MIGRAINE

People may generally refer to any recurrent severe headache as, ‘Migraine’; however, Migraine is a complex disorder caused by specific physiologic changes in the brain. Most often it is unilateral and may or may not be associated with visual or sensory symptoms, which are known as Aura. Aura arises mostly before headache, and may occur during or after too. Migraine is more common among women and it has a very strong genetic component.

Signs and Symptoms

Typical symptoms of migraine are:

  • Pain mostly on one side of your head and only in areas around forehead and eyes, but you may feel the pain throughout your head, face, and neck
  • Pulsating headache, the pain intensifies with physical activity
  • Pain builds up over 1-2 hours and may last for 4-72 hours.
  • Nausea, vomiting, eating disorder, intolerance towards food, and feeling light-headed
  • Increased sensitivity towards light and sound

Migraine Aura

More than 30% of people with migraine experience aura. Most commonly occurring auras are visual, however, they can also be sensory, motor, or any combination of these. Some of the migraine auras are:

  • Visual: People have experienced a flashing light, a zig-zag pattern, an arc or band of absent vision and even blind spots. The most common visual aura is a scintillating scotoma, an arc/band of absent vision with a shimmering/glittering zigzag border
  • Sensory: People have experienced numbness, hearing noise, and a needle-like tingling sensation especially in arms that progresses to neck and head or to one side of entire body,
  • Motor: most people have experienced dizzy feeling, some people have experienced difficulty in speaking, uncontrollable jerking or other movements, and in some rare cases, loss of consciousness

Aura varies among individuals. Typical characteristics of migraine aura are:

  • May precede or accompany the migraine and may occur in isolation
  • Build up over 5-20 minutes, and may last up to 60 minutes
  • Visual aura could be positive or negative

Stages of Migraine

Migraine builds up and progresses in multiple stages, however not everyone goes through all of these stages. The stages of migraine are:

  • Pre-headache Stage: Also known as prodromal stage, onsets several hours/days before the migraine attack, and people experience fluctuations in their mood, behavior, energy level, and appetite; they also experience constipation, neck stiffness, frequent yawning, and increased thirst and urination
  • Migraine Aura Stage: People may or may not experience migraine aura
  • Headache Stage: unilateral pulsating pain along with other symptoms of migraine
  • Resolution Stage: aura, headache, and the symptoms fade away, however, one may continue to feel tired for few days

Types of Migraine

There are various types of migraine, including:

  • Migraine without aura/Common migraine
  • Migraine with aura/Classic migraine
  • Probable migraine without aura
  • Probable migraine with aura
  • Childhood periodic syndromes
  • Chronic migraine
  • Chronic migraine, associated with analgesic overuse
  • Silent migraine/migraine aura without headache

Causes of Migraine

The causes of migraine are not clearly understood, however studies have shown that genetics and environmental factors play a significant role. Any abnormal brain activity that temporarily affects signals from nerves, chemicals, and blood vessels in brain is thought to cause migraine.

Migraine Triggers

Migraine triggers vary among individuals. One may have more than one trigger. It is also difficult to separate triggers form the symptoms. Some of the most common triggers are:

  • Hormonal changes in women: Changes in estrogen level is known to trigger migraine among women, before and during menstruation, and during pregnancy and menopause.
  • Emotional triggers: Certain emotions such as stress, anxiety, excitement, tension, shock, and depression may trigger migraine.
  • Physical triggers: Any sudden change in your routine related to physical activity or rest may trigger migraine. Some of the common physical triggers are exhaustion, lack of sleep, poor quality of sleep, working in shifts, jet lag, poor posture, unusual strain, and tension in neck and shoulder.
  • Dietary triggers: drinking caffeine such as coffee or tea, drinking alcohol, dehydration, having irregular meal pattern, consuming salty or aged foods such as cheese, consuming processed food, artificial sweeteners, some preservatives, and some food such as chocolate and citrus fruit trigger migraine.
  • Environmental triggers: Bright light, flickering light, loud noise, smoky and/or stuffy atmosphere, and weather changes such as sudden drop in temperature and high humidity trigger migraine.
  • Medicinal triggers: vasodilators such as nitroglycerine, few sleeping pills, and oral contraceptive pills may trigger migraine. Pills prescribed for hormone replacement therapy may increase or decrease the tendency to migraine attack.

Uncontrollable Risk Factors

Certain factors make one more prone to migraine. These factors cannot be controlled and they are:

  • Gender: Women are at the risk of migraine thrice as much as men.
  • Age: Before adolescence boys are more prone to migraine attacks, however, after puberty women are more susceptible to migraine.
  • Family history: If either one of your parents or any other family members have migraine, it is most likely for you to have one too. Studies show that around 90% of migraine patients have family history.

Treatment

The current treatment techniques do not fully cure migraines, however they help you reduce the severity of both the symptoms and the pain. There are plenty of medications available and they have different effect on each individual.

If you are trying over-the-counter painkillers for the headache, read the leaflet for possible side effects, and any suggested precautions. If the patient is below 16 years of age or is pregnant or is breastfeeding, it is highly recommended not to try these medications and consult a doctor right away. It is also advisable to take these painkillers immediately when the pain onsets. Do not wait for the pain to become worse. Sooner the painkiller enters your bloodstream, the easier it is to manage pain. It is for the same reason you may want to try the dissolvable medications. If you have vomiting sensation, try suppositories.

Consult your doctor immediately if the painkillers are not effective, or if you have a pre-existing condition such as stomach problem, liver problem, and kidney problem. Your doctor may prescribe various combinations of the medications till you find the one that works best for you. The prescribed medications can be broadly classified into two categories:

  • Painkillers: There are some advanced painkillers available, which your doctor may prescribe along with some anti-sickness medications, to ease migraine. These medications are available in tablet, injection, suppositories and nasal spray forms. Taking too much of such painkillers may result in medication ‘chronic migraine, associated with analgesic overuse’, hence your doctor may recommend a follow-up appointment.
  • Preventive medications: If you have more than four migraine attacks in a month, if the prescribed pain relieving medications are not effective, if you suffer from a long pre-headache and post-headache stages, your doctor may suggest preventive medications, which you need to take regularly to reduce the frequency and severity of migraine attacks. Preventive medication strategies are highly specific to an individual. What works for one, may not work for another. For example, some patients who have ‘migraine with aura’ could successfully manage migraine with Transcranial Magnetic Stimulation (TMS). In case of patients suffering from menstrual related migraine, hormonal treatments are beneficial for some while non-hormonal treatments work best for others. Acupuncture works well for some who have failed to manage migraine with medications.

If the treatment is not effective, your doctor may recommend consulting a specialist for further investigation and treatment.

Life-style Changes

In addition to treatments above mentioned, you may try changing your lifestyle to reduce the frequency of migraines. Alterations such as eating in time and sleeping enough, avoiding migraine triggers, drinking plenty of fluids, being physically active, and avoiding stress will help you to a greater extent in effectively managing your migraine attacks.

 

 

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