Overview
A migraine is a neurological condition or disorder which is characterized by severe headaches accompanied by symptoms like nausea, vomiting, speaking difficulties, numbness or tingling, light and sound sensitivity. Migraines could be genetic and can affect people of almost all ages. In young children, migraine goes undiagnosed as it is misunderstood to be a common headache or weakness.
The duration of migraine varies between individuals. Most of the attacks last for a minimum of 4 hours. If an attack of a migraine lasts longer than three days, it has to be treated in a hospital setting.
Migraine headaches can include a wide range of debilitating neurological symptoms. A headache usually occurs on one side of the head and is typically throbbing in nature.
The most common types of migraine are
- Classic Migraine: Also called as a migraine with aura, it occurs with specific warning signs before the attack begins. It is seen in 25% of people with migraine. It is also termed as complicated migraine and hemiplegic migraine. An aura is the initial phase of the migraine attack accompanied by distinct symptoms like flashing lights, loss of vision, dizziness, confusion and weakness.
- Migraine without aura: occurs without any warning signs and is the most common type.
Migraine aura without headache: The symptoms of aura occur but the person does not develop headache. This is also known as a silent migraine.
The characteristic symptoms of migraine without aura are
1) Any two of the symptoms –
- A one-sided headache
- Pulsating or throbbing pain
- Moderate to severe pain level
- Worsening of pain during movement (walking, climbing stairs)
2) At least one symptom from the following –
- Sensitivity to light
- Sensitivity to sound
- Nausea with or without vomiting or diarrhea
Other types include
- Retinal migraine or Ocular migraine
- Abdominal migraine
Certain types of headaches which closely resemble a migraine attack but are not categorized as a migraine include
- Cluster headache
- Tension-type headache
- Sinus headache
Migraine pain is usually described as
- Pulsating
- Throbbing
- Perforating
- Debilitating
Migraine pain mostly affects the forehead area. It is usually on one side but can occur on both sides or shift from one side to another.
While people suffering from migraine may experience the attack frequently, up to several times in a week, there are some cases where an occasional experience of a migraine attack is experienced. At times, it could take up a gap of a few years for one to experience a migraine again. Migraine is widely addressed by neurologists and specialists who come from a variety of backgrounds.
Migraines could affect the quality of life and stop one from carrying out normal daily activities.
Causes
The causes of migraine may vary from person to person.
Genetics and environmental factors play a major role in the cause of migraine.
Migraine could be caused by changes in the brainstem and the trigeminal nerve, which is the major pathway for pain.
An imbalance of chemical in the brain like serotonin could also be the cause of a migraine. Serotonin helps regulate pain in the nervous system. The role of serotonin in migraine is still being studied by researchers. In a migraine attack, there is a drop in the level of serotonin, causing the trigeminal nerves to release substances called neuropeptides, which travel to the outer covering of the brain or the meninges. The results in headaches.
Certain substances and habits are known to make an individual more vulnerable to migraines. The common factors that trigger migraines are as follows:
- Hormonal Fluctuations: Changes or fluctuations in the levels of estrogen trigger headaches in women. Many women have headaches immediately before or during their periods.
- Hormonal changes in pregnancy and menopause also cause migraine.
- Medications like oral contraceptives and hormone replacement therapies can worsen migraines. Oral contraceptives and vasodilators are known to trigger migraine attacks as they change the hormone levels in the body. However, some women find migraines reduce when they take these medications.
- Skipping meals or being on a fast can trigger migraine attacks. Consuming salty foods, aged cheese, and processed foods could also trigger migraines.
- Food additives like monosodium glutamate (MSG) in food and aspartame may also trigger migraines.
- Consuming alcohol, especially wine and beverages with high amounts of caffeine may trigger migraines.
- Stress at work or home can trigger migraine attacks.
- Bright lights, loud sounds and sun glare can induce migraines. Sometimes a strong smelling perfume, paint thinner, passive smoke, etc. can also trigger migraines.
- A migraine could also be triggered by an altered sleep pattern like sleeping too much or too little. A jet lag could also be a trigger.
- Physical Factors: Intense physical activity or sexual activity can trigger migraines.
