Migraines

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migraine

What is a Migraine?

A localized headache accompanied by high sensitivity to sound and light is called migraine. In slightly severe cases, the person may feel nauseous. Migraines are a progressive problem and develop gradually. Most people complain of having a steady, dull and deep throbbing sensation in a certain region of the head.

In severe cases, the throbbing is unbearable and feels as if the head will explode. Besides bright lights and loud sounds, movement of the head, strain, sneezing or physical stress can elevate the pain in some cases. For most patients, lying down in a quiet dark room helps in the relieving the pain.

Migraines affect more women than men. A chronic ailment, migraine “attacks” do not have a specified time or setting. Maximum migraine patients report having a mild throbbing headache when they wake up, so the early morning time is considered the most vulnerable for migraine patients. “Attacks” can occur numerous times in a day, to maybe just once in a week.

Migraine can affect children as young as 5 years of age, and even 35 year olds. There is no cure for migraine, but medication and lifestyle changes can help in reducing the attacks or the pain in most cases. In extremely severe cases, migraine could cause heart attack or stroke, but for maximum cases it is not life-threatening. Migraine, if left untreated, can develop really fast and disrupt everyday life.

Types and Symptoms of Migraine

Migraines can be classified into 2 broad categories:

  1. Migraines with aura or classic migraine: the most common neurological symptom of this type of migraine is visual disturbances, which manifest in the form of a zigzag flickering line around the periphery of the field of vision. Other symptoms include tingling in the lips, face, or one hand, numbness, and in some cases, partial temporary paralysis. Auras do not usually last more than an hour, but precede headaches in majority cases.
  1. Migraines without aura or common migraine: almost 80% of migraine patients deal with this type of migraine. Common symptoms include mood swings, fatigue, fluid retention or bloating and mental fuzziness. Some patients may also experience diarrhea, nausea, vomiting and increased frequency in urination. Common migraines can last as long as 4 days, but the pain and the duration of the migraine can be reduced under treatment.

Both types of migraine also have a common set of symptoms like: nasal congestion, increased tearing up, running nose, and sinus. Diagnosis of these symptoms can often be confused as a sinus headache.

Different Forms of Migraine

Other than migraine with and without auras, there are 6 types of migraines. They are:

  • Hemiplegic migraine: symptoms are temporary partial paralysis, dizziness and impaired vision.
  • Ophthalmologic migraine: this types if migraine is characterized by the pain localized around the area of the eye. The headache is followed by other symptoms which include vision problems and droopy eyelid. Diagnosis suggests that this type of migraine could actually be a sign of some neurological disorder.
  • Basilar artery migraine: affecting mostly young women and teens, this migraine is caused due to a spasm in the basilar artery, which is a major artery located at the base of the brain. The headache is accompanied by giddiness, disturbed motor coordination, altering states of consciousness, impaired vision, and difficulty in hearing and speaking.
  • Benign exertional headache: this type of migraine is triggered due to physical stress, which may include activities like running, lifting, bending, or even something simple as sneezing or coughing. It does not last more than a few minutes.
  • Status migrainosus: a very rare migraine, the nausea and pain during the headache are extremely intense, so much so that the patient may need to be hospitalized.
  • Headache-free migraine: this condition has all the symptoms of a migraine such as nausea, constipation, vomiting, diarrhea, and visual impairment, but there is not headache.

Differences Between Migraine and Other Headaches

Headaches other than migraines have specific symptoms in addition to the ones experienced during migraine. Here are a few other types of headaches:

Tension headache: linked with fatigue and stress, patients of arthritis, depression and psychological distress also suffer from tension headache. These headaches can be caused due to strain on the eyes, poor posture, abnormalities of the neck bones or muscles, misalignment of the jawbones or teeth, or unusual light or sound conditions.

Patients of this type of headache range between 20 and 40 years of age. Also, women are more prone to these headaches as compared to men. Signs of tension headaches are continuous pain and tightness around the neck and head, generally in the forehead and temple region.

Cluster headache: associated with increased histamine levels, cluster headaches occur in, as the name suggests, clusters of around 4 separate headache “attacks”, specifically only on one side. They are sudden, intense, severe and stop as suddenly as they start. Symptoms include a stabbing pain around the eyes, and running nose on the same side. Lasting less than hour sometimes, they can also last for hours. These headaches affect mostly men, and occur between 20 to 45 years of age. Alcohol and smoking can elevate the headache.

Risk Factors for Migraines

The possibility of Migraines being a genetic disorder and hence inherited, are undergoing research. Scientists are also attempting to identify the genes responsible for migraines.

