Migraine Facts – Marcello Cherchi MD, PhD

Hi All,

Molly was given this paper by Dr Hain’s group a few months back. I think it’s a great piece of information.

29 April 09 EDIT: I thought this one should be put up as a sticky for a while. It’s timely given the other info we’ve had from Dr Rauch and Dr Hain and is a must read for someone who is just coming to grips with this junk.

Scott 8)

[size=200]Migraine Facts[/size]
Marcello Cherchi MD PhD

**[size=130]Migraine is very common[/size] **
Migraine is a very common disease, estimated by some studies to affect as much as 10% of the general population. It is sometimes difficult to diagnose migraine because it can have a wide variety of symptoms (Buchholz and Reich 1996).

**[size=130]Migraine is poorly understood[/size] **
The underlying pathophysiology of migraine remains incompletely understood despite considerable research efforts. Some of the proposed explanations include abnormal electrical activity in the brain, abnormal constriction of the cerebral blood vessels, and abnormal reactivity of those parts of the brainstem that process sensation from the face and head. The fact that migraine is poorly understood has made it difficult to come up with good treatments.

[size=130]Migraine is often misdiagnosed because it can masquerade as other diseases[/size]
Often patients do not receive appropriate medical treatment because they do not recognise that they have migraines (Cady and Schreiber 2002; Kaniecki 2002; Schreiber et al. 2004). A recent survey of several thousand people reported the startling statistic that 46.6% of patients who met the criteria for migraine actually thought that they had some other kind of headache. The most common erroneous self-diagnoses were “sinus headaches” or “tension headaches” (Lipton et al. 2002).

[size=130]Migraine can manifest with non-pain symptoms[/size]
A common misperception of migraine is that it is just a “really bad headache.” While it is true that many people with migraines find the headache to be the most incapacitating part of their migraines, it is very important to understand that migraine often involves non-pain symptoms. These non-pain symptoms are quite variable, and can include things such as visual changes, numbness or tingling, weakness of part of the body incoordination, language impairment, cognitive changes, and even alterations in consciousness. One of the most common non-pain symptoms of migraine is disequilibrium in its various forms, such as unsteadiness, dizziness, lightheadedness, or vertigo (Kayan and Hood 1984).

[size=130]Migraine is the most common brain-related cause of dizziness[/size]
Unsteadiness can be caused by problems in a variety of body systems, including the ears, eyes, neck, joints, muscles, cardiovascular system, and peripheral nerves. Unsteadiness can also result from brain problems, and when this is the case, the cause is usually migraine (von Brevern et al. 2005).

[size=130]The pain and non-pain parts of migraine can behave independently[/size]
Migraine is sometimes difficult to recognize because the pain part (the headache) and the non-pain part (whether it is dizziness, visual changes, weakness, etc.) do not necessarily occur simultaneously. In fact, the pain and the non-pain parts of migraine can follow completely separate schedules (Bisdorff 2004). Sometimes the non-pain parts of migraine have a rather chronic nature, and can even go on for several months, totally independent of actual headaches.

[size=130]Migraine can occur even without headache[/size]
Though rare, some people have migraines that rarely or never involve headaches. In other words, their migraines only have non-pain symptoms. You may have heard of so- called “ocular migraines,” and this is one example of a migraine that only has only non-pain symptoms (namely, visual symptoms) and no headache whatsoever. But any of the other non-pain symptoms mentioned above can also be the sole manifestation of migraine (Amos and Fleming 2000; Freedom and Jay 2003).

[size=130]Migraine characteristics can change over one’s life[/size]
The symptoms of migraine can change over the course of one’s life, and this is probably one of the features that make it difficult to recognize. Migraines can come and go; they can change in intensity, frequency or duration; and their non-pain characteristics can also change (Bigal et al. 2006; Kelman 2006).

[size=130]Migraine patterns are sometimes associated with hormonal fluctuations[/size]
It is fairly common for migraine patterns to coincide with other physiologic changes. A common example is that migraine can be affected by hormonal changes such as those that occur during the menstrual cycle (Brandes 2006).

[size=130]Migraine often occurs in association with other diseases[/size]
Migraine seems to occur in association with certain other diseases more frequently than would be expected by chance. For instance, migraine is found with greater than average frequency in people with thyroid problems, benign paroxysmal positional vertigo, seizures, Ménière’s disease, and mal de debarquement syndrome. This does not mean that they are the same disease. The reasons for these assocations are not clear.

[size=130]Migrane patients usually have normal neurological examinations[/size]
If a person with migraines has no other medical problems, then his or her physical examination is usually normal. One exception to this is that people with migraines sometimes have subtle abnormal eye movements which we can observe in clinic using infrared video Frenzel goggles (Kayan and Hood 1984; von Brevern et al. 2005). Sometimes migraine patients also have eye movement abnormalities that can be detected by a test we use in the clinic called electronystagmography (Szirmai 1997).

[size=130]There are no good tests for migraine[/size]
We diagnose migraine primarily based on the patient’s description of the symptoms. We rely on this because there is no blood test for migraine, and for the most part there is no CT or MRI that detects migraine. The only exception to this is that a small percentage of migraine patients will have small abnormalities on brain MRI (Swartz and Kern 2004). However, those abnormalities can also occur in certain other diseases, so the mere presence of the abnormalities does not make the diagnosis of migraine definitive.

[size=130]Keeping a diary may help make the diagnosis and identify triggers[/size]
Since the diagnosis of migraine relies on the patient’s description of the symptoms, it is often helpful if a patient keeps a diary. The diary should include a detailed log of the particular symptoms, including when they start, when they end, how intense they are, and whether a particular episode has any unusual characteristics. It is also helpful to include in the diary things such as foods eaten, activities, and sleep schedules, because sometimes a pattern emerges which helps identify potential triggers for migraines (Tepper et al. 2004).

[size=130]Migraine must be distinguished from other types of headaches[/size]
As discussed earlier, migraine can have a broad range of symptoms. This can make it difficult to distinguish from other diseases, including other types of headaches, particularly since the International Classification of Headache Disorders identified 184 distinct types of headache under 14 major headings (2004). Your doctor will work with you in trying to determine whether your symptoms might be related to migraine.

See the full paper above for all references.

Thanks Scott and Molly.

— Begin quote from “scott”

… the International Classification of Headache Disorders identified 184 distinct types of headache under 14 major headings…

— End quote

Wow, that’s a lot of different type of headaches! I think I can “only” identify about a half dozen with myself.


I definitely have the “No-Pain symptoms” which is referred to as a Ocular Migraine. I feel the pultze and motion in my head but no pain other than tension. I could relate a number of the symptoms mentioned. Thanks for posting.


— Begin quote from “joseph0952”

I definitely have the “No-Pain symptoms” which is referred to as a Ocular Migraine. I feel the pultze and motion in my head but no pain other than tension. I could relate a number of the symptoms mentioned. Thanks for posting.


— End quote

I know what you mean Joe. you and I talked about that a number of times. On bad days, I have this symptom as well. I used to have it 24/7 before topamax. I understand completely



I’m glad someone out there in MAV land understands the symptoms I have. By the way, I have e-mailed you and called you but did not hear from you. I hope you and your wife recovered completely from the flu or whatever it was.


hey buddy good to hear from you. Oh, if you called but didn’t leave a message, I wouldn’t have answered because your number comes up as “private”, and there are a few people I am avoiding that have numbers that come up as “private” lol so leave me a message and I’ll DEFINITELY call ya back buddy ;-). and yeah, Everything is well on my end. Talk to you soon!