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What is Migraine?

From the sufferers' viewpoint classical migraine begins with what is known by doctors as an aura. This is often a disturbance of vision that usually starts in the middle of the field of vision and slowly moves outwards to the outside. It will start as a fuzzy spot that turns into an expanding ring of wavy lines that over twenty minutes or so will slowly progress outwards and then vanish. The aura may also be a mood change, pins and needles in one side of the face, tongue or arms or even a strange but familiar smell or taste. Rarely it may show itself as weakness of one side, loss of consciousness or double vision. This first part of the attack is thought to be the result of the release of certain chemical transmitters around the blood vessels that go through the neck. These chemicals cause a tight narrowing of the blood vessels to the brain and this starves the brain of blood.

The longest of the nerve fibres in the brain deal with vision and these are the most vulnerable to the reduction of blood flow caused by the tightened arteries and they react to it by not working properly. They react to this reduction of blood flow by not working properly for the length of time that they are starved of blood by the tightened arteries. It is this starvation that causes the sight disturbance. It is not known exactly what triggers the blood vessel tightening but as well as the three major factors of stress, heredity and food intolerance the long list includes too much or too little sleep, fever and flashing lights.

The next phase begins as the blood vessels return to a normal size. Unfortunately they continue to widen and overshoot to become far too wide, just like a pendulum that has been pushed too hard. The degree of over wideness can go on for a few days before the blood vessels slowly return to a normal size. The blood vessels that are most affected by this wideness change spread all over the head and scalp and they have sensors that detect any change in size. The blood vessel walls are repeatedly over-stretched and released as each heart beat pushes the blood through the vessel, making the sensors send out signals which cause a pounding headache.

Another effect of having a supply of too much blood to the brain is that the brain cells become a little swollen with excess fluid. This leads to the nausea and vomiting, and the dislike of bright lights and loud sounds that are such a problem in migraines. The blood vessels are affected on only one side of the head so the headache of any one attack is only one-sided. This is thought to be an adaptive measure to make sure that the brain is not permanently damaged by the migraine attack. Reducing the blood flow on both sides could well cause so little blood to get to the brain that there could be permanent brain damage. Despite the fact that the blood supply is reduced on only one side the visual disturbance is experienced on both sides, seeming to be in both eyes. This is because of the way that the bundles of nerve fibres dealing with vision split and go to both sides of the brain where they produce the things that you recognise as sight.

Each eye has a left side and a right side, so the left eye would contribute to both the left and the right sides of the vision, and if its nerve fibres are starved then it's contribution to both the left and the right sides of your sight are affected. This is how you can shut one eye, look at a distant object and see almost the same as you could if you shut that eye and opened the other one.

The brain slowly recovers from this blood starvation and for a few days after the headaches have gone you will feel tired and any coughing or sneezing will produce a spike of headache on the affected side. Most people who have migraine attacks regularly have them on the same side, either left or right. However they can alternate or change sides permanently but this is unusual

Migraine is a very variable problem both in frequency and severity and the pattern described above is the standard textbook pattern. Some people only have one or two mild attacks a year that cause little inconvenience except during the "aura phase" when driving or operating machinery may be difficult. Others may have two or three attacks each week and have to spend many days each month lying down in a darkened room. The attacks can also fluctuate in frequency and severity in the same person over time. As you get older the arteries tend to become hardened and less able to tighten and widen. In these circumstances people may well grow out of their migraines whatever their cause.

Certain preparations containing ergot used sometimes by mainstream medicine are dangerous in these circumstances because they work by tightening the arteries and if your arteries are already narrowed and hardened there is the risk of causing a stroke or heart attack. Ergot preparations are also dangerous in pregnancy as they can cause miscarriage by tightening the muscles of the womb that are of a similar structure to the muscles in the arterial walls.

In children there is a variant of migraine where the major symptom is abdominal pain, bloating and vomiting. This follows the usual timescale and triggers of ordinary migraine but there is often little or no aura or headache. It is thought that in these children the blood vessels in the abdomen and intestine react in a similar way to the neck arteries in normal migraine and tighten then expand causing disturbance to the normal functioning of the bowel. That leads to the abdominal pain, vomiting and bloating of the abdominal migraines.

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