Everything you need to know about migraines
The extreme pain that migraines cause can last for hours or even days.
According to the American Migraine Association, they affect 36 million Americans, or approximately 12 percent of the population.
Migraines can follow an aura of sensory disturbances followed by a severe headache that often appears on one side of the head. They tend to affect people aged 15 to 55 years.
- Some people who experience migraines can clearly identify triggers or factors that cause the headaches, such as allergies, light, and stress.
- Some people get a warning symptom before the start of the migraine headache.
- Many people with migraine can prevent a full-blown attack by recognizing and acting upon the warning signs.
- Over-the-counter (OTC) medications can eliminate or reduce pain, and specific medications can help some people with migraine.
- People who have severe attacks can take preventive medicines.
The cause of migraines is not yet known.
It is suspected that they result from abnormal activity in the brain. This can affect the way nerves communicate as well as the chemicals and blood vessels in the brain. Genetics may make someone more sensitive to the triggers that can cause migraines.
However, the following triggers are likely to set off migraines:
- Hormonal changes: Women may experience migraine symptoms during menstruation, due to changing hormone levels.
- Emotional triggers: Stress, depression, anxiety, excitement, and shock can trigger a migraine.
- Physical causes: Tiredness and insufficient sleep, shoulder or neck tension, poor posture, and physical overexertion have all been linked to migraines. Low blood sugar and jet lag can also act as triggers.
- Triggers in the diet: Alcohol and caffeine can contribute to triggering migraines. Some specific foods can also have this effect, including chocolate, cheese, citrus fruits, and foods containing the additive tyramine. Irregular mealtimes and dehydration have also been named as potential triggers.
- Medications: Some sleeping pills, hormone replacement therapy (HRT) medications, and the combined contraceptive pill have all been named as possible triggers.
- Triggers in the environment: Flickering screens, strong smells, second-hand smoke, and loud noises can set off a migraine. Stuffy rooms, temperature changes, and bright lights are also possible triggers.
There is currently no single cure for migraines. Treatment is aimed at preventing a full-blown attack, and alleviating the symptoms that occur.
Lifestyle alterations that might help reduce the frequency of migraines include:
- getting enough sleep
- reducing stress
- drinking plenty of water
- avoiding certain foods
- regular physical exercise
Some people also find that special diets can help, such as gluten-free.
Consider seeking further treatment if the above changes do not relieve the symptoms or frequency of migraines. The treatment of migraine symptoms focuses on avoiding triggers, controlling symptoms, and taking medicine.
The last decade has seen the development of new approaches to the treatment of migraines. A doctor may administer an injection of botulinum toxin, or Botox, to the extracranial sensory branches of the trigeminal and cervical spinal nerves. These are a group of nerves in the face and neck linked to migraine reactions.
A 2014 review also showed that surgical decompression of these nerves could reduce or eliminate migraines in patients who do not respond to first-line treatment.
Migraines are often managed through a course of medication. There are many different types of migraine medication, including painkillers.
Painkillers should be taken early in the progress of a migraine rather than allowing the headache to develop.
Over-the-counter (OTC) medications effective for treating migraines include:
Other painkillers, such as aspirin with caffeine and acetaminophen, can often stop the headache or reduce pain.
Drugs that treat nausea
Some people who experience migraines will need to take medications that treat the accompanying symptoms.
Metoclopramide may be used to control certain symptoms, such as nausea and vomiting. Serotonin agonists, such as sumatriptan, may also be prescribed for severe migraines or for migraines that do not respond to OTC medications.
Selective serotonin reuptake inhibitors (SSRIs) and antidepressants, such as tricyclics, are prescribed to reduce migraine symptoms, although they are not approved in all countries for this purpose.
Migraine prevention begins with avoiding triggers. The main goals of preventive therapies are to reduce the frequency, pain level, and duration of migraine headaches and increase the effectiveness of other therapies.
There are several medications and supplements that help prevent migraine attacks, including:
- coenzyme Q10
- herbal extracts, such as feverfew
- magnesium citrate
- vitamin B-12 supplements
It is worth noting that some people can experience a medication overuse headache (MOH), or rebound headache. This can occur after taking too many medications in an attempt to prevent migraine attacks.
