Though I’m kind of just parroting some of what others have said already, I think we will eventually find a few “common denominators” of the entire “migraine spectrum.” That is, I suspect we’ll discover that certain mechanisms underlie / characterize ALL forms and manifestations of migraine disorders.
But beyond that, I think there has to be a fundamental shift in how medicine – and doctors – tries to understand migraine and treat it. It used to be that “migraine” was defined as “really bad headache,” right? (And what we now call “MAV” used to be “floating-woman syndrome,” as Rauch says.) But now we better understand migraine as, quote, “A global disturbance of sensory signal processing.”
Most doctors still think of migraine, however, as a simple mechanism with a simple symptom: headache. That is, they figure “migraine” means “(head) pain,” nothing more, nothing less. Until doctors get beyond that antiquated mindset, they will continue to do little more than throw painkillers at it; those patients who present with dizziness or other symptoms will be handed off to an ENT (who will invariably misdiagnose, because they’ve basically been taught that dizziness equals inner-ear problem).
Anyway, when I spoke of a “fundamental shift,” I also had a second meaning. The first part was that doctors need to understand the full scope of migraine. Secondly, though, migraine OF ANY FORM ought to be treated on a patient-by-patient basis. Clearly there is no single treatment approach that works for everyone [or if there is, we’re far from finding it] – otherwise, there’d be a drug that works for EVERY MAV’er.
*[Edit: Consider Topamax. It’s an anticonvulsant, it enhances GABA, and it inhibits glutamate receptors, sodium channels, calcium channels and carbonic anhydrase (weakly). And what happens with most people? Their brain goes completely crackers! This drug should show us what happens when there are so many mechanisms of action that not only do we have NO CLUE what’s doing what, but some of those effects are at best unneeded, and at worst counterproductive, thus making the patient worse rather than better.[/i]
No, medicine ought to be working on somehow trying to determine what the entire migraine spectrum encompasses – the variables. What’s the person’s age, gender, family history of migraine, etc.? How long have they suffered migraine? Constant or episodic? True vertigo or some other form of dizziness (like lightheadedness)? Actual imbalance or mere feeling of it? What are the patient’s symptoms? (e.g., visual distortions? insomnia? rocking sensation? imbalance? light intolerance? visual hyperstimulation?)
There are a million and one such considerations, and given all the disagreement that exists about what causes migraine and what treats it (especially when it’s MAV), I think we have to deduce that each person’s migraine (…brain) is different because its mechanisms are greatly varied (except, as I said earlier, for a few mechanisms that I suspect are common to all forms of migraine).
Now if only we could start to somehow “map out” or discern whether certain symptoms correspond to certain mechanisms. Only then, I think, will we see migraine treatment move beyond what it is now – a hit-or-miss game of trying to nail the right drug (or combination) until one finally calms the storm.
… Sorry, guess I’m wordy today.*