Migraine
Migraine
Overview
A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head. Many people also have symptoms such as feeling sick, being sick and increased sensitivity to light or sound.
Migraine is a common health condition, affecting around 1 in every 5 women and around 1 in every 15 men. It usually begins in early adulthood.
Table of Contents
There are several types of migraine::
- migraine with aura – where there are specific warning signs just before it begins, such as seeing flashing lights
- migraine without aura – the most common type, where the migraine happens without the specific warning signs
- migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop
Some people have migraines frequently, up to several times a week. Other people only have it occasionally. Sometimes years pass between two attacks.
When to get medical advice
You should see your family doctor if you have frequent or severe symptoms of migraine, or your symptoms are not reduced with over the counter medicines. Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time.
Causes of Migraines
The exact cause of migraines is unknown, although they’re thought to be the result of temporary changes in the chemicals, nerves and blood vessels in the brain. Around half of all people who experience it also have a close relative with the condition, suggesting that genes may play a role. After a concussion, headache is one of the most prevalent symptoms, and mild traumatic brain damage (mTBI) is linked to chronic migraine (CM). About 15% of people suffer migraine headaches for the first time as a result of the head injury.
Some people find attacks of migraine are associated with certain triggers, which can include:
- Starting of menstrual period
- Stress
- Tiredness
- Certain foods or drinks
Treating migraines
There’s no cure for migraines, but a number of migraine treatments are available to help reduce the symptoms.
- Painkillers – including over-the-counter medicines like paracetamol and ibuprofen
- Triptans – medicines that can help reverse the changes in the brain that may cause it
- Anti-emetics – medicines often used to help relieve people’s feeling of sickness (nausea) or being sick
During an attack, many people find that sleeping or lying in a darkened room can also help.
Preventing migraines
If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing it.
It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep, and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.
Medicines used to prevent migraines include the anti-seizure medications topiramate and a medicine called propranolol that’s usually used to treat high blood pressure.
It may take several weeks before its symptoms begin to improve.
Outlook
Migraines can severely affect your quality of life and stop you carrying out your normal daily activities. Some people find they need to stay in bed for days at a time. But a number of effective treatments are available to reduce the symptoms and prevent further attacks. It just need a simple goggle search “migraine doctor near me” these days to locate and identify a neurologist in your locality.
Symptoms
- The moderate or severe throbbing sensation gets worse when you move and prevents you carrying out normal activities.
- In some cases, the pain can occur on both sides of your head and may affect your face or neck.
- Feeling sick, being sick
- Increased sensitivity to light and sound, which is why many people with it want to rest in a quiet, dark room
- Additional symptoms: sweating. poor concentration, feeling very hot or very cold, abdominal pain, diarrhoea
Not everyone experiences these additional symptoms. Its symptoms usually last between 4 hours and 3 days, although you may feel very tired for up to a week afterwards.
Symptoms of aura
About 1 in 3 people with migraines have temporary warning symptoms, known as aura, before it starts. Aura in migraine includes:
- Visual problems – such as seeing flashing lights, zig-zag patterns, or blind spots
- Numbness or a tingling sensation like pins and needles – which usually starts in 1 hand and moves up your arm before affecting your face, lips, and tongue
- Feeling dizzy or off-balance
- Difficulty speaking
- Loss of consciousness – although this is unusual
Stages of a Migraine
It often develop in distinct stages, although not everyone goes through all of these:
- Prodromal (pre-headache) stage – changes in mood, energy levels, behavior, and appetite that can occur several hours or days before an attack
- Aura – usually visual problems, such as flashes of light or blind spots, which can last for 5 minutes to an hour
- Headache stage – usually a pulsating or throbbing pain on 1 side of the head, often accompanied by feeling sick, vomiting, or extreme sensitivity to bright light and loud sounds, which can last for 4 to 72 hours
- Resolution stage – when the headache and other symptoms gradually fade away, although you may feel tired for a few days afterwards
Causes
The exact cause of it is unknown, but they’re thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain. It’s not clear what causes this change in brain activity, but it’s possible that your genes make you more likely to experience it as a result of a specific trigger.