There are two main types of migraine. This classification depends on whether the individual experiences any disturbances of the senses leading up to a migraine. These are known as auras.
Migraine with aura
This picture is an illustration of what a person experiencing migraine with aura might see.
For many people with migraine, the auras act as a warning, telling them that a headache is soon to come. The effects of an aura can include:
- confusing thoughts or experiences
- the perception of strange, sparkling or flashing lights
- zig-zagging lines in the visual field
- blind spots or blank patches in the vision
- pins and needles in an arm or leg
- difficulty speaking
- stiffness in the shoulders, neck, or limbs
- unpleasant smells
If the following symptoms are unusual for the person with migraine, they should not be ignored:
- an unusually severe headache
- visual disturbance
- loss of sensation
- difficulties with speech
When migraines with aura affect vision, the patient may see things that are not there, such as transparent strings of objects. They may also not see parts of the object in front of them or even feel as if part of their field of vision appears, disappears, and then comes back again.
People experiencing an aura may describe the visual disturbance as similar to the sensation that follows being exposed to a very bright camera flash.
Migraine without aura
More commonly, a person will experience a migraine without any sensory disturbance leading up to the attack. Between 70 and 90 percent of migraines occur without an aura.
There are other types of migraine related to specific syndromes or triggers, including:
- Chronic migraine: This refers to any migraine that triggers attacks on over 15 days of the month.
- Menstrual migraine: This is when the attacks occur in a pattern connected to the menstrual cycle.
- Hemiplegic migraine: This causes weakness on one side of the body for a temporary period.
- Abdominal migraine: This is a syndrome that connects migraine attacks to irregular function in the gut and abdomen. It mainly occurs in children under 14 years of age,
- Migraine with brainstem aura: This is a rare type of migraine that can trigger severe neurological symptoms, such as affected speech.
Speak to a doctor after identifying a migraine pattern in any headaches experienced. They will be able to advise the type and prescribe suitable treatment.
Symptoms of migraine can start a while before the headache, immediately before the headache, during the headache, and after the headache. Although not all migraines are the same, typical symptoms include:
- moderate to severe pain, usually confined to one side of the head but capable of occurring on either side of the head
- severe, throbbing, or pulsing pain
- increasing pain during physical activity or when straining
- inability to perform regular activities due to pain
- feeling sick and physically vomiting
- increased sensitivity to light and sound, relieved by lying quietly in a darkened room
Some people experience other symptoms such as sweating, temperature changes, stomach ache, and diarrhea.
Migraine vs headache
It is important to know the difference between a migraine attack and a headache.
Headaches can vary a great deal in how long they last, how severe they are, and why they happen. They may not occur in a recognizable pattern as migraine attacks do.
MIgraine attacks will present as moderate-to-severe headaches on one side of the head that occur with other symptoms, such as nausea and vomiting. Migraine and non-migraine headaches are different and can indicate different causes.
To help identify a migraine headache, it can be useful to keep a diary of symptoms noting the time of onset, any triggers, the duration of the headaches, any noticeable signs or auras leading up to a migraine attack, and any other symptoms.
A headache diary should ideally be used for a minimum of 8 weeks and record:
- the frequency, duration, and severity of headaches
- any associated symptoms
- all prescribed and OTC medications taken to relieve headache symptoms
- possible triggers
- the relationship of headaches to menstruation
The International Headache Society recommends the "5, 4, 3, 2, 1" criteria to diagnose migraines without aura.
This stands for:
- 5 or more attacks with a duration of 4 hours to 3 days
- At least two of the following qualities: Occurring on one side of the head, a pulsating quality, moderate-to-severe pain, and aggravation by routine physical activity
- At least one additional symptom, such as nausea, vomiting, sensitivity to light, or sensitivity to sound.
During the initial diagnosis of migraines, the doctor may suggest a range of tests to exclude any other causes of a headache. These can include electroencephalography (EEG), CT, and MRI scans, or a spinal tap.
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