Migraines

The exact cause of migraines is not known, but genetics are thought to play a role. Other factors are thought to include stress, hormonal changes, foods, sleep, and environmental factors. Migraine often appears as a severe and throbbing pain down one side of the head. Here, we will take a closer look at the causes, symptoms, and treatments available.

Common symptoms of migraine

Symptoms of migraine vary from person to person, but common symptoms include moderate to severe head pain that may throb. Other symptoms include feeling sick, and sensitivity to loud noises, light and smells. The pain from migraines also becomes worse with physical activity.

Migraine attacks consist of four separate phases. These are known as prodrome, aura, headache, and postdrome. Not everyone will experience each phase, and the length of time of each phase may also vary.

Prodrome symptoms

These symptoms occur before a migraine attack and serve as an early warning sign. Symptoms include:

• Tiredness
• Food cravings, changes in appetite, increased thirst
• Mood changes
• Bloating, constipation, or diarrhea

Aura symptoms

These occur before or during a migraine attack. Neurological symptoms may include:

• Visual disturbances, such as flashing lights or bright lights
• Pins and needles
• Dizziness
• Difficulty speaking
• Changes in smell, taste, or touch

Headache Phase Symptoms

This is the most recognizable phase. Symptoms include:

• Intense, throbbing migraine headaches, normally on one side of the head
• Sensitivity to light and sound
• Feeling sick or being sick
• Pale clammy complexion
• Tiredness
• Difficulty concentrating

Postdrome symptoms

Postdrome symptoms (migraine hangover) follow a migraine attack, symptoms include:

• Feeling tired or irritable
• Muscle pain or weakness
• Food cravings
• Lack of appetite

Causes and other migraine triggers

The cause of migraines is not fully understood, but is thought to be both genetic and environmental. Migraine attacks may be spontaneous, run in families, or have triggers such as stress or hormonal changes.

Risk factors and demographics

Women are three times as likely to suffer from migraines, with changes in the balance of hormones during menstruation influencing the frequency and severity of the migraine attack. Those with a family history of migraines or other medical conditions such as depression, epilepsy or anxiety, may also be more likely to develop migraines.

Types of migraine

There are many types of migraines, with their own specific symptoms. The most common types include:

• Migraine without aura (common migraine): Symptoms include severe headache without any warning signs or visual disturbances
• Migraine with aura: Symptoms include warning signs, such as visual disturbances (flashing lights), pins and needles, dizziness, and difficulty speaking
• Silent migraine (migraine aura without a headache) presents with aura symptoms but without headache pain
• Menstrual migraine: This is affected by hormonal changes, and occurs in women before, during, or after their periods
• Vestibular migraine: Symptoms include problems with balance, dizziness, nausea and vomiting, with or without a headache
• Abdominal migraines: These mainly affect children, causing stomach pain, nausea, and vomiting
• Hemiplegic migraine: This may cause temporary paralysis down one side of your body
• Retinal migraine (ocular migraine): This may cause temporary, partial or complete loss of vision, with a dull ache behind the eye that may spread
• Chronic migraine: This type of headache lasts for at least 15 days each month
• Migraine with brainstem aura: Symptoms include dizziness, loss of balance, slurred speech and double vision, before the headache
• Status migrainosus: This is more rare and severe and can last more than 72 hours

Migraine treatment options

There is no cure for migraines, but several treatment options are available. Options are acute (immediate relief during an attack) and preventive (reducing the frequency and severity of migraines).

Acute medications

Acute treatment is used to relieve pain and symptoms during a migraine attack. Common acute migraine medications include:

• Over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen and acetaminophen for the relief of mild to moderate migraine pain
• Triptans (such as rizatriptan or sumatriptan) that narrow blood vessels and reduce inflammation in the brain. These are available as oral tablets, nasal sprays, or injections
• Anti-nausea medications, such as metoclopramide, used to relieve nausea and vomiting

Preventive measures for migraine

Preventive treatment reduces the frequency, severity, and duration of the migraine by treating the underlying causes. Preventive medications include:

• Beta-blockers, such as propranolol (also used to treat high blood pressure) work by relaxing blood vessels
• Antidepressants, such as amitriptyline, that work by changing neurotransmitter levels in the brain
• Anti-seizure medications, used to treat epilepsy are effective in preventing migraines

Calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies

These are a newer class of preventive medications that work by blocking the action of CGRP. They are injected once a month or every few months, depending on the medication.

Non-medication treatment approaches

As well as medication and lifestyle changes, complementary therapy may also play a role in the management of migraines. Speak to a healthcare professional for further advice.

• Biofeedback, which helps gain control over heart rate and muscle tension
• Relaxation techniques, such as meditation
• Cognitive-behavioral therapy (CBT) to identify and change negative thoughts and behavior
• Avoiding certain foods, such as cheese, caffeine, alcohol, and foods containing monosodium glutamate
• Exercise, to promote the release of natural pain-relieving chemicals, such as endorphins in the brain
• Magnesium supplements, which have been shown to provide some benefit when used in combination with other treatments
• Acupuncture

Migraine in women

Many women experience migraine attacks before, during, or after menstruation, during pregnancy or menopause. Understanding how hormonal changes can affect migraines may help with the management of migraine symptoms in women.

Conclusion

Understanding the causes, symptoms, and treatment options for migraines, can help you take the necessary steps to manage your symptoms more effectively. Speak to a healthcare provider for medical advice and to discuss what the best treatment options are for you.

Sources

• NHS – Migraine
• clevelandclinic – Migraine
• NIH – Migraine
• Hopkinsmedicine – Migraine
• Mayoclinic – Migraine
• WebMD – Migraine