Migraine Triggers
Hormonal Changes
Some women experience migraines around the time of their period, possibly because of changes in the levels of hormones such as oestrogen around this time. These types usually occur between 2 days before the start of your period to 3 days after. Some women only experience it around this time, which is known as pure menstrual migraine. Many women find their migraines improve after menopause, although menopause can trigger it or make them worse in some women.
Emotional Triggers
Some of the emotional triggers are:
- stress
- anxiety
- tension
- shock
- depression
- excitement
Physical triggers
- tiredness
- poor-quality sleep
- shift work
- poor posture
- neck or shoulder tension
- jet lag
- low blood sugar (hypoglycaemia)
- strenuous exercise, if you’re not used to it
Dietary triggers
- missed, delayed, or irregular meals
- dehydration
- alcohol
- caffeine products, such as tea and coffee
- specific foods, such as chocolate and citrus fruit
- foods containing the substance tyramine, which include cured meats, yeast extracts, pickled herrings, smoked fish (like smoked salmon), and certain cheeses (such as cheddar, stilton, and camembert)
- Also, foods that have been stored at room temperature, rather than being refrigerated or frozen, can have rising levels of tyramine.
Environmental triggers:
- Bright lights
- Flickering screens, such as a television or computer screen
- Smoking (or smoky rooms)
- Loud noises
- Changes in climate, such as changes in humidity or very cold temperatures
- Strong smells
- A stuffy atmosphere
Medicines which trigger Migraine
- Some types of sleeping tablets
- The combined contraceptive pill
- Hormone replacement therapy (hrt), which is sometimes used to relieve symptoms associated with the menopause
Diagnosis
There’s no specific test to diagnose migraines. For an accurate diagnosis to be made, your migraine doctors must identify a pattern of recurring headaches along with the associated symptoms. it can be unpredictable, sometimes occurring without the other symptoms. Reaching the proper diagnosis can sometimes take time.
Some points of interest for a diagnosis 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 diary
To help with the diagnosis, it can be useful to keep a diary of your attacks for a few weeks. Note down details like:
- What were the date and times?
- What you were doing when the it began?
- How long did the attack last?
- What symptoms did you experience?
- What migraine medicines do you take (if any)?
- For women – when does the period start?
Treatment
There’s no permanent cure for migraines. But a number of treatments are available to help ease the symptoms. It may take time to work out the best treatment for you. You may need to try different types or combinations of migraine tablet and medicines before you find the most effective ones.
During an attack, most people find that sleeping or lying in a darkened room is the best thing to do. Others find that eating something makes them feel better. Pressing and messaging acupressure points for migraine can also help.
Painkillers
Triptans
Sometimes painkillers need to be taken along with medicines called triptan. Anti-emetics [medicines to stop vomiting and nausea] may also have to be taken.
Triptan for migraine are a specific painkiller for headaches. They’re thought to work by reversing the changes in the brain that may cause migraine headaches. They cause the blood vessels around the brain to narrow (contract). This reverses the widening of blood vessels that are believed to be part of the its process. Triptans are available as tablets, injections, and nasal sprays.
Side effects of Triptans
- warm sensations
- tightness
- tingling
- flushing
- feelings of heaviness in the face, limbs, or chest
- Some people also experience feeling sick, a dry mouth, and drowsiness.
Anti-sickness medicines
Anti-sickness medicines, known as anti-emetics, can successfully treat it in some people even if you do not experience feeling or being sick. These are taken alongside painkillers and triptans. As with painkillers, anti-sickness medicines work better if taken as soon as its symptoms begin.
Acupuncture
If medicines are unsuitable or do not help to prevent migraines, you can try acupuncture. Evidence suggests a course of up to 10 sessions over a 5- to 8-week period may be beneficial.
If the treatments above are not effectively controlling it, your GP may refer you to a specialist migraine clinic for further investigation and treatment.
