By Tamara Sandler, M.Ed., ATC
Migraines are non-discriminating; they affect men, women, and children of all ages, and all ethnicities. There are two main types of migraines: classic migraines and common migraines.
Classic migraines are associated with a proceeding aura. The aura, which occurs in about 20% of migraines, is a disturbance to one of the five senses: visual, usually distorted vision or zigzag lines; auditory, resulting in a buzzing sound; olfactory, a familiar smell with no logical explanation; or some type of physical sensation. The aura usually lasts about an hour before the throbbing effects of the migraine kicks in. Only about 15-20% of patients with migraines present with the classic migraine aura.
Classic migraines are broken down in to five phases:
- Phase One (prodome) – occurs anywhere from several hours to several days before the headache. During this phase sufferers will feel drowsy and irritable.
- Phase Two – the aura disturbances are present. This lasts for about one hour.
- Phase Three – the patient will experience a pulsating pain of the headache on one side only.
- Phase Four (the resolution phase) – the headache begins to lessen and eventually exhausts.
- Phase Five (postdrome) – during this phase suffers loose appetite and seems very fatigued.
Common migraines are associated with the extreme pain with no signs or symptoms previous to its occurrence.
Symptoms that are associated with the common migraine (without aura) include nausea, vomiting, sensitivity to light, sound and movement. These migraines can last anywhere from four hours to 2-3 days depending on treatment.
The International Headache Society (IHS) came up with certain criteria to classify and diagnose migraines. To be clinically diagnosed with common migraine without a proceeding aura, patients must present with at least five headaches lasting any where from 4-72 hours. The migraine should be experienced unilaterally, with a pulsating nature, and/or it must inhibit the daily activities of the patient. During the headache the patient should experience nausea, vomiting, and/or sensitivity to light or sound. Clinical diagnoses of patients with classic migraines that include a proceeding aura are slightly different. Patients must experience only two instead of five attacks of migraines that include a fully reversible aura; the aura symptom must not last more then one hour preceding the debilitating headache.
Who do Migraines Affect?
Men and women are both susceptible to migraines. As children, headaches affect boys more often they do girls. As they reach puberty, girls become more prone to headaches than boys. As the female matures, migraines become most prevalent around the ages of 20-35. In the United States migraines affect 8.7 million women and 2.6 million men every year.
Migraines affect people of all ethnicities, African American, Caucasian, Asian Americans, etc.; although, migraines affect some ethnicities more then others. Studies have shown that Caucasian women have the highest frequency of migraines, although Asian and African men and women’s migraines occur earlier in life then Caucasians. The African American population has shown to have a higher rate of the classic migraines then common migraines. Symptoms that African Americans have associated with their migraines include increased pain and photophobia. Another complaint has been increased pain with increased activity. In looking at the work habits associated to their migraines, African Americans seemed to have more migraines, but were less likely compare to their Caucasian counterparts to miss work due to their migraine. Stewart et al found that education levels showed a trend in migraine frequencies as well. The more education an individual has (college degrees or masters) the less frequently migraines occur compared to the individuals who finished school with just a high school diploma.
There are many different stimuli that can trigger a migraine. Some of the common triggers include some types of food or beverages, different types of lighting, weather, sounds, stress, and hormones.
The first step in formulating a treatment plan is to educate the patient as to what migraines are and what steps will be taken to control the effects of the migraine. Identifying the severity, duration, frequency, and triggers of the migraines is critical in choosing a proper treatment plan. This can be identified through the use of headache diaries. Patients are recommended to document any occurrence of migraine symptoms including: time, frequency, duration, intensity, and what they feel might have triggered the migraine at that time. This tool has shown to be very valid and effective in treatment planning. When formulating a treatment plan the use of non-medication treatments should be used first. This can be done by suggesting alterations of the patients life style including; nutrition, sleep habits, and daily exercise programs.
Migraines affect people of all ages, races, and types. They can have a negative affect on people’s daily life, both socially and economically. Identifying the stimuli that may trigger a migraine and making some life style changes may help in decreasing, or even preventing, migraine attacks. The use of migraine diaries have shown to be a useful tool in keeping track of those things. The use of medications and alternative treatments may also aid in controlling the attacks of migraines.
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- Lipton RB, Bigal ME, scher AI, Stewart WF. Migraine: epidemiology, impact, and risk factors for progression. Headache. 2005; 45:S1-S3
- Cuppett M, Walsh KM. General Medical Conditions in Athletes: Neurlogic Disorders. Philadelphia : Mosby INC
- Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 1988;8(suppl 7):1-96
Lewis DW. Headaches in children and adolescents. Ame family phy. 2002
Tamara Sandler, M.Ed., ATC, will continue to serve as the Head Athletic Trainer at Carver High School through Hughston Hospital’s Athletic Training Outreach Program. This will be Tamara’s third year with the Tigers. She was a recipient of the Hughston Athletic Training Fellowship in 2006 and completed her Masters of Education in Health and Physical Education, with teacher certification in May of 2008. Tamara is employed with the Muscogee County School District and will be teaching physical education at Rigdon Road and Georgetown Elementary Schools.
She received her Bachelors of Science Degree in Sports Medicine/Athletic Training from the University of South Florida in May of 2006. While at USF, her responsibilities included women’s soccer, softball, men’s basketball, and football. Along with her commitment to school and athletic training duties, she was an active member of the student athletic training association and served as the Social and Intramural Chair for the organization. She is also an active member of the National Athletic Trainers Association (NATA), Southeast Athletic Training Association (SEATA) and the Athletic Training Association of Florida (ATAF). She is married to Jared Sandler, Assistant Athletic Trainer at Columbus State University.