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Migraine

What is Migraine ?

The pain of a migraine headache is often described as an intense pulsing or throbbing pain in one area of the head. However, it is much more; the International Headache Society diagnoses a migraine by its pain and number of attacks (at least 5, lasting 4-72 hours if untreated), and additional symptoms including nausea and/or vomiting, or sensitivity to both light and sound. Migraine is three times more common in women than in men and affects more than 10 percent of people worldwide.

Migraine
Headache

Roughly one-third of affected individuals can predict the onset of a migraine because it is preceded by an “aura,” visual disturbances that appear as flashing lights, zig-zag lines or a temporary loss of vision. People with migraine tend to have recurring attacks triggered by a number of different factors, including stress, anxiety, hormonal changes, bright or flashing lights, lack of food or sleep, and dietary substances.

Migraine in some women may relate to changes in hormones and hormonal levels during their menstrual cycle.  For many years, scientists believed that migraines were linked to the dilation and constriction of blood vessels in the head. Investigators now believe that migraine has a genetic cause.

What are the Various Categories of Migraines?

There exists a range of migraine types, each potentially referred to by different names:

  1. Migraine with Aura (Complex Migraine): Approximately 15% to 20% of individuals with migraines experience an aura.
  2. Migraine without Aura (Common Migraine): This variety of migraine strikes without the preceding aura, though the symptoms remain consistent.
  3. Migraine without Head Pain: Also known as “Silent Migraine” or “Acephalgic Migraine,” this type includes aura symptoms but lacks the typical headache phase.
  4. Hemiplegic Migraine: Individuals with this type may experience temporary paralysis or sensory changes on one side of their body, often associated with numbness, extreme weakness, tingling, or vision alterations. Head pain may or may not accompany these symptoms.
  5. Retinal Migraine (Ocular Migraine): This type may cause temporary vision loss in one eye, along with a dull ache behind the affected eye that may radiate to the rest of the head. Vision loss can range from seconds to months, and it should always be reported to a healthcare professional due to its potential seriousness.
  6. Chronic Migraine: Chronic migraines occur at least 15 days per month, with symptoms and pain severity frequently fluctuating. Those with chronic migraines may rely on headache pain medications, which can unfortunately exacerbate the problem.
  7. Migraine with Brainstem Aura: This type is characterized by vertigo, slurred speech, double vision, or loss of balance preceding the headache. The pain is typically located in the back of the head and may be accompanied by an inability to speak properly, ringing in the ears, and vomiting.
  8. Status Migrainosus: A rare and severe form of migraine that lasts longer than 72 hours, accompanied by intense headache pain and nausea. Certain medications or medication withdrawal can trigger this type of migraine.

What Causes Migraines?

Researchers believe that migraine has a genetic cause. There are also a number of factors that can trigger a migraine. These factors vary from person to person, and they include

  • Stress
  • Anxiety
  • Hormonal changes in women
  • Bright or flashing lights
  • Loud noises
  • Strong smells
  • Medicines
  • Too much or not enough sleep
  • Sudden changes in weather or environment
  • Overexertion (too much physical activity)
  • Tobacco
  • Caffeine or caffeine withdrawal
  • Skipped meals
  • Medication overuse (taking medicine for migraines too often)

Some people have found that certain foods or ingredients can trigger headaches, especially when they are combined with other triggers. These foods and ingredients include

  • Alcohol
  • Chocolate
  • Aged cheeses
  • Monosodium glutamate (MSG)
  • Some fruits and nuts
  • Fermented or pickled goods
  • Yeast
  • Cured or processed meats

Who is at Risk for Migraines?

About 12 percent of Americans get migraines. They can affect anyone, but you are more likely to have them if you

  • Are a woman. Women are three times more likely than men to get migraines.
  • Have a family history of migraines. Most people with migraines have family members who have migraines.
  • Have other medical conditions, such as depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.

