Migraine

1 What is Migraine?

Migraine headaches can cause a variety of symptoms, these may include intense throbbing or pulsing sensation in one particular part of the head and most often it is also accompanied by nausea, vomiting and also extreme sensitivity to light and sound.

One can experience a significant amount of pain that can go for hours to days and can be very intense that all one can think about is a quiet place to lie down.

Migraines can also be preceded or accompanied by sensory warning symptoms (aura) these include the following: flashes of light, blind spots and tingling in one's arm or leg.

The use of certain type of medication can be used to help reduce the regularity and severity of migraines.

For individuals who have tried the medication that never worked previously, it is important to let the doctor know about a different type of migraine medication.

Big differences can be made when the right form of medicine, remedies and lifestyle changes are implemented.

headache

2 Symptoms

The main symptoms of migraines are usually a very intense headache that mostly occurs at the front or on the side of the head.

This pain is known to be a severe throbbing sensation that always worsens when one moves. This pain normally prevents one from performing normal activities.

These headaches usually begin to appear in childhood, adolescence or the early stages of adulthood.

There are four particular stages in which migraines progress, these include prodrome, aura, headache, and postdrome.

It is very common for one not to experience all of the previously named phases.

In the stage of prodome, one can notice subtle changes that signify an oncoming migraine and usually happens about 2 days before an actual migraine.

The signs of prodome include the following: constipation, depression, food cravings, hyperactivity, irritability, neck stiffness or uncontrollable yawning.

The aura phase can happen before or at the time of migraine headaches.

Visual disturbances are a common feature that describes auras (nervous system symptoms), an example can be flashes of light, and an individual may see various shapes, bright spots or flashes of light.

Other characteristics can be vision loss Pins and needles sensations in an arm or leg. Speech and language problems also known as aphasia.

In a few cases, an aura can be associated with limb weakness (a hemiplegic migraine). When untreated, a migraine can last from four to seventy-two hours.

This frequency various in each individual. One may have migraines several times a month or much less often.

During a migraine, one may experience the following symptoms: Pain can be on one or both side of the head. Pain that has a pulsating or throbbing quality.

Sensitivity to light is also experienced during a migraine. Nausea and vomiting blurred vision, light-headedness and sometimes followed by fainting.

The final phase, known as postdrome, takes place after a migraine attack. During this period, on feels drained and washed out, though some people report feeling mildly euphoric

3 Causes

Not a lot a lot is understood about the cause of migraines but it is widely accepted that genetics and the environment tend to play a role.  

They can be caused by changes in the brainstem and its interactions with the trigeminal nerve which is the major pain pathway in the area.

Some imbalances in certain brain chemicals such as serotonin which play an important role in pain regulation in the nervous system.

Research is still being done on the role of serotonin in migraines.

During migraine attacks, serotonin levels plummet which can cause the trigeminal system to release substances called neuropeptides.

Neuropeptides leave the brain's meninges (outer covering) resulting in headaches. Whatever the exact cause of the headaches may be, a number of things may trigger them.

There are some common triggers, some of which include: Hormonal changes in women. Estrogen level fluctuation seems to trigger headaches in many women with migraines.

These migraines are called menstrual-related migraines and commonly occur between two days before the start of a period to three days after.

Some women only experience migraines during this time, but most can experience them at other times. Some women can have their migraines improve after menopause.

However, menopause can sometimes trigger migraines or make them worse in other women.

Other causes can be dietary triggers which include: alcohol, caffeine products such as coffee and tea, specific foods like chocolate and cheese.

Physical triggers like exhaustion, bad quality sleep, neck or shoulder tension or low blow sugar.

Environmental triggers can also cause migraines, these are bright lights, flickering screens, loud noises, smoke, strong odours or a stuffy atmosphere. All these are factors that cause migraines.

4 Making a Diagnosis

If you have migraines or a family history of migraines, a doctor trained in treating headaches (neurologist) will likely diagnose migraines based on your:

  • medical history,
  • symptoms,
  • physical and neurological examination.

Appointments can be very brief but there is a lot of discussions to be done between the patient and the doctor. It is therefore very wise to be prepared for an appointment ahead of time.

It is very important to write down the symptoms one is experiencing, in some case, they may not be influential or related to the migraines.

Key personal information such as major stresses or recent life changes. Making a list of all medication, vitamin or any supplements being taken.

When making this list, it is particularly important to write down all medications including the dosages that have been used to treat the headaches.

It is advisable to be in the company of a family member or friend during the session as remembering all provided information may be difficult.

It is also important to write down questions the questions to ask the doctor which may include:  

  • What is likely triggering my migraine headaches?
  • Are there other possible causes for my symptoms?
  • What kinds of tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach that you're suggesting?
  • What changes to my lifestyle or diet do you suggest I make?
  • I have these other health conditions, how can I best manage them together?
  • Is there a generic alternative to the medicine you're prescribing for me?
  • Are there any printed material that I can take home with me?
  • What websites do you recommend? 

