Migraine 1: The Experience

this video is about the experience of migraine hello my name is Craig Blackwell I'm an ophthalmologist in Santa Cruz California in this video we will look at how you experience migraine for example what you may see or feel and what are common triggers in the second video we discussed the medical aspect and give an overview of treatment strategies and in the third video we take a careful look at the mechanism of migraine what is going on in your head to make all that happen it is important to understand that this is for your information and does not replace consultation with your doctor we are starting with this portrait of Thomas Jefferson because he was probably the most famous person with migraines the following quote is from biographer Charles Ellis in April of 1776 Jefferson was struck with a mysterious malady that left him incapacitated for more than a month the ailment turned out to be a migraine headache the first recorded occurrence of what proved to be a lifelong affliction that flared up whenever he felt unduly pressured that is a story that many with migraine would identify with well we know a lot more about it now we are still a long way from a full understanding let's start off by recognizing that migraine is not defined by the headache it is best to think of migraine is a group of various neurologic symptoms that occur in episodes and that all come from a common cause there is usually a headache but not always and migraine appears to be inherited speaking of various neurologic symptoms this is the full International Headache Society list of different types of migraines there are too many to discuss them all so we will limit this discussion to the three most common types these three types are different ways of combining two things headache and aura aura is a particular visual display or sensory defect that comes just before the headache if there is one the three types are one common migraine which is the headache alone with no aura classic migraine which is aura followed by headache and the aura alone visual or otherwise but with no following headache the International Headache Society has different terms but I will stick with these historic names because they are familiar and easy to remember the features that identify a headache as being a migraine are the headache is one-sided usually throbbing particularly with motion or straining usually it is moderate to severe in intensity there is nausea possibly vomiting there is sensitivity to light and sound pain is made worse by physical activity and the headache lasts from 4 to 72 hours people with the headache usually prefer to be in a quiet dark room and sleep often the headache is gone on waking the aura is a sensory disturbance that occurs with the migraine episodes it can involve vision sensation or movement 30% of the people with migraine have the aura here is the beginning of the typical visual display on the left there is a little missing area which over a few minutes grows into a crescent of zigzag flashing lights like on the right some described it is like a kaleidoscope others use the term scintillations at full development it may cover half of the field of vision within the Crescent there is an area of vision that goes missing that is called a scotoma not that the visual display is present in both eyes occupying the same half of vision it evolves over 15 to 30 minutes sometimes longer then the flickering lights gradually fade away and vision returns like in the picture on the right other descriptions of visual symptoms include a sensation of watery movement a blurred area or a star-shaped figure rarely there can be a blackout of vision but that must be distinguished from other worrisome causes like stroke surprisingly some people take artistic inspiration from their aura pattern this is one of at least two websites that collect people's artistic interpretation of their aura experiences there is a gallery including even big name artists like Salvador Dali if you are a migraine person looking at other people's or experiences in both interesting and disturbing some people have an aura that is not visual instead it involves sensations of numbness and tingling that march down the arm or numbness of the hand or around the mouth for some there's a feeling of heaviness or weakness of a limb or there may be difficulty speaking to recap the features of the aura are it contains positive features such as the flickering light and negative features such as the missing area the scotoma visual symptoms occur on 1/2 a vision affecting both eyes while sensory symptoms occur only on one side all the features are reversible that is they usually return to normal symptoms usually last from 5 to 60 minutes looking at the whole migraine process it may have four stages one is the prodrome this is a set of odd feelings starting a day ahead of the actual migraine there may be feelings of fatigue difficulty concentrating feelings of increased sensitivity or vague discomfort these are not the same as the aura the aura is the visual or sensory disturbance described above as the aura resolves the headache if there is one usually starts 3 then the headache and for after the headache has resolved there may still be vague feelings of dysfunction like difficulty speaking or recognizing objects in the mechanism video we go into detail about what is going on in the brain with migraine in this one we will summarize briefly the old theory of migraine was based on a vascular cause blood vessel constriction causing the aura and vessel dilation causing the pain as accurate methods for measuring blood flow became available the vascular mechanism was proven wrong it was replaced by a neuronal cause which works like this there is still a trigger event then the aura is caused by a disturbance in electrical activity on the surface of the brain called cortical spreading depression cortical refers to the cortex the outer layer of the brain where the nerve cells are located because it is made of nerve cells that is constantly abuzz with electrical activity cortical spreading depression is a disturbance of the normal electrical activity it is like the passage of a thunderstorm a wave of increased electrical activity starts out at a particular spot usually in the visual cortex it spreads gradually forward over the surface of the brain at about 2 to 3 millimeters per minute after the wave passes electrical activity in the area behind is significantly depressed the speed and spread of the electrical excitation exactly matches the progression of the shimmering part of the visual aura the following area of depressed activity is responsible for the missing area the scotoma the next big question is where does the pain come from currently there are two theories the leading theory is that the cortical spreading depression causes inflammation in the meninges that inflammation triggers pain impulses which are sent along the trigeminal nerve labeled P G in through the brainstem and then to the pain sensing parts of the brain several investigators suspect the brain stem is the origin of the migraine specifically there are nerve centers here that when activated can send pain signals directly to the brain and send signals that cause the cortical spreading depression but there are a number of details yet to be filled in here there is a third cortical pathway that is also important migraine people have been found to have abnormal sensory processing of pain signals some researchers think abnormal pain perception may end up being a key factor in migraine pain if you have migraines you are not alone migraine is surprisingly common affecting about 8% of men and over 25% of women this graph shows the peak occurrence of migraine comes roughly between ages 30 and 50 it is an interesting feature that the severity of the headache usually decreases with age sometimes going away entirely leaving only the aura here is one survey of how long migraine episodes last varying from minutes to hours here is a survey showing the most common triggers of migraine out of 1,200 people in this survey with migraines 76% reported having some identifiable trigger event stress is the most common cause interestingly for some the migraine comes after relief of stress also very common our hormonal changes particularly surrounding menstruation diet about a quarter of people with migraine can identify a particular food or chemical which can reliably trigger an attack common examples are food that contain a chemical called tyramine which is in aged cheese sour cream chopped liver sausage and Chianti wine and other things others include phenylalanine msg nitrates and aspartame here is the frequency of symptoms people report notice about a third have the aura which leads us to the next question how do you distinguish various migraine symptoms from other worrisome things like a stroke or retinal detachment sometimes this is a difficult to answer even for your doctor that is the subject to the next video covering the medical aspects of migraine in the third video we will discuss the mechanism of migraine what is going on in your head to produce all those symptoms you

Channel: Craig Blackwell

Views: 21,729

Keywords: Migraine., Headache., Visual, Aura., Sensory, Triggers.

Id: s3s1zkIXiCU

Length: 11min 9sec (669 seconds)

Published: Sun Dec 19 2010