A migraine is a severe headache that causes a pulsing sensation or extreme throbbing pain on either side of the head. This neurological disease is accompanied by vomiting, nausea, and acute sensitivity to sound and light. Migraine attacks are intense enough to interfere with your daily chores and can confine you to bed for days.
Associated Anatomy
The brain.
Causes of Migraine
Migraines seem to be related to genes and the brain, and their exact cause remains unknown. They can be genetically transferred.
Currently, studies are of the opinion that migraines start when your trigeminal nerve is triggered, and receives signals from overactive nerve cells. This causes sensations in the face, and head, and gives your body cues to release certain chemicals like calcitonin gene-related peptide (CGRP) and serotonin. CGRP acts on the blood vessels on the lining of the brain to make them swell, and then, the neurotransmitters lead to pain and inflammation.
Signs or Symptoms
Migraines can give you trouble for around four hours, and severe migraines can last much longer. As migraines attack in phases or stages, each phase has different signs and symptoms.
Common symptoms of Migraine
- Sensitivity to noise, light, and odors
- Upset stomach
- Abdominal pain
- Loss of appetite
- Nausea and vomiting
- Feeling tired
- Tender scalp
- Feeling cold (chills) or warm (sweating)
- Pale skin color
- Blurred vision
- Fever (rare)
- Diarrhea (rare)
Prodrome Symptoms
- Irritability
- Depression
- Problems concentrating
- Difficulty reading and speaking
- Difficulty sleeping
- Fatigue
- Nausea
- Muscle stiffness
- Sensitivity to sound and light
- Food cravings
- Increased urination
Aura Symptoms
- Speech changes
- Numbness and tingling
- Weakness on either side of the body
- Visual disturbances (one might see blurry spots, lines, or sparkles)
Headache Symptoms
- Stiffness or neck pain
- Giddiness
- Anxiety
- Insomnia
- Nausea and vomiting
- Sensitivity to smell, light, and sound
- Nasal congestion
Postdrome Symptoms
- Depression
- Mood swings (euphoric mood)
- Fatigue
- Inability to concentrate
- Lack of comprehension
Migraine Treatment
Migraines cannot be cured completely. Therefore the treatment aims to prevent future attacks and stop the symptoms. A few medications that are used to treat migraines include:
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Pain relievers
A few prescription medications or over-the-counter painkillers include ibuprofen or aspirin. Other migraine relief pills with the combination of aspirin, caffeine, and acetaminophen work well in mild migraine attacks.
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Triptans
Prescription drugs such as rizatriptan (Maxalt-MLT, Maxalt) and sumatriptan (Tosymra, Imitrex) block the pain pathways to the brain and are used in the treatment of migraines. Administered in the form of shots, pills, and nasal sprays, they provide relief from the symptoms of migraines. However, these are not safe options for heart patients.
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Dihydroergotamine (D.H.E. 45, Migranal)
Administered as an injection or a nasal spray, this drug is effective when taken when migraine symptoms are experienced.
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Lasmiditan (Reyvow)
Lasmiditan is an oral pill that significantly improves headaches, but it can cause dizziness.
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CGRP antagonists
Drugs from this class relieve migraine symptoms such as pain, nausea, and sensitivity to sound and light.
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Opioid medications
These medications are highly addictive and are allowed only when no other treatments are working for a migraine patient.
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Anti-nausea drugs
Metoclopramide, chlorpromazine, prochlorperazine (Compro), and metoclopramide (Reglan) can help combat migraine symptoms that are accompanied by vomiting and nausea. They are usually prescribed pain relievers.
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Alternative Care
Alternative treatments like meditation, acupuncture, cognitive behavioral therapy, meditation, yoga, or acupressure can be considered for relieving migraine symptoms.
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Neuromodulation devices
These devices act on the trigeminal nerve and the vagus nerve to provide relief from migraines.
Risk Factors
Factors that make you more prone to getting migraines are:
- Family history: If any of your family members suffer from migraines, then your chances of developing it increase.
- Age: Migraines can be experienced at any age, but in many cases, the first attack is experienced during adolescence. It peaks in the 30s and gradually subsides in the following decades.
- Sex: Women are three times more prone to migraines than men.
- Hormonal changes: Migraine headaches among women can begin before or after the onset of their period cycles. The symptoms tend to change during pregnancy and improve after menopause.
Migraine Stages
Migraines can typically progress through four stages or phases: prodrome, aura, attack, and post-drome. However, every person with migraines would not necessarily experience all the stages.
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Prodrome
A day or two before a migraine attack you can notice subtle changes in your behavior (mood swings, food cravings) and health (constipation, fluid retention, increased urination) which indicates an upcoming migraine attack.
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Aura
Some people can visualize aura before or during migraines. This phase can include other disturbances (speech changes, numbness, and tingling) along with visualizing aura. The symptoms gradually build up within a few minutes of the start of migraines and can last up to an hour.
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Attack
A migraine attack or acute headache generally begins as a mild ache and develops into throbbing pain. If you indulge in any physical activity, the pain might get worse. Furthermore, the pain can begin in the forehead, travel from one side of the head to another, or affect your entire head. While a migraine headache lasts for about 3 to 4 hours, the severe ones can last over three days.
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Postdrome
Post the attack phase, you might feel confused and drained. Sudden head movements can bring back a brief pain.
Typical Test
Migraines are diagnosed based on factors like family history, medical history, symptoms, and neurological examination. If your doctor observes any unusual or complex headache patterns, a few tests including Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) scan may be recommended to rule out other illnesses. Both these tests will help doctors diagnose bleeding in the brain, tumors, infections, strokes, and other brain and neurological conditions.
Primary and Secondary Prevention
Since the exact cause of migraine attacks remain unknown, primary prevention is not possible. However, secondary preventive medication can reduce the intensity of migraines. A few options include:
- Blood pressure-lowering medications
- Antidepressants
- Anti-seizure drugs
- Botox injections
- CGRP monoclonal antibodies
Epidemiology
Migraines affect children, teenagers, and adults. In adults, the peak of migraines is observed in the 30s and it gradually lessens in the following decades. Women are more prone (three times more than men) to migraines.
Expected Prognosis
Migraines affect different people in different ways, therefore its management also varies from person to person. The best outcomes can be achieved by following your doctors’ advice, managing symptoms, avoiding personal migraine triggers, practicing preventive methods, and reporting any vital changes in normal patterns as they occur.
Natural Progression
An untreated migraine can lead to health ailments like panic disorders, depression, and anxiety. It could also lead to sensory problems like photophobia and cardiovascular diseases such as stroke, hypertension, and coronary heart diseases.
Pathophysiology
A migraine is a primary sensory processing disturbance that involves neurovascular headaches. During the attack or neural events, the blood vessels are dilated which results in further nerve activation and pain aggravation.
Possible Complications
Medication overuse remains the biggest complication in case of migraines. Drugs like acetaminophen, aspirin, and the ones with caffeine combinations come with a great risk of overuse.
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