More than half of migraine sufferers rely on over-the-counter pain relievers or simply tough it out with no drugs at all to treat their migraine headache. Over 40 percent have never used preventative therapies such as propranolol (Inderal), topiramate (Topamax), and divalproex sodium (Depakote) to treat a migraine attack, although these drugs have been proven to significantly decrease migraine occurrence, severity, and duration. And an estimated 60 percent use over-the-counter treatments only to ease the pain of migraine. Overuse of some OTC treatments can result in rebound headaches, resulting in a constant cycle of headache pain.
With such effective treatments available to ease this debilitating condition, why do so many people continue to suffer the pain and poor quality of life associated with migraine? Sometimes, migraineurs who have had a bad previous experience with a doctor or course of drugs will attempt to self-treat the condition. The patient may discontinue a medication due to side effects, unaware that dosage adjustments or other medications are an option. Or, the patient and doctor may not be up-to-date on the available therapies. Understanding the nature of your condition and the choices available to you are key to getting the best possible care.
Migraine is classified by two major types -- migraine with aura and migraine without aura. An aura is a group of changes that proceed a migraine headache, including visual, sensory, and cognitive changes. Both types share some common features, including a duration of roughly four to seventy-two hours and a one-sided, pulsating headache that worsens with even light physical activity.
Around 80 percent of migraineurs have migraine without aura, also called common migraine. Their headache begins without the "early warning system" of the aura. However, some people with this type of migraine may experience a prodrome -- a group of physical and/or emotional symptoms occurring up to seventy-two hours before a migraine headache.
There are some uncommon health conditions that may mimic migraine with aura. For this reason, your physician will take a complete health history and perform a physical and neurological exam to rule out other causes of aura and headache.
There are several less common classes of migraine that fall outside of the two major classes described previously. These are:
Basilar Migraine: A migraine with aura causing neurological dysfunction in the area of the brain supplied by the basilar artery, the brainstem. It has a specific aura profile, and the migraine pain affects both sides of the head.
Familial Hemiplegic Migraine: A severe but rare migraine with aura that causes weakness or paralysis on one side of the body and can result in coma.
Retinal (or Ocular) Migraine: A rare type of migraine associated with blindness or blurred vision in one eye for an extended period (to be distinguished from typical migraine aura which upon careful assessment involves the same points in the visual field of both eyes for five to thirty minutes). (Tests have shown that lens replacement surgery or laser eye surgery may have some benefits in this regard.)
Abdominal Migraine: Most common in children, abdominal migraine is characterized by bouts of abdominal pain, nausea, and vomiting that can last for up to seventy-two hours.
Migraine Aura Without Headache: In this type of migraine, the typical visual and neurological symptoms of aura occur, but there is no headache that follows.