can take more than three months to start working and they often have unwanted side effects.
A popular relief medication that is available over the counter are tablets that contain sumatriptan. Taken as early as possible whenever a migraine is noticed, this medication can help reduce the effects of an attack and, in some people, they can shorten the episode.
But medication is not the cure, it is merely a sticking plaster to help relieve the symptoms. To get to the root cause of migraine another approach is needed. One very successful therapy is hypnosis. Treating and preventing chronic migraine headaches with hypnosis is a cost-effective alternative to drugs. Hypnotherapy doesn’t just help relieve the acute symptoms such as pain, it can also help stop migraines completely, by looking at the underlying reasons why migraines are occurring.
Two uses of hypnotherapy to treat migraine
There are two uses of hypnotherapy in the treatment of migraine. Firstly, self-hypnosis is a technique to help patients deal with the pain when an attack does occur. Teaching self-hypnosis can be a wonderful alternative to using painkillers. Patients are taught how to induce a deep state of relaxation whenever a painful headache comes on. Some of my patients say that 20 minutes in a self-hypnotic state usually takes the pain away completely.
Secondly, and more importantly, is the use of hypnotherapy as a way to treat the underlying cause of migraine. Stress and anxiety are two of the most common triggers of migraine and so it is important to treat these properly. A migraine is the body’s way of telling us something is wrong. It is something abnormal. However, the conscious mind might not be able to understand exactly what is wrong. I will talk about the conscious and subconscious mind in later posts.
Hypnotherapy is a gentle and powerful way to reach into the subconscious mind to understand why migraines are being triggered. There is a reason why people have migraines. Neuroscience can help explain the ‘what’ but it cannot fully explain the ‘why’. The subconscious mind has most of the answers but it is only accessible through deep relaxation and through hypnotherapy. By discovering the underlying reasons for migraine, the patient can be helped to eliminate them completely.
I hope you enjoyed this brief insight into migraine headaches. I would love to hear your stories about migraine and how you manage to cope with this debilitating condition.
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