Now, let’s get to something a little less gruesome and frankly something a little more common, which is migraine. Migraine is very, very prevalent in the United States. Seventeen percent of women and 6% of men in the United States suffer from at least one migraine a year. So we are talking about a very prevalent problem. What’s spooky about the American Migraine Study is this: although it is very prevalent, the diagnosis rate is terrible. Look at this. Only 41% of women with migraine get diagnosed, only 29% of men with migraine get diagnosed in the United States. Common problem, terrible diagnosis rate. There seems to be a sentiment out there that men don’t get migraine.

Now migraine being with a prodrome.

Very often migraine begin with a prodrome and that’s not very often spoken about. We talk about auras – I’ll talk about aura’s a little bit too – but prodromes are very common. Prodromes occur up to a day before a migraine begins, and I’ll give you some examples of what prodromes are like. There are often changes in mentation. Many people feel depressed before their migraine, but actually more people with migraine feel euphoric. Many people are actually in a great mood, feel very, very well the day of their migraine. Some begin to yawn. I’ll tell you that spouses are better than headaches sufferers at figuring this out. Someone’s walking down the street, three o’clock, they slept well, suddenly they are yawning because a migraine prodrome can be a mild encephalopathy. People don’t think very clearly. Cold hands and feet, and anyone who sleeps with someone with migraine will tell you that even interictally they have colder hands and feet than the general population, but often before their migraine, they get even colder. Then frequent urination can occur, neck stiffness can occur and food cravings can occur as a migraine prodrome. Now this is interesting because the food craving that seems to do it the most is a craving for chocolate. Now we are very familiar, all of us are familiar with food cravings and food aversions in pregnancy. Very neurobiologically mediated. We have to accept this. But food cravings for chocolate are a very common migraine prodrome. I don’t know if you realize this, but if you give migraineurs chocolate or a placebo, you can generally distinguish between who gets a migraine. Probably chocolate doesn’t trigger a migraine, but at the same time a chocolate craving can be a migraine prodrome, people act upon it and they relate eating the chocolate to triggering the migraine. But that’s probably not the mechanism.

New we divide migraine into migraine with and without aura and that changes the terminology that I learned in medical school, of classic and common migraine.

Everyone learn this? Okay, forget it. You can’t use it anymore, so don’t ever say that word. It’s now migraine with or without aura. Now migraine without aura is more common. About 85% of people with migraine have migraine without aura. Now what is that? Basically it is a pain which, in adults, is usually unilateral. In children it’s usually bilateral. But most of the time, in adults, it’s usually unilateral, usually pulsatile and worse with routine movement. I’m sure there are people out here who have migraine; if you have a migraine and someone drops something on the floor, you will do anything you can to avoid leaning over and picking it up. That kind of maneuver is awful, terrible. Migraineurs don’t like to exert themselves. That enhances the pulsatile quality of their migraine. They last 4-72 hours, by definition and they are associated with autonomic symptoms; light sensitivity, sound sensitivity, and although the IHS doesn’t include this, smell sensitivity. Migraineurs don’t like you to be doing a whole lot of cooking when they are getting a migraine.

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