Understanding Chronic Pain

Migraine

[From Chapter 15 of Understanding Chronic Pain]

Migraine is a disease of periodic headaches separated by intervals of wellness. That is the briefest and possibly the best definition we have for the disease. There are, of course, more elaborate diagnostic criteria for migraine. The location, duration, and character of the pain, and the variety of accompaniments that attend the painful interval allow us, at least in typical cases, to make a diagnosis of migraine with relative ease. In clinical medicine, however, most patients are not typical, and the distinction between migraine and other forms of headache can be quite difficult. Some of the difficulty is of our own making. In our efforts to define migraine on the basis of its painful characteristics, we overlook the cardinal feature of the disease, that it goes away, and between attacks the patient is quite well.

The typical migraine attack, formerly called classic migraine, but now migraine with aura (more descriptive, but it does lack flair), begins with a prodromal or aural experience. This is usually a change in mood or temperament, often a sense of restlessness or despondency. The senses of taste and smell may be disordered during the migraine prodrome, but it is vision that is most often disturbed. The migraine aura may consist of scintillations, sparkling lights across the field of gaze. A blind spot, typically geometric and polyangular in configuration, may appear. This scotoma, frequently bordered by scintillations, may remain fixed in visual space, but more often it expands in size and migrates from one segment of the visual field to another, crossing left-right boundaries. Visual field defects may occur. This is the effect of a drape moving across one half of the vision producing a hemianopia. Sometimes only a quarter of vision is lost, a quadrantanopia. Curiously, the visual effects of migraine are almost invariably geometric hallucinations of vision. Always inanimate, there is never a hallucination of people, places, or recognizable things. Remarkable when you think about it. The dysfunctional brain of migraine expresses itself, at least visually, in abstract structural configurations. This occurs in no other disease. It is unique to migraine.

Somatic as well as visual sensation is disordered in the migraine aura, usually in a very lateralized manner. A sense of localized numbness and tingling is often a prodromal experience. It is usually confined to one side of the face but sometimes extends to the hand. Motor function is disturbed also, and it too is unilateral, consisting of transient weakness, usually in one arm. The function of speech, a unilateral left brain attribute, is frequently impaired.

You can read the rest in Dr. Cochran's book, Understanding Chronic Pain

Last Updated: Nov 19, 08:31 AM

Comment

1. I don’t have the aura of lights when a migrain is coming on, mine lets me know within 24 hours by being bone chilled. I can be in 100 degree weather and be freezing. With my clusters I found going to the ER and be put on 100% air for half an hour and they go away. But the migrains that I get, makes me so sick that they have to give me Dilauda with Pheneragan and oxygen. I am currently suffering with burning pain from my neck into my shoulder blades and a splitting migrain on top. They have become a daily thing. I have no pain medication left, and my only recourse is the Emergency room. I don’t know what else to do and I don’t have any muscle rub either. Most of the time when they strick, I have to have a very cold room, about 10 quilts on me to help with the shivers, and a Chiropractor had me rub Ben Gay on the temple where the pain was. Along with the pain medication it would help ease the pressure so I could sleep. But now they are a daily occurance because of the cancer in my bone marrow and with my neck so messed up. What can I do?

   — Kathy Newton · Jan 22, 02:59 AM · #

2. Thanks, Interesting that your migraine prodrome is chilling. Haven’t heard that before but I certainly accept it. Migraine can do almost anything! Im not sure, from limited information, that worsening migraine is necessarily related to the cancer. May be related to mood but there are lots of other posibilities. Regardless, I’m rather sure you can get better with pharmacy. Best Bob Cochran

   — Robert Cochran · Jan 22, 12:11 PM · #

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