What are the symptoms of migraines? There are four different phases of migraines. You may not always go through every phase each time you have a migraine. Prodome. This phase starts up to 24 hours before you get the migraine. You have early signs and symptoms, such as food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination. Aura. If you have this phase, you might see flashing or bright lights or zig-zag lines. You may have muscle weakness or feel like you are being touched or grabbed. An aura can happen just before or during a migraine. Headache. A migraine usually starts gradually and then becomes more severe. It typically causes throbbing or pulsing pain, which is often on one side of your head. But sometimes you can have a migraine without a headache. Other migraine symptoms may include Increased sensitivity to light, noise, and odors Nausea and vomiting Worsened pain when you move, cough, or sneeze Postdrome (following the headache). You may feel exhausted, weak, and confused after a migraine. This can last up to a day. Migraines are more common in the morning; people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.

Common Migraine Triggers

Migraine attacks can be triggered by a variety of factors. Common migraine triggers include:

  1. Emotional Stress: Emotional stress is a frequent trigger for migraine headaches. Stressful events can lead to the release of certain brain chemicals, which can induce a migraine. Emotions like anxiety, worry, and excitement can also increase muscle tension and dilate blood vessels, potentially intensifying a migraine.
  2. Skipping Meals: Delaying or missing a meal can trigger a migraine in some individuals. Maintaining regular eating patterns can help prevent this trigger.
  3. Dietary Factors: Certain foods and beverages can be migraine triggers. These include aged cheeses, alcohol, chocolate, and foods containing additives like nitrates (found in pepperoni, hot dogs, and luncheon meats) and fermented or pickled foods. For some people, up to 30% of migraines can be attributed to dietary factors.
  4. Caffeine: Excessive caffeine consumption or sudden caffeine withdrawal can lead to headaches, as caffeine can affect blood vessels. While caffeine is sometimes used to treat acute migraine attacks, it should be used cautiously and not excessively.
  5. Medication Overuse: Frequent use of pain-relieving medications meant to alleviate headache pain can paradoxically lead to rebound headaches. This is a common issue in individuals who rely on pain relievers too often.
  6. Hormonal Changes in Women: Hormonal fluctuations in women, particularly around the time of menstruation, can trigger migraines. The drop in estrogen that occurs during the menstrual cycle is a common trigger. Hormonal changes can also be influenced by factors like birth control pills and hormone replacement therapy.
  7. Sensory Triggers: Sensory factors, such as exposure to bright or flashing lights (including from screens like TVs and computers), as well as sunlight, can provoke migraines in some individuals.

It’s important to note that migraine triggers can vary from person to person, and what triggers a migraine in one individual may not affect another. Identifying personal triggers can be helpful in managing and preventing migraine attacks.

What are the Four Stages or Phases of a Migraine?

The four stages or phases of a migraine are:

  1. Prodrome: This is the initial phase that can occur before the headache itself. It may last for a few hours to a few days and is experienced by some individuals as a set of symptoms that signal an impending migraine. Common prodrome symptoms include mood changes, fatigue, food cravings, and increased thirst.
  2. Aura: Not everyone with migraines experiences an aura, but for those who do, it typically occurs before or during the headache phase. Aura symptoms are usually temporary and can include visual disturbances, such as flashing lights or blind spots, as well as sensory disturbances like tingling or numbness in the face or extremities.
  3. Headache: This is the most well-known phase of a migraine. It involves a severe, pulsating headache that can last from a few hours to several days. The pain is often on one side of the head and is accompanied by other symptoms like nausea, vomiting, and sensitivity to light and sound.
  4. Postdrome: After the headache phase subsides, some individuals experience a postdrome phase, often referred to as a “migraine hangover.” During this phase, people may feel drained, fatigued, and mentally foggy. It can last for a day or two.

It’s important to note that not everyone with migraines experiences all four phases, and the severity and duration of each phase can vary from person to person.

What are the Symptoms of Migraines?

There are four different phases of migraines. You may not always go through every phase each time you have a migraine.

  • Prodome. This phase starts up to 24 hours before you get the migraine. You have early signs and symptoms, such as food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination.
  • Aura. If you have this phase, you might see flashing or bright lights or zig-zag lines. You may have muscle weakness or feel like you are being touched or grabbed. An aura can happen just before or during a migraine.
  • Headache. A migraine usually starts gradually and then becomes more severe. It typically causes throbbing or pulsing pain, which is often on one side of your head. But sometimes you can have a migraine without a headache. Other migraine symptoms may include
    • Increased sensitivity to light, noise, and odors
    • Nausea and vomiting
    • Worsened pain when you move, cough, or sneeze
  • Postdrome (following the headache). You may feel exhausted, weak, and confused after a migraine. This can last up to a day.

