Migraine

Migraines are headaches that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. In addition to headaches, it includes nausea, vomiting, and sensitivity to light and sound. Around 12% of the global population suffers from migraines (Burch RC, et al.). These attacks can last for hours or days, and the pain can be so severe that it interferes with your daily activities. Migraines are more common in women than in men. Symptoms can appear in childhood or early adulthood. Some people have more than one episode per week, while others only have them occasionally. Some people experience an aura before or along with their headaches. Auras can include vision disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling in one arm or leg and difficulty speaking.
Some migraines can be prevented and made less painful with medications. Pain-relief medications sold over-the-counter (OTC) may be helpful for some headache types, but they should not be used excessively. You may also experience worse attacks if you overuse your medication. Migraine headaches can be managed with the right medicines, self-help remedies, and lifestyle changes.

In children and teenagers as well as adults, migraines progress through four stages: Prodrome, Aura, Attack, and Postdrome. Every migraine sufferer does not go through all stages.

Prodrome

In the days leading up to a migraine, you might notice subtle changes such as:

• Constipation
• Mood changes, from depression to euphoria
• Food cravings
• Neck stiffness
• Increased urination
• Fluid retention
• Frequent yawning

Aura

Some people experience auras before or during migraine attacks. Auras are reversible symptoms of the nervous system. There are usually visual disturbances, but they can include other types of disturbances as well. A symptom usually begins gradually, builds up over several minutes, and can last up to 60 minutes.

Examples of migraine auras include:

• Visual phenomena, such as seeing various shapes, bright spots, or flashes of light
• Vision loss
• Pins and needles sensations in an arm or leg
• Weakness or numbness in the face or one side of the body
• Difficulty speaking

Attack

A migraine usually lasts from 4 to 72 hours if untreated. Each person experiences migraines differently. Migraines might occur rarely or strike several times a month.
During a migraine, you might have:

• The pain is usually on one side of your head, but often on both sides
• Pain that throbs or pulses
• Sensitivity to light, sound, and sometimes smell and touch
• Nausea and vomiting

Post-drome

After a migraine attack, you might feel drained, confused, and washed out for up to a day. People report feeling elated in some cases. A sudden head movement might trigger the pain again.

Although migraine causes are not fully understood, genetics and environment may play a role.
Changes in the brainstem and its interactions with the trigeminal nerve, which is a major pain pathway, may be contributing factors. So might imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system. Researchers are studying the role of serotonin in migraines. There are other neurotransmitters involved in migraine pain, including calcitonin gene-related peptide (CGRP).

Migraine triggers

There are several migraine triggers, including:

• Hormonal changes in women– Pregnancy, menopause, and fluctuations in estrogen seem to trigger headaches in many women. Also, hormonal medications, like oral contraceptives, can aggravate migraines. Taking these medications, however, can reduce migraine frequency for some women.

• Drinks – These include alcohol, especially wine, and too much caffeine, such as coffee.

• Stress– Stress at work or home can cause migraines.

• Sensory stimuli– Loud sounds or bright lights can trigger migraines. Some people are triggered by strong smells, such as perfume, paint thinner, and secondhand smoke.

• Sleep changes– Missing sleep or getting too much sleep can trigger migraines in some people.

• Physical factors– Intense physical exertion, including sexual activity, might provoke migraines.

• Weather changes– A change of weather or barometric pressure can prompt a migraine.

• Medications– Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.

• Foods– Migraines may be triggered by aged cheeses, salty foods, and processed foods. So might skipping meals.

• Food additives– These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods.

Migraines or migraine attacks can occur with or without the risk factors listed below. Migraine headaches are more likely to occur if you have more risk factors. These risk factors include:

• Family history– You are more likely to develop migraines if you have a family member who suffers from them.

• Age– While migraines can begin at any age, they are most common during adolescence. During your 30s, migraines tend to peak and gradually decrease in severity and frequency.

• Sex– Women are three times more likely than men to have migraines.

• Hormonal changes– Menstruation may trigger migraine headaches for women who suffer from migraines. During pregnancy and menopause, they might also change. Menopause generally improves migraines.

There’s no specific test to diagnose migraines. If you have a migraine, your doctor will identify a pattern of recurring headaches and associated symptoms. Your doctor may take some time to confirm the final diagnosis, so you may need to be with him.

Clinical history and examination

During your first visit, your doctor may examine your vision, coordination, reflexes, and sensations after reviewing your detailed medical history. By doing so, he will be able to rule out or confirm some other possible underlying causes of your headaches.

They may ask if your headaches are:

• On 1 side of the head.
• A pulsating pain.
• Severe enough to prevent you from carrying out daily activities.
• Made worse by physical activity or moving about.
• Accompanied by feeling and being sick.
• Accompanied by sensitivity to light and noise.

Migraine treatment is aimed at stopping symptoms and preventing future attacks.

There are many different medications used to treat and prevent migraines. However, natural treatments can also be used as alternatives or to supplement medical treatment. The migraine treatment is based on the severity of the migraine and the associated symptoms.

• Non-specific drugs such as analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) are the medicines of the first choice for mild or moderate migraine.

• Specific drugs such as ergot derivatives and triptans are also recommended to treat migraine in more severe cases depending upon the individual requirement.

• The new class of drugs such as calcitonin gene-related protein (CGRP) antagonists and laminarin is given in case of acute attacks.