- Environment Change: A change in climate and weather conditions can trigger a migraine.
Symptoms
Symptoms of migraine and its severity can vary from person to person. A throbbing headache is the most common symptom of a migraine attack. This usually occurs on one side. Alongside headache, a person may experience one or more of the following symptoms –
- Nausea
- Vomiting
- Sensitivity to light
- Sensitivity to sound
- Sensitivity to smell
- Visual disturbances
- Dizziness
- Fatigue
- Numbness
- Tingling
- Pain on one side of the head
- Vertigo
- Puffy eyelids
- Fatigue
- Difficulty in concentrating
- Mood swings
- Food cravings
- Fever
- Neck pain
- Aura
- Weakness
Throbbing/pulsating pain and sensitivity to light are the two most common symptoms. A typical migraine attack progresses through four stages and symptoms of the attack vary from stage to stage.
The four stages of migraine attack are as follows
- Prodrome
- Aura
- Headache
- Postdrome
In the prodrome stage, the individual experiences difficulty in speaking, constipation or diarrhea, difficulty in concentrating, fatigue, hyperactivity, food cravings, increased urination, mood changes and neck pain.
In the aura phase of a migraine, varied symptoms occur which include sensitivity to touch/feel, difficulty to talk, auditory or olfactory hallucinations (hearing or smelling things that are not there), paralysis of a side of the body, dizziness, vertigo and paraesthesias. About 5 % of the general population experiences migraine with aura. Not every migraine attack comes with an aura. Among those that suffer from migraine, about 19% tend to experience an aura with every attack.
The headache phase of migraine is characterized by headache occurring on one side of the head. The pain is made worse by physical activity and lasts for four or more hours.
Postdrome or the last phase of migraine can lead to a feeling of “hungover” and is usually characterized by symptoms like fatigue, mood swings, difficulty to concentrate, etc.
Individuals who suffer from migraine are advised to maintain a journal of symptoms experienced during each attack and the activity they were doing just before the attack started. It is important to note the duration of pain as well. Writing the symptoms down each time will give the patient an idea of the pattern of pain being experienced and also what activities he/she must refrain from in order to prevent migraine attacks in the future.
Risk Factors
Migraines can occur due to several factors. Some of the factors associated with migraine include:
- Family History: Migraines can be genetic and hence if one person in a family suffers from migraine, there is an increased probability for others in the family to have it too.
- Age: Migraines begin at any age. The first attack of migraine is usually experienced during adolescence. Migraines tend to peak in a person’s life during his 30s and gradually tend to be less severe in the following decades.
- Sex: Women are three times more likely to have migraine than men. Among children, the headaches are more common in boys than girls. But by puberty, girls are more affected. This could be due to the fluctuations in the hormonal levels for a menstrual cycle to occur. In later stages, conditions like pregnancy, menopause, etc. become a reason for migraine attacks in women.
- Hormonal Changes: Many women complain of a headache at the onset on menstruation. Menopause is known to improve migraines. For some women, migraine attacks increase during pregnancy. However, the attacks may be absent in the later stages of pregnancy and return during the postpartum period.
Diagnosis
A doctor diagnoses a migraine in a person by analyzing the symptoms. Tests may be done to detect unusual, complex or severe conditions. The doctor might recommend the following tests.
- Blood Tests: These tests are used to identify problems in blood vessels and also to diagnose infections in spinal cord and brain.
- Magnetic Resonance Imaging (MRI): A strong magnetic field and radio waves are used in MRI test to produce detailed images of the brain and blood vessels. MRIs can diagnose tumours, strokes, bleeding in the brain, infections and other neurological conditions.
- Computerized Tomography (CT) Scan: A CT scan uses a series of x-rays to create detailed cross-sectional images of the brain. Using a CT scan, a doctor can identify infections, brain damage, bleeding in the brain and spinal tumors, and other issues that cause headaches.
- Spinal Tap (Lumbar Puncture): This test may be recommended if an individual is suspected to have an infection or bleeding in the brain. This procedure involves the insertion of a thin needle between two vertebrae in the lower back to draw a sample of the cerebrospinal fluid (brain fluid) for further laboratory analysis.