Migraines are more common in the morning; people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.

How are Migraines Diagnosed?

To make a diagnosis, your health care provider will

  • Take your medical history
  • Ask about your symptoms
  • Do a physical and neurological exam

An important part of diagnosing migraines is to rule out other medical conditions which could be causing the symptoms. So you may also have blood tests, an MRI or CT scan, or other tests.

Migraine is a neurological disease characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous systemsymptoms

Migraine is a neurological disease characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous systemsymptoms. The word is derived from the Greek ἡμικρανία (hemikrania), “pain on one side of the head”, from ἡμι- (hemi-), “half”, and κρανίον (kranion), “skull”.

Typically, the headache affects one half of the head, is pulsating in nature, and lasts from 2 to 72 hours. Associated symptoms may include nausea, vomiting, andsensitivity to light, sound, or smell. The pain is generally made worse by physical activity. Up to one-third of people with migraine headaches perceive an aura: a transient visual, sensory, language, or motor disturbance which signals that the headache will soon occur. Occasionally, an aura can occur with little or no headache following it.

Migraines are believed to be due to a mixture of environmental and genetic factors. About two-thirds of cases run in families. Changing hormone levels may also play a role, as migraines affect slightly more boys than girls before puberty, but about two to three times more women than men.  The risk of migraines usually decreases during pregnancy. The exact mechanisms of migraine are not known. It is, however, believed to be a neurovascular disorder.  The primary theory is related to increased excitability of the cerebral cortex and abnormal control of pain neurons in the trigeminal nucleus of the brainstem.

Initial recommended management is with simple pain medication such as ibuprofen and paracetamol (also known as acetaminophen) for the headache, medication for the nausea, and the avoidance of triggers. Specific agents such as triptans or ergotamines may be used by those for whom simple analgesics are not effective. Globally, approximately 15% of the population is affected by migraines at some point in life.

Responsive prevention and treatment of migraine is incredibly important.  Evidence shows an increased sensitivity after each successive attack, eventually leading to chronic daily migraine in some individuals  With proper combination of drugs for prevention and treatment of migraine attacks most individuals can overcome much of the discomfort from this debilitating disorder.  Women whose migraine attacks occur in association with their menstrual cycle are likely to have fewer attacks and milder symptoms after menopause.

Who gets Migraines?

Migraines can affect people of all ages, genders, and backgrounds. They are a common neurological disorder, and while they can occur at any age, they often begin during adolescence or early adulthood. Here are some key points about who may experience migraines:

  1. Gender: Migraines are more prevalent in women than in men. Hormonal fluctuations, particularly those associated with the menstrual cycle, can trigger migraines in some women. However, men and people of all genders can also experience migraines.
  2. Family History: Migraines often run in families, suggesting a genetic component. If you have a family history of migraines, you may be more susceptible to developing them.
  3. Age: Migraines can start at any age, but they are most commonly first experienced in the teenage years or early adulthood. They can continue throughout a person’s life.
  4. Other Health Conditions: Some medical conditions, such as certain neurological disorders, can increase the risk of migraines. Additionally, people with conditions like depression, anxiety, and sleep disorders may be more prone to migraines.
  5. Triggers: Migraines can be triggered by a variety of factors, including stress, hormonal changes, certain foods, dehydration, lack of sleep, and environmental factors. Different individuals may have different triggers.
  6. Lifestyle and Environment: Factors such as diet, physical activity, and exposure to environmental stimuli can influence migraine frequency and severity.
  7. Hormonal Factors: Hormonal fluctuations, particularly in women, can play a significant role in migraine occurrence. Some women may experience menstrual migraines triggered by hormonal changes during their menstrual cycle.

It’s important to note that migraines are a complex neurological condition, and their exact cause is not fully understood. They are influenced by a combination of genetic, environmental, hormonal, and lifestyle factors. Migraines can vary greatly in terms of frequency, duration, and severity among individuals. If you experience frequent or severe migraines, it’s advisable to consult a healthcare professional for diagnosis and management options.

