UHAM029

12 ^ UNDERSTANDING HEADACHES AND M I G RAI N ES von Bingen. She died around 800 years ago and is famous for many things, including her composition of religious musie. She also experienced ‘visions’ throughout her life, which were interpreted as visitations from angels and other holy phenomena. Of course, it’s not for us to say that this interpretation is not the truth. However, some now argue that the visions match very closely the visual disturbances found among migraineurs, such as the scintillating aura. Hildegardsaw ares of light in front of her eyes, like the wings of angels. Of course, to the non-religious, this bears a striking similarity to a symptom of migraine. She saw showers of stars, which can be interpreted today asphosphenes (which many people occasionally experience, not just migraineurs). Our evidence for this comes from the illustrations and descriptions that she left behind in her writings. To a modern doctor, the parallels between her visions and the signs of migraine are startling. To readmore about Hildegard von Bingen, try 01iver Sacks’s book Migraine, or try an internet search for Hildegard herself.

Men and women

Migraines are mainly experienced by women - in fact they affect three times morę women than men. Ob viously, this figurę is added to by the fact that some women have migraines which are associated with their menstrual cycle. These can take two forms, the true menstrual migraine and the menstruation-related migraine. True menstrual migraines are caused, it is thought, by hormonal changes and can be treated by drugs similar to those in contraceptive pills. This type of migraine affects around 10 per cent of women and occurs on the first day of the menstrual cycle plus or minus two days. Therefore, they can occur as early as two days before the start of the cycle, or three days into it. (Of course, when a woman has a disrupted cycle this may be morę difhcult to determine.) True menstrual migraines are most likely to be migraines without aura.

Menstrual-relatedmigraines, however, aremorecommon (uptotwo-thirds of women claim that their periods can make migraines worse) and can happen at any time in the menstrual cycle, but they are often experienced at a particular point within the cycle, such as ovulation. Migraines can be part-and-parcel of generał PMS and can be caused by a number offactors, including psychological factors such as stress. For some women, periods are very stressful: they may be painful or are perceived to be messy; they may make the women feel ill; or the women may also have problems that make the periods unpredictable. We know that stress contributes to migraines, and so it makes sense to assume that menstrual stress can lead to menstrual-related migraines. Tension-type