Treatment
Treatment of migraine is required to relieve the symptoms and prevent attacks in the future. The medications that are used to treat migraine are classified into two broad categories:
- Pain-relieving medications
- Preventive medications
- Pain-relieving medications are also known as acute or abortive treatment. The drugs falling under this category are taken during the migraine attack and are designed to minimize or eliminate the symptoms.
Common pain-relieving medications include:
- Pain Relievers: used in migraine include aspirin, ibuprofen and paracetamol. These drugs may be taken as combinations with caffeine. These drugs are however not effective for severe migraines.
- Triptans: Triptans make blood vessels contract and block pathways of pain in the brain. These drugs are effective in relieving pain and other symptoms associated with migraines. They are available in the form of a pill, nasal spray and injection. Triptan medications include sumatriptan, rizatriptan, etc.
- Ergots: Less effective than triptans are ergots, which are a combination of ergotamine and caffeine. Ergots are more effective when taken soon after an attack of migraine starts.
- Anti-nausea Medications: Chlorpromazine, metoclopramide and other medications are frequently prescribed for nausea in combination with other medications.
- Opioid Medications: These medications contain narcotics, primarily codeine. These are used to treat migraine pain in patients who cannot take triptans and ergots.
- Glucocorticoids: A glucocorticoid is used in combination with other medications to improve pain relief.
Preventive medications are drugs that have to be taken regularly to reduce the severity or frequency of migraine attacks. Preventive medication is recommended if a patient suffers from four or more debilitating attacks in a month and if the attacks last longer than 12 hours.
The most common preventive medications for a migraine include:
- Cardiovascular Drugs: Beta-blockers like propranolol, metoprolol and timolol and calcium channel blocker can prevent migraines.
- Antidepressants: Tricyclic antidepressants can reduce the frequency of migraine by affecting the level of serotonin and other brain chemicals.
- Anti-Seizure Drugs: To reduce the frequency of migraine attacks, certain anti-seizure drugs like valproate and topiramate are used.
- Onabotulinum Toxin A (Botox): Botox treatment is also helpful in treating chronic migraines in adults.
- Pain Relievers: NSAIDs or non-steroidal anti-inflammatory drugs like naproxen may prevent migraines and minimize symptoms.
The treatment strategy depends on the frequency of a headache and its severity. It also depends upon the degree of disability caused by the attack and other underlying health conditions of the patient.
Treatment varies in certain conditions like pregnancy and breastfeeding. The doctor should be informed of such conditions, as some medicines aren’t recommended during these stages.
Prevention
Identifying the pattern of migraine is a good way to prevent its repetition. Maintaining a journal of activities and keeping a track of symptoms that are experienced each time will help an individual understand the triggers of a migraine attack. Abstaining from such tasks will eventually help the individual to prevent attacks in the future.
Apart from this, the following lifestyle modifications may help prevent migraines
- Regular schedule for eating
- Regular schedule for sleeping
- Avoiding foods that trigger migraine
- Drinking plenty of water and keeping oneself hydrated
- Exercise may promote muscle relaxation and help manage pain during migraine.
- Relaxation strategies
- Prompt medication schedule
- Some foods are known to trigger migraine. Avoiding them can also help prevent migraines
- Red wine
- Aged cheese
- Preserved, smoked meat foods
- Monosodium glutamate
- Aspartame and artificial sweeteners
- Chocolate
- Dairy products
- Alcoholic beverages
- Highly-caffeinated beverages
Apart from these, daily use of medications and being stress-free are effective tips in the prevention of migraine. Apart from medications prescribed by the doctor, hot packs and heating pads can help relax tense muscles. Having a warm bath can also soothe a migraine attack.
FAQs
Is migraine permanent?
Migraine is a chronic condition which can be effectively controlled by treatment measures.
What are the treatment measures for migraines?
Medications prescribed by the doctor and preventive measures can help treat migraine.
Why do I get a migraine pain when I wake up?
A migraine is often triggered when you miss meals or delay them. If you are experiencing migraine attacks every morning you wake, you might have to add a short meal just before you go to bed so that you do not stay long on an empty stomach.
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