How to Treat Migraine ?

Migraine headaches are a chronic condition that cannot be cured, but they can be effectively managed and their frequency and severity reduced. There are two main approaches to migraine treatment, which involve the use of medications: abortive and preventive treatments.

Abortive Medications: Abortive medications are most effective when taken at the first sign of a migraine, ideally when the pain is still mild. These medications are designed to stop or reduce the progression of a migraine attack and alleviate its symptoms, which may include pain, nausea, sensitivity to light, and more. Some abortive medications work by constricting blood vessels, returning them to their normal state and providing relief from the throbbing pain associated with migraines.

Preventive (Prophylactic) Medications: Preventive medications are typically recommended when migraine headaches are severe, occurring more than four times a month, and significantly disrupting a person’s daily activities and quality of life. These medications are taken regularly, usually on a daily basis, to reduce the frequency and severity of migraine attacks. The goal of preventive treatment is to decrease the overall occurrence of migraines and make them less debilitating.

chronic-migraine-tension-headche

Medications Used to Relieve Migraine Pain

Medications used to relieve migraine pain fall into two main categories: over-the-counter (OTC) and prescription medications. The choice of medication depends on the severity of the migraine and individual response to treatment. Here are some examples of both OTC and prescription migraine relief medications:

Over-the-Counter (OTC) Medications:

  1. Ibuprofen: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can help alleviate mild to moderate migraine pain.
  2. Aspirin: Aspirin, another NSAID, can provide relief from migraine pain. Some OTC products combine aspirin with caffeine, which can enhance its effectiveness.
  3. Acetaminophen: Acetaminophen (paracetamol) is a pain reliever and fever reducer that may be used for mild to moderate migraines.
  4. Naproxen: Naproxen is another NSAID that can be effective in reducing migraine pain.
  5. Combination Medications: OTC products designed specifically for migraines, such as Excedrin® Migraine, Advil® Migraine, and Motrin® Migraine Pain, often combine ingredients like aspirin, acetaminophen, ibuprofen, and caffeine for enhanced relief.

It’s essential to use OTC medications as directed, and if you find yourself using them frequently (more than two to three times a week), consult a healthcare provider to discuss alternative treatments.

Prescription Medications:

  1. Triptans: Triptans are a class of prescription medications specifically designed to treat migraines by targeting blood vessel constriction and inflammation. Examples include sumatriptan, zolmitriptan, and naratriptan.
  2. Calcium Channel Blockers: Medications like verapamil, a calcium channel blocker, may be prescribed to prevent migraines by regulating blood vessel constriction and relaxation.
  3. Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibodies: These newer medications, such as erenumab, fremanezumab, galcanezumab, and eptinezumab, are designed to prevent migraines by targeting CGRP, a neurotransmitter involved in migraine attacks.
  4. Beta Blockers: Medications like atenolol, propranolol, and nadolol, which are commonly used to treat high blood pressure and heart conditions, may also be prescribed to prevent migraines.
  5. Antidepressants: Certain antidepressants, such as amitriptyline, nortriptyline, doxepin, venlafaxine, and duloxetine, can be used to prevent migraines in individuals who also have depression or anxiety.
  6. Antiseizure Drugs: Valproic acid and topiramate are antiseizure medications that have shown effectiveness in preventing migraines.
  7. Other Medications: In some cases, steroids, phenothiazines, corticosteroids, or anti-nausea medications may be prescribed to provide relief during severe migraine attacks.

Additionally, some individuals may explore complementary and alternative treatments, including vitamins (e.g., riboflavin and magnesium) and herbal supplements (e.g., feverfew and butterbur), under the guidance of their healthcare provider.

The choice of medication and formulation (e.g., pills, tablets, injections, suppositories, nasal sprays) will depend on the individual’s specific migraine profile and response to treatment. It’s crucial for individuals with migraines to work closely with their healthcare provider to develop a personalized treatment plan that addresses their unique needs and symptoms.

in addition to the medications mentioned, drugs to relieve nausea and vomiting, known as antiemetics, may also be prescribed when needed for migraine management. These medications can help alleviate the gastrointestinal symptoms that often accompany migraines.