One can also ask the doctor during their appointment, what to expect from them. The doctor is likely to ask you a number of questions as well.

Being ready to answer them may reserve time to go over any points you want to spend more time on.

Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Has anyone in your family experienced migraines?
  • What can you do in the meantime ? 

Keep a headache diary. This diary helps an individual and their doctor determine what triggers their migraines.

The use of a CT scan, which a series of X-rays to create detailed cross-sectional images of the brain can help doctors diagnose tumors, infections, brain damage, bleeding in your brain and other possible medical problems that may be causing your headaches.  

An MRI uses a powerful magnetic field and radio waves to produce detailed images of your brain and blood vessels.

MRI scans help doctors diagnose tumors, strokes, bleeding in your brain, infections, and other brain and nervous system (neurological) conditions.  

If a doctor suspects an underlying condition, such as infections or bleeding in your brain, he or she may recommend a spinal tap (lumbar puncture).

In this procedure, a thin needle is inserted between two vertebrae in your lower back (usually at the level between the third and fourth lumbar vertebrae), to extract a sample of cerebrospinal fluid for laboratory analysis

5 Treatment

There are several treatments specially designed to help treat this migraine. It has been well established that migraines cannot be cured but can be managed.

Furthermore, some drugs that are commonly used to treat other condition may also be used in this case. There are two categories of medications used to treat migraines.

These are pain relieving medications or acute or absorptive treatment and preventive medications which are regularly to reduce the severity and periodicity of migraines.  

The choice on which route to take solely depends on the severity, degree of disability and other medical conditions.

Some medication is not recommended for pregnant women, breastfeeding women and children.

For the most effective result, it is vital to take pain-relieving medication as soon as symptoms are experienced.

Sleeping in a dark room can also be very helpful after the medication has been taken. Medications include Pain relievers. Aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others), may help relieve mild migraines.

Pain relievers, such as acetaminophen (Tylenol, others), also may help relieve mild migraines in certain individuals.

Some drugs are marketed with the prime emphasis on migraines, such as the combination of acetaminophen, aspirin, and caffeine (Excedrin Migraine), also, may reduce the severity of migraine pain, but are not effective alone for severe migraines.

This medication can cause ulcers, gastrointestinal bleeding, and medication overuse headaches if taken for long periods of time.

The prescription pain reliever known as indomethacin may help thwart a migraine headache and is available in suppository form, which may be helpful when one is nauseated.

Many people with migraine attacks use triptans to treat their migraines. These drugs work by facilitating constriction of blood vessels and blocking pain pathways in the brain.

They effectively relieve the pain and other symptoms that are associated with migraines.

Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), zolmitriptan (Zomig), frovatriptan (Frova) and eletriptan (Relpax).

Some triptans may be available as nasal sprays and injections, in addition to tablets. They have several side-effects such as nausea, dizziness, drowsiness and muscle weakness.

These medications are not recommended for individuals at risk of strokes and heart attacks.

A single-tablet combination of sumatriptan and naproxen sodium (Treximet) is more effective in relieving migraine symptoms than either medication on its own.

Ergotamine and caffeine combination drugs (Migergot, Cafergot) are less effective than triptans. Ergots are more effective in those whose pain lasts for more than 48 hours.

Ergotamine may cause worsened nausea and vomiting related to one’s migraines and other side effects. It may also lead to medication-overuse headaches.

Dihydroergotamine (D.H.E. 45, Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine. It's available as a nasal spray and in injection form.

This medication may cause fewer side effects than ergotamine and is less likely to lead to medication-overuse headaches.

Because migraines are often accompanied by nausea, with or without vomiting, medication for nausea is appropriate and is usually combined with other medications.

Frequently prescribed medications are chlorpromazine, metoclopramide (Reglan) or prochlorperazine (Compro).

Opioid medications containing narcotics, particularly codeine, are sometimes used to treat migraine headache pain for individuals who can't take triptans or ergot.

Narcotics are habit-forming and are usually used only as a last resort. Glucocorticoids (prednisone, dexamethasone). A glucocorticoid may be used in conjunction with other medications to improve pain relief.

Because of the risk of steroid toxicity, glucocorticoids shouldn't be used frequently.

Preventive medications one may be a candidate for preventive therapy if they have four or more debilitating attacks a month, if attacks last more than 12 hours, if pain- relieving medications aren't helping, or if  migraine signs and symptoms include a prolonged aura or numbness and weakness  or numbness and weakness.

6 Prevention

It does not matter whether one take preventive medications or not, lifestyle changes can always be very beneficial for migraine. These changes can help reduce the number and severity of migraines.

One can follow the following suggestions may be very helpful to some to prevent migraines: It is important to avoid certain triggers such as food odours that might have triggered migraines in the past.

Doctors can often recommend that once reduces on caffeine and alcohol intake and also try to avoid tobacco.

Another helpful is by setting up a day to day routine with regular sleep patterns and meals One can also try to control stress. Exercise can be very beneficial as well.

Regular aerobic exercise can reduce tension to a good extent and help prevent migraines.

