Migraine is more than just a headache. In fact, for many people it’s not a headache at all. Bouts of vertigo, waves of nausea, vision loss, and the inability to speak or walk are just some of the scary symptoms that people with migraine with aura can experience.
Dr. Shazia Afridi is a neurologist at Guy’s and St. Thomas’ National Health Service Foundation Trust, where she runs the headache service in the neurology department. She has also been a council member of BASH, the British Association for the Study of Headache, and is a current trustee of the Migraine Trust, one of the largest migraine foundations in Europe. Dr. Afridi was also on the scientific committee for The Migraine Trust International Symposium in 2018.
What are the two primary types of migraine?
Dr. Afridi: “The most common form of migraine is migraine without aura, but about 30 percent of people have aura. Migraine, itself, is defined by the International Headache Society criteria as a headache which can be moderate to severe in intensity. It can be on one side of the head or on both sides of the head, and it has certain features associated with it. For example, nausea or vomiting can occur. People can be light sensitive during the migraine episode. They can also be sound sensitive so they don’t like to be in areas where it’s very noisy. Also, people like to keep still because when you do a bit of exercise the headache gets worse. So that’s migraine without aura.
Migraine with aura often has those features, as well, but it has separate features which are aura symptoms. The most common one is a visual symptom, visual aura, and that takes the form of, classically, zigzag lines or flashing lights which can move across the vision field. They can also take the form of almost blindness in half of the visual field. In addition to visual symptoms, patients may feel that they have sensory symptoms like numbness or tingling, and that can occur in the hands, mouth and tongue. Other people may find they have word finding difficulties during the attack.”
Are patients who have migraine with aura more at risk of stroke?
Dr. Afridi: “There has been some recent evidence to suggest that the relative risk of stroke is higher. You’re twice as likely to have a stroke if you have migraine with aura as opposed to those who don’t have any migraine. But you’ve got to put that into context. The absolute risk of stroke in a young healthy person is probably anything between two and four in 100,000. So if you’re doubling that, you may be going to between four and eight in 100,000. So there was a lot of controversy about whether this also affected migraine without aura, but it’s now widely believed that it’s mainly migraine with aura that confers that slightly increased risk.”
How do you tell the difference between migraine with aura and stroke?
Dr. Afridi: “Obviously, if it’s the first time you were having an episode, I can understand why people might be concerned. However, if you’re having repeated episodes of, for example, say a visual disturbance or sensory disturbance followed by a headache, and it’s always the same and it happens, say, every few months, then that’s migraine. That’s not going to be a stroke. The thing that would worry me are a first presentation. So never having had these symptoms before, something that comes on very, very suddenly … sudden weakness down one side, for example. Sudden symptoms that come on within a few seconds. Migraine with aura tends to come on over a couple of minutes. And then, of course, the duration of the symptoms is important. If someone has symptoms that persist and don’t go away, that’s also concerning because usually 20 minutes or so is typical.”
Watch the full interview to find out:
What types of head pain can occur with migraine?
Should women with migraine with aura take estrogen-containing pills for contraception?
How soon after an aura begins should the patient take their migraine medications?
What medications are used to prevent migraine with aura?
What are some medications for patients with hemiplegic migraine or basilar-type migraine?
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Posted in: Migraine Education