It’s essential for individuals seeking migraine relief to work closely with a healthcare provider or headache specialist who is knowledgeable about migraine therapy. Following label instructions and adhering to the guidance of the healthcare provider is crucial when using any medication.

Home Remedies or Complementary Approaches of Migraine

Alongside medications, there are various alternative migraine management methods, often referred to as home remedies or complementary approaches, that can be used to complement medical treatment. These methods can help individuals cope with migraines and improve their overall well-being. Some of these approaches include:

  1. Rest and Relaxation: Finding a dark, quiet, and cool room to rest in during a migraine attack can provide relief. Some people also benefit from lying down with their eyes closed.
  2. Temperature Therapy: Applying a cold compress or washcloth to the forehead or the back of the neck can help soothe migraine-related head pain for some individuals. Others may prefer warmth, such as a warm bath or heating pad.
  3. Scalp Massage: Gentle massage of the scalp can help relax tense muscles and alleviate headache symptoms.
  4. Yoga: Practicing yoga, with its focus on gentle stretching and relaxation, can be a helpful method for managing stress and reducing the frequency and intensity of migraines.
  5. Acupressure: Applying pressure to specific points, such as the temples or the space between the thumb and forefinger, in a circular motion, may provide relief for some people.
  6. Mindfulness and Meditation: Techniques like meditation and deep breathing exercises can promote relaxation and reduce stress, which are common migraine triggers.
  7. Biofeedback: Biofeedback is a therapeutic technique that helps individuals learn to control physiological functions, such as muscle tension, to reduce the frequency and severity of migraines.

Prevention of Migraines

While there is no cure for migraine headaches, there are proactive steps and strategies that can be taken to manage migraines, reduce their frequency, and potentially mitigate their severity. Here are some tips and approaches for migraine prevention and management:

  1. Keep a Migraine Diary: Keeping a detailed migraine diary can help identify triggers and patterns specific to your migraines. Note foods, activities, and environmental factors that may be associated with migraine attacks and make necessary lifestyle changes to avoid or minimize these triggers.
  2. CGRP Monoclonal Antibodies: Discuss with your healthcare provider the option of CGRP (calcitonin gene-related peptide) monoclonal antibodies. These medications are specifically designed to prevent migraines and can be effective for some individuals.
  3. Prioritize Sleep: Aim for seven to nine hours of quality sleep each night. Consistent and sufficient sleep can help reduce the likelihood of migraine attacks.
  4. Healthy Eating Habits: Maintain regular meal schedules, avoid skipping meals, and stay hydrated. Make dietary adjustments to minimize potential triggers.
  5. Regular Exercise and Weight Management: Engage in regular physical activity and maintain a healthy weight. Exercise can help reduce stress and promote overall well-being.
  6. Stress Management: Learn stress-reduction techniques such as meditation, yoga, relaxation training, or mindful breathing. Managing stress is crucial, as it is a common migraine trigger.
  7. Medication Management: Take prescribed medications as directed by your healthcare provider. Preventive medications may include antidepressants, anti-seizure medications, blood pressure-lowering drugs, CGRP inhibitors, and Botox injections. Common preventive medications may include timolol, amitriptyline, topiramate, and divalproex sodium. Some of these medications can also help manage acute migraines.
  8. Hormone Therapy: If your migraines are associated with hormonal fluctuations, discuss hormone therapy options with your healthcare provider, especially if linked to your menstrual cycle.
  9. Transcutaneous Supraorbital Nerve Stimulation (tSNS): Some individuals find relief from migraines using tSNS devices, which emit electrical charges to stimulate nerves involved in migraine pain. Consult with your healthcare provider to determine if this option is suitable for you.
  10. Therapy and Counseling: Seek counseling or therapy from a mental health professional to help manage stress and emotional triggers. Your healthcare provider can provide referrals to appropriate specialists.

It’s essential to work closely with your healthcare provider or a headache specialist to create a personalized migraine management plan tailored to your specific needs and migraine profile. With diligent monitoring, lifestyle adjustments, and appropriate treatments, many individuals can effectively reduce the frequency and intensity of their migraines and improve their quality of life.

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