Aerobic exercises like swimming, walking and cycling may be among the types of exercise recommended by the doctor.

It is always good to take into consideration that warm ups should be done slowly, sudden intense exercises are known to cause headaches.

Another factor thought to bring about migraines is obesity. Regular exercise helps one to lose weight and this, in turn, helps reduce migraines.

7 Alternative and Homeopathic Remedies

Several alternative remedies exist for migraine.

Non-traditional treatments may be helpful to people who suffer from chronic migraines pain.

Acupuncture is a treatment where a practitioner inserts a lot of thin, disposable needles into several areas of defined points on the skin.

Several clinical trials have found that acupuncture may be very helpful for headache pain. Relieving migraine pain can also be accomplished by using biofeedback.

This is a special relaxation technique that uses certain special equipment to teach one how to monitor and control certain physical responses linked to stress.

Massage therapy can also be widely used to help reduce the frequency of migraines. Scientific research is still being done to study the effectiveness of massage therapy in the prevention of migraines.

Another preventive method comes in the form of cognitive behavioural therapy which may benefit several individuals suffering from migraines.

There is some noted evidence that butterbur may help prevent migraines or reduce their severity. Another herb that can be used is known as feverfew.

This herb has, however, shown mixed results. High doses of vitamin B-2 or riboflavin may also prevent migraines or reduce the frequency of headaches.

Coenzyme Q10 supplements may also help reduce the severity of migraines although this is not done.

Due to low magnesium levels in certain individuals with migraines, magnesium supplements have been used to treat migraines, but with mixed results.

It is vital for one to as their doctor if these treatments are right for them. It is not advised to use feverfew, riboflavin or butterbur if you're pregnant or without first talking with your doctor.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with migraine.

It is known fact that relaxation may help ease the pain of a migraine headache. Relaxation techniques may include progressive muscle relaxation, meditation, and yoga.

Sleep is a very important aspect of one’s health. It is always vital to get enough sleep, oversleeping is not advisable, though.

Get an adequate amount of sleep each night. It's best to go to bed and wake up at regular times, as well. If possible, one can rest in a dark, quiet room when a feeling of a headache comes on.

Placing an ice pack wrapped in a cloth on the back of the neck and apply gentle pressure to painful areas on the scalp. Keeping a headache diary is also an important step.

It is necessary to continue keeping a headache diary even after the appointment with the doctor. It is very helpful to learn more about what triggers migraines and what treatment is most effective.

9 Risks and Complications

There are several risks and complications associated with migraine.

Several factors contribute to making one more prone to having migraines. About 90 percent of people with migraines have a family history of migraine attacks.

The chance of a child developing migraines in a family with parents who have migraines is high. Age can also add to the risks of developing migraines.

Migraines can begin at any age, though most people experience their first migraine during adolescence. By age 40, most people who have migraines have had their first attack.  

Women are three times more likely to have migraines. Headaches tend to affect boys more than girls during childhood, but by the time of puberty and beyond, more girls are affected.

Women with migraines usually experience them shortly after the onset of menstruation. Generally, migraines improve after menopause.

Some women report that migraine attacks begin during pregnancy, or the attacks may intensify. However, for many, the attacks improved or didn't occur during later stages in the pregnancy.

Certain pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others), may cause abdominal pain, bleeding, ulcers and other complications, especially if taken in large doses or for a long period of time.

Medication-overuse headaches. If you take over-the-counter or prescription headache medications more than 10 days a month for three months, or in high doses, you may be setting yourself up for a serious complication known as medication-overuse headaches.

Medication-overuse headaches occur when medications not only stop relieving pain but also cause headaches. You then use more pain medication, which continues the cycle.

Serotonin syndrome. Serotonin syndrome is a rare, potentially life-threatening condition that occurs when your body has too much serotonin, which is a chemical found in your nervous system.

It may occur if you take migraine medications called triptans and antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs).

These medications naturally raise serotonin levels. When combined, they cause increased serotonin levels in your system, more than if you were taking one of these medications.

Triptans include medications such as sumatriptan (Imitrex) or zolmitriptan (Zomig). Some common SSRIs include sertraline (Zoloft), fluoxetine (Sarafem, Prozac) and paroxetine (Paxil).

SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor XR). Also, some people experience complications from migraines such as a chronic migraine.

If a migraine lasted for 15 or more days a month for more than three months, an individual had a chronic migraine.

People with a condition known as status migrainous experience migraine attacks that last for more than three days. Persistent aura without infarction.

Usually, an aura goes away after the migraine attack. However, some people have an aura that lasts for more than one week after a migraine attack has finished.

A prolonged aura may have similar symptoms to bleeding in the brain (stroke). In this condition, though, one has a prolonged aura without signs of bleeding in the brain or other problems.

Migrainous infarction. Some people who have a migraine with aura may have aura symptoms that last longer than one hour. This can be a sign of bleeding in the brain (stroke).

If a migraine is experienced with aura, and the aura symptoms last longer than one hour, one should have it evaluated.

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