Migraine can be precipitated by tension, anxiety or any stress and can be relieved at times by pressure over the carotid vessels in the neck. Certain food items, smoking, alcohol, hormonal changes, environmental factors, etc. can trigger a migraine episode. It is important to note that, for example, coffee may relieve headache in some people while it may precipitate or aggravate a headache in others. Usually the same person always responds in the same way. Routine physical exercise or activity may also aggravate the severity of migraine. Some people exhibit high sensitivity to noise or light. Many sufferers prefer to lie down in a quiet, dark room. If they get sleep, they feel much better and the headache is eased. Therefore, a person with a headache must try to sleep, if possible.
When a patient has a positive family history, i.e. more than one sibling or one of the parents also suffers from migraine, the doctor will be interested in finding out how his or her headache differs from that of the other sibling(s) or parents(s). Often, it turns out that the sibling’s or parent’s headaches have been mild and even forgotten. However, when they are asked to compare their headaches, their periodicity and accompanying nausea are undoubtedly established. Family history is more frequently elicited in classical migraine than in common migraine.
According to both the vascular and the neurogenic theory there is vasoconstriction (narrowing of blood vessels) in the early phase of each migraine episode. Vasoconstriction leads to deprivation of blood to the area in which it takes place. It should now be easier to understand the various focal neurological signs developing during the course of migraine. These are more apparent and frequent in the aura phase. The symptoms depend on which artery is involved, how severely and for how long. Some symptoms are not very specific to an area, like the cortex. Seeing flashes of white or multicolored light and zigzag lines before the eyes indicated retinal ischemia. These are due to ischemia of the visual cortex in the occipital lobe. There may be motor, sensory, speech, or any combination of motor and sensory symptoms. In a given patient these tend to occur in the same combination during each attack. The neurological defect is usually temporary but in rare cases it may become permanent. Neurologic abnormality recurs with regularity in the beginning but subsequently becomes irregular, with decreasing frequency and severity. But there are variations. As mentioned earlier, the symptoms depend on the arterial territory and specific syndromes have been recognized. These are ophthalmologic (basilar artery) and hemiplegic retinal artery) migraine.
