Migraines are a debilitating and painful neurological condition, but psychological therapies can offer some respite. By Marc Wilson.
Many a bargain book has graced my shelves, some of which I have even read. I remember buying one in particular, for my wife – Migraine, by neurologist Oliver Sacks.
She opened it and immediately recoiled. Inside were several pages showing migraine patients' artistic renderings of their "aura" – the visual disturbance that precedes the onset of a migraine for up to a third of sufferers.
The most common type of visual aura is called a "fortification spectrum", a kind of zigzag pattern, often in the shape of a crescent, which typically moves and expands across the visual field. It's caused by the migraine "electrical storm" travelling across the visual cortex of the brain.
This particular picture of a fortification spectrum looked exactly like what my wife has experienced, and it's a sign of how potent that reminder was that just seeing someone else's drawing was enough to make her feel nauseous.
Auras don't always take this form and can also involve flashes of light or colour. Scotomas are auras or blind spots that obstruct part of your vision. The effects of auras can last up to 30 minutes.
If you're not a migraine sufferer and you're interested in what these auras look like, there are plenty of images on the internet. For more examples of auras and an academic commentary, look up "Exploring the visual hallucinations of migraine aura: the tacit contribution of illustration", by neurologist Geoffrey Schott. In this article, Schott summarises the drawings and accounts of scientists who recorded their own migraine experiences. I'm not going to show it to my wife.
Migraines affect more than 10 per cent of people worldwide, with women being affected three times more than men. There are different kinds of migraines, too, and the word describes a family of symptoms rather than a distinct malady. However, symptoms typically include severe, throbbing headaches, which last as little as four hours or as long as three days, and can be accompanied by sensitivity to sound, light or even smell. Nausea and vomiting are not uncommon.
Although many people who get migraines don't seek medical advice for the condition, they're still one of the most common reasons people go to the doctor, and one of the most common reasons for referrals to a specialist. Although we know there's a significant genetic component to migraines, the academic literature often includes the phrase "complicated and not fully understood". Recent advances in genomic analysis do seem to confirm that they're "neurovascular" – nerves in our blood vessels flash a pain signal that results in the release of inflammatory chemicals into the brain.
The mechanisms of migraines are clearly physiological, but there are also psychological dimensions. We know that stress is one of the most common triggers. Unsurprisingly, acute or chronic migraines are also stressful. Given this, it's not surprising that longitudinal research with sufferers has found that low moods can both precede and follow an "attack".
Thanks to new genomic discoveries that have identified specific markers for migraines, there are now some pretty swanky new medications, which is great. But there's still an important space for psychological therapy. These have been shown to be effective for helping people who experience acute and chronic pain.
A recent review of studies looking at treatments specifically for migraines concluded that therapies such as cognitive behavioural therapy, biofeedback and relaxation training resulted in a reduction in migraine frequency of up to 50 per cent, which is pretty good. If you want to find out more about them, take a look at the information provided by the Neurological Foundation. Or, if you experience symptoms similar to those I’ve described here and haven’t been to see your doctor, why not make an appointment? You won’t be alone.