TMS
In addition to the medicines mentioned above, a specialist may recommend other treatments, such as Transcranial Magnetic Stimulation [TMS]. TMS involves holding a small electrical device to your head that delivers magnetic pulses through your skin. But TMS is not a cure for it and does not work for everyone.
Treatment for pregnant and breastfeeding women
In general, migraine treatment with medicines should be limited as much as possible when you’re pregnant or breastfeeding. Instead, trying to identify and avoid potential triggers is often recommended. If medicine is essential a low-dose painkiller, such as paracetamol will be useful. In some cases, anti-inflammatory medicine or triptans may be prescribed
Complications
Migraines are associated with a small increased risk of ischaemic strokes, and a very small increased risk of mental health problems.
An ischaemic stroke happens when the blood supply to the brain is blocked by a blood clot or fatty material in the arteries. It’s not clear why ischaemic strokes are linked to it.
Contraceptive pill: The risk of having an ischaemic stroke is increased by using the combined contraceptive pill. So it is advisable for migraine patients with aura to avoid the combined contraceptive pill.
Mental health problems
Migraine is associated with a very small increased risk of mental health problems, including:
- Depression
- Bipolar disorder
- Anxiety disorder
- Panic disorder
Prevention
Identifying and avoiding triggers
One of the best ways of preventing migraines is recognizing the things that trigger an attack and trying to avoid them. You may find you tend to have it after eating certain foods or when you’re stressed, and by avoiding this trigger you can prevent a migraine.
Keeping a migraine diary can help you identify possible triggers and monitor how well any medicine you’re taking is working.
Topiramate
Topiramate is a type of medicine originally developed to prevent seizures in people with epilepsy but is now much more commonly used in migraine. It’s been shown to help prevent it and is usually taken every day in tablet form. Topiramate for migraine should be used with caution in people with kidney or liver problems. It can also harm an unborn baby if taken during pregnancy and can reduce the effectiveness of hormonal contraceptives.
Side effects of topiramate can include:
- Decreased appetite
- Feeling sick
- Being sick
- Constipation or diarrhea
- Dizziness
- Drowsiness
- Problems sleeping
Propranolol
Propranolol is a medicine traditionally used to treat angina and high blood pressure, but consuming propranolol in migraine is also been shown to effectively prevent it.
Side effects of propranolol can include:
- Cold hands and feet
- Pins and needles
- Problems sleeping
- Tiredness
- Amitriptyline
Amitriptyline can make you feel sleepy, so it’s best to take it in the evening or before you go to bed.
Botulinum toxin type A
In June 2012, NICE recommended the use of a medicine called botulinum toxin type A by headache specialists to prevent headaches in some adults with long-term migraine.
Monoclonal antibodies
If you have frequent headaches and other treatments have not helped, medicines called monoclonal antibodies may be recommended. Examples include fremanezumab, galcenezumab and erenumab.
These medicines are given as an injection, usually every month or every few months. After a few months of treatment, you’ll have a check-up to see how well the medicine is working and to decide whether to continue the treatment.
Menstruation & Migraine
Menstrual-related migraines usually occur from 2 days before the start of your period to 3 days after. As these are relatively https://vetom.kiev.uahttps://vetom.kiev.ua predictable, it may be possible to prevent them using either non-hormonal or hormonal treatments.
Non-hormonal treatments
- non-steroidal anti-inflammatory drugs (NSAIDs) – a common type of painkiller
- triptans – medicines that reverse the widening of blood vessels, which is thought to be a contributory factor
These medicines are taken as tablets 2 to 4 times a day from either the start of your period or 2 days before, until the last day of bleeding.
Hormonal treatments
Combined hormonal contraceptives, such as the combined contraceptive pill, patch or vaginal ring progesterone-only contraceptives, such as progesterone-only pills, implants or injections, oestrogen patches or gels, which can be used from 3 days before the start of your period and continued for 7 days. Hormonal contraceptives are not usually used to prevent menstrual-related migraines in women who experience aura symptoms because this can increase your risk of having a stroke.