Migraines are caused due to numerous triggers that set in motion the symptoms and the pain:

  • Missing meals and hunger
  • Consumption of alcohol (more so red wine)
  • Consuming foods that contain monosodium glutamate, high levels of caffeine, nitrates, and or nitrites, and tyramite. These include foods like preserved meats, aged cheese, coffee, colas and tea.
  • Use of oral contraception and menstruation
  • Lack or excess of sleep
  • Emotional, mental or physical stress
  • Surroundings that may be too noisy, too bright, or changes in weather including high altitudes

Migraine and Other Medical Conditions

The relation between migraines and other health disorders has not yet been established, even though people with a variety of other health problems have reported to be suffering from migraines. Also, migraines have not been known to cause other health problems.

Even though the reasons are still unclear, two of the most common disorders that migraine co-exists with are anxiety and depression. People with cardiovascular problems also have a high vulnerability to migraines. Sinus inflammation and nasal issues are also known to cause migraines.

People who have undergone traumatic experiences, be it emotional, mental or physical are also at a high risk of being affected by migraines. These could include head injuries, neck injuries, brain hemorrhages and also infections.

A lot of migraine related symptoms overlap with symptoms for other diseases. It is hence, extremely important to undergo through diagnosis to ascertain the cause of the headaches and get treated accordingly. Someone with a headache could assume it to be migraine, but in actuality, they could be suffering from sinus inflammation. Correct diagnosis and medication is very important in any kind of disorder or disease.

Diagnosing Migraine

Migraine has very distinct, clear symptoms, which if monitored for a period of time, can for a pattern. Suspected patients are asked questions about the frequency of the headaches, the location, duration, and severity of pain. Also required is the complete medical history, including records of any head injuries, strain in the eyes, sinus problem, and even dental issues is required. Parental history may also be asked for as someone with a family history of migraine is more susceptible to having it themselves.

Diagnostics such as blood tests are also required in ascertaining the cause of the headaches. In certain situations, such as sinus or head injuries and hemorrhage, X-rays or brain scans such as MRIs and CAT scans may be required. In case nothing comes up in all of these tests, a patient may be asked to undergone neurological examination. Patients turning up with sudden bursts of pain and severe headaches are usually scanned first, for ruling out chances of aneurysm (balloon like bulges in blood vessels).

Treating Migraine

Medications for treating migraine can be categorized into 2: Abortive medication and preventive medication.

Migraine drugs fall generally into two categories. Those for acute migraine headaches are considered abortive treatments because they interrupt an attack or episode of migraine headache and are given once the symptoms of a migraine have appeared. The second category is preventive medications, which are taken regularly to keep headaches from occurring.

Abortive medication: are prescribed to patients who suffer from acute migraine. These medicines disrupt the migraine attacks and are prescribed only when the symptoms are clear and occur repeatedly. These include the following categories:

  • OTC medications: include naproxen, ibuprofen, aspirin, or acetaminophen. A few of these may be coupled with caffeine.
  • Non-steroidal anti-inflammatory drugs (NSAIDS) and analgesics which include both non-narcotic and narcotic medication
  • Serotonin agonists: sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan and frovatriptan: these are vasoconstriction medicines and are thus not prescribed to patients with existing problems such as high blood pressure, history of heart attack, basilar migraine and stroke, and angina pectoris. A pill which is a combination of sumatriptan and naproxen: Treximet.

Preventive medications: are medicines prescribed to patients with mild to moderate case of migraine. These are taken on a regular basis to avoid the progression of the condition and reduce instances of the “attacks”. These include:

  • Anti-depressants (Tricyclic) (including amitriptyline)
  • Beta-blockers (timolol or propranolol)
  • Calcium channel blocking medication (verapamil)
  • Anti-convulsants (Topamax; Depakote, salt divalproex sodium; Neurontin)
  • Alternative multi-vitamin treatments (Vit. B2, magnesium)
  • Vasodilators (Sansert, maleate or methysergide)
  • Hormone therapy is prescribed for women experiencing menstrual migraine

Non-Drug Treatments for Migraine

Behavioral and lifestyle changes are recommended in both abortive and preventive treatments. A key in treating and avoiding instances of migraines is to avoid triggers that may induce the headaches.

Behavioral treatments, such as those listed below, are recommended as treatments for stress related migraines:

  • Relaxation: these include both electromyographic biofeedback and thermal techniques. These help patients in training themselves to sustain and voluntarily control their blood pressure, temperature, pulse, muscle tension and brain waves.
  • Stress management: including Cognitive-behavioral therapy
  • Regular physical exercise: can include outdoor or indoor activities and games, such as jogging, running, swimming and walking. Regular physical workout can help in reducing stress and hence, the frequency and severity of migraine headaches.
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