Parafon (Chlorzoxazone)
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THE TWO TYPES OF MIGRAINE
Migraine is divided into two major forms, the classical migraine and the common migraine. The common variety accounts for approximately 80 percent of all migraine attacks, although ironically it is the less frequently occurring classical form that is the most familiar and the easiest to diagnose. The term “classical” is applied because of the many historical references to this form of the syndrome.
Migraine is divided into these two types because differences exist between their symptom patterns, although both do share the common feature of headache and are thought to come from the same or similar biological abnormalities. In many people, attacks share features of both types of migraine and a separation into distinct forms is impossible.
Symptoms of classical migraine-In classical migraine the attack occurs in two phases. The first phase begins before the headache develops and is appropriately called the preheadache phase, or the prodrome. The word “prodrome” comes from the Greek word “prodromos,” meaning running (drotnos) before (pro). The preheadache phase usually begins approximately ten to thirty minutes before the beginning of the headache phase and is characterized by one or more of several symptoms.
Visual symptoms represent the most common preheadache disturbance in the classical migraine, varying from blurriness to partial blindness. The visual symptoms are often dramatic. Some people describe “flashbulb” blind spots occurring in one or, more commonly, both eyes. Others have the experience of illuminating or sparkling phenomena appearing as either small spots or unusual shapes and forms. Some of these phenomena are multicolored as well. One common pattern is called the “fortification spectra,” an elaborately designed zigzag form that glares or scintillates like a neon sign. The fortification spectra gets its name from the complex zigzag walls that were constructed around embattled cities for fortification.
During the preheadache phase, a partial blindness may occur. This blindness may take the form of a decrease or a complete loss of vision in one-half of each eye, a condition known as hemianopsia. An irregular blind spot located somewhere in the field of vision is also a common preheadache symptom. This blind area is called a scotoma. It is an island, or spot, of decreased or absent vision within an otherwise normal visual field. A person with a scotoma may, when peering into a mirror, be unable to see his/her own nose, ear, face, or other area, depending upon the scotoma’s size and location.
Occasionally migraine victims report tunnel vision, an effect that is like looking through binoculars. Some patients bump into Or stumble over objects during the preheadache phase of their attacks, citing clumsiness as the reason, when impairment of their side, or peripheral, vision is actually to blame.
Another bizarre visual phenomenon that can occur in migraine during the preheadache phase is referred to as the Alice in Wonderland syndrome. Lewis Carroll suffered from classical
migraine. It is possible that many of the unusual events depicted in Alice’s adventures actually reflect some of Lewis Carroll’s own migraine patterns, such as alterations in shape, hearing, taste, smell, touch, and body image.
While visual impairment is perhaps the most common preheadache symptom and may represent the only preheadache complaint, other dramatic nonvisual disturbances can also occur. A temporary weakness and sensory symptoms similar to numbness or tingling may develop on one side of the body or one section of the body. Slurring of words or an inability to express one’s self clearly may develop. Some victims experience increased sensitivity of their skin, which causes irritation when the skin is lightly touched.
Other symptoms that may occur in the preheadache phase include mental confusion, irritability, unexpected exhaustion and fatigue, mild fever, flushing or pallor, sweating, and dizziness. Some individuals describe a swelling in various parts of their body, while others state that they have diarrhea or an increased need to urinate. The hands and feet may become cold. Abdominal pain may also occur during the preheadache phase, although “abdominal migraine” is more common in children than in adults.
Many of the preheadache symptoms, particularly the ones related to neurological disturbances, such as weakness, visual distortions, and numbness or tingling, are believed to result from impaired blood circulation to specific areas of the brain. When these symptoms begin suddenly, they may seem like the beginning of a stroke. The neurological abnormalities may remain for some time after the preheadache period ends and, rarely, they become permanent disabilities.
Depending on one’s imagination, it is possible to find many references in Alice’s adventures that suggest symptoms of migraine. For example, the following is found in Through the Looking Glass:
The sun was shining on the sea
Shining with all his might: He did his very best to make
The billows smooth and bright?And this was odd, because it was
The middle of the night.
The moon was shining sulkily,
Because she thought the sun Had got no business to be there
After the day was done?’It’s very rude of him,’ she said
To come and spoil the fun!’
Is the sea, shining with all his might, a reference to the scintillating light phenomena that accompany so many migraine attacks?
“‘It’s very rude of him,’ she said, ‘To come and spoil the fun!’” Could this statement refer to the disruptive influence that a migraine headache can have?
The following passage is from the chapter “Queen Alice”:
“Take care of yourself!” screamed the White Queen, seizing Alice’s hair with both her hands. “Something’s going to happen!”
And then (as Alice afterwards described it) all sorts of things happened in a moment. The candles all grew up to the ceiling, looking something like a bed of rushes with fireworks at the top. As to the bottles, they each took a pair of plates, which they hastily fitted on as wings, and so, with forks for legs, went fluttering about in all directions: “and very like birds they look,” …
Notice the references to abnormal shapes and sizes, nickering lights, and the head, the latter suggested by the White Queen seizing Alice’s hair with both hands.
*15/88/2*
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