Migraines

Overview

Migraine is a prevalent neurological condition characterized by various symptoms, with the most prominent being a pulsating, throbbing headache typically affecting one side of the head. These migraine attacks can last for hours or even days, significantly impeding daily activities due to the intensity of the pain.

A warning sensation known as an aura develops before or with the headache in some people. Aura is a group of sensory, motor, and verbal symptoms. It can involve visual abnormalities like flashes of light or blind spots, as well as physical symptoms including tingling on one side of the face, arm, or leg, and difficulties speaking. Auras can last anywhere from 10 to 60 minutes. It occurs in about 15% to 20% of migraine sufferers.

Physical exertion, lights, sounds, and certain smells are common triggers that can exacerbate a migraine. Nausea and vomiting often accompany these debilitating headaches. However, there are medications specifically designed to prevent migraines and alleviate their discomfort. When used in combination with self-help treatments and lifestyle modifications, appropriate medications can provide relief and improve the overall management of migraines.

Symptoms

The predominant symptom of a migraine is a headache, which is experienced by a majority of individuals affected. The pain associated with migraines is often described as pounding or throbbing. It typically initiates as a mild, dull ache and intensifies into pulsating pain that can range from mild to moderate or severe.

Migraines can affect both children and adults, and they generally manifest through four stages: prodrome, aura, attack, and post-drome.

Each phase of migraine attack has varying symptoms and not everyone who suffers from migraines progresses through all stages.

• Prodrome: It is sometimes referred to as the “preheadache” or “premonitory” phase. Minor changes that indicate an impending migraine may occur one or two days before a migraine, such as:
  • Concentration issues
  • Irritability and/or depression
  • Sleeping problems
  • Excessive yawning
  • Food cravings
  • Muscle stiffness, especially on neck
  • Frequent urination
  • Fluid retention
  • Constipation
  • Nausea
  • Fatigue
• Aura: The aura phase might last up to 60 minutes or as little as five minutes. Most people do not have an aura, while others have both the aura and the headache at the same time. They are typically visual but can sometimes contain other types of disturbances. Each symptom often develops gradually which may include:
  • Temporary loss of vision
  • Disturbances in vision, perceiving different shapes, bright spots, or light bursts
  • One-sided numbness or weakness of the body
  • Feelings of pins and needles in an arm or leg
  • Speech changes
  • A “funny” feeling
  • Tinnitus, or ringing in the ears
  • Smell or taste changes
• Attack or Headache: It usually starts on one side of the head and progresses to the other. The headache can persist anywhere from four to 72 hours. Migraines can occur frequently or multiple times per month.

During a migraine episode, common symptoms may include:

• • Headache: Pain that typically occurs on one side of the head usually throbbing or pulsating, although it can affect both sides.
  • Sensitivity to stimuli: Increased sensitivity to light, sound, and occasionally smell and touch.
  • Nausea and vomiting
• Post-drome: This stage lasts for a day or two. It is commonly referred to as a migraine “hangover,” and it affects 80% of migraine sufferers. A sudden head movement may temporarily reactivate the pain. Generally, one may feel confused, and drained, while some people claim to be elated. Other symptoms include:
  • Inability to comprehend
  • Poor concentration
  • Depressed mood
  • Euphoric mood

A migraine journal may be beneficial to those with a history of headaches or frequent migraines. Keeping a record of all the migraine attacks and how it was handled could later help with the diagnosis. It is important to track pattern changes or if the headaches feel different than usual. Consult a healthcare provider for proper diagnosis and treatment.

A migraine can become a medical emergency which signals a more serious medical concern, if the following signs and symptoms occur:

• A terrible headache that comes on suddenly, like a thunderclap
• Headache following a head injury
• A persistent headache that worsens with coughing, exercise, straining, or a sudden movement
• Headache which may indicate stroke, usually accompanied by fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any area of the body

Causes

Migraine is a complex condition that lacks a definitive cause. Headaches arise when specific nerves within the blood vessels transmit pain signals to the brain. This process triggers the release of inflammatory compounds into the nerves and blood vessels of the brain. However, the exact reasons behind the abnormal behavior of these nerves are still not fully understood.

Alteration in the brainstem and its connection with the trigeminal nerve, which is a primary pain pathway, could be at work. As could chemical abnormalities in the brain, such as serotonin, which helps regulate pain in the nerve system.

Heredity and environmental factors are believed to play a role. Scientists are actively investigating the involvement of various neurotransmitters in migraines, with serotonin being one of the key focuses.

• Migraine triggers: Migraine attacks can be triggered by a several factors, such as:
  • Hormonal changes in women: Migraines are more common in women throughout their menstrual cycles. The sudden drop in estrogen that causes menstruation might cause migraines. It tends to be worse between puberty and menopause. If hormones play a significant role in chronic migraines, women may experience less headaches after menopause.

Birth control medications and hormone replacement therapy can also cause hormonal changes which might aggravate migraines as well. However, some women report that using these drugs makes their migraines less frequent.

• • Drinks: Caffeine overdose or withdrawal can induce headaches when the caffeine level decreases abruptly. Excessive consumption of alcohol, particularly wine, may also cause migraines.
  • Stress: A migraine can be caused by the release of certain substances. Specific chemicals in the brain are released during stressful events to confront the circumstance, known as the “flight or fight” reaction. Anxiety, concern, and excitement can all cause muscle tension and dilation of blood vessels which can aggravate migraine.
  • Sensory stimuli: Migraines may be triggered by exposure to strong smell such as smoke, perfumes, and other scents, loud noises, flashing lights, fluorescent lights, TV or computer light.
  • Sleep patterns shift: Some people can acquire migraines from not sleeping enough or sleeping too much.
  • Physical factors: Being overly tired and overexertion can induce migraines in some people.
  • Weather changes: Storm fronts, barometric pressure fluctuations, high winds, or changes in altitude are examples of changing weather conditions that can trigger migraines.
  • Medications: Rebound headache may occur with using headache medications too frequently. Migraines can be exacerbated by oral contraceptives and vasodilators such as nitroglycerin.
  • Foods and preservatives: Certain foods and beverages, such as aged cheese, alcoholic beverages, chocolate, fermented or pickled foods, and food additives such as nitrates, sweetener aspartame and the preservative monosodium glutamate may cause up to 30% of migraines.

Risk factors

While predicting the occurrence of migraines is challenging, certain risk factors can increase an individual’s vulnerability to experiencing them. These risk factors include:

• Genetics: Up to 80% of migraine sufferers have a first-degree relative who has the condition. A person will most likely get migraines if someone in the family suffers from it too.
• Age: Headaches typically occur throughout adolescence or in the 30s and then steadily lessen in severity and frequency over the next few decades. However, it can start at any age.
• Gender: Because of the influence of hormones, it is more common among women. Migraines affect women three times more than men.
• Hormone: Women who experience migraines often notice that their headaches can occur just before or shortly after the onset of menstruation. Additionally, the nature of migraines can also undergo changes during pregnancy and menopause.
• Stress level: A migraine can be brought on by stress. A person who is under a lot of stress may get more migraines.