Migraine – Causes, Symptoms, Diagnosis, Treatment and Prevention

A migraine is a neurological condition or disorder which is characterized by severe headaches, usually giving a throbbing or pulsating feeling on either one or both sides of one’s head. The headache will be accompanied by symptoms like nausea, vomiting, speaking difficulties, numbness or tingling, and light and sound sensitivity. 

Studies say that Migraine is the sixth most disabling disease in the world. It could be genetic and can affect people of almost all ages. In young children, migraine goes undiagnosed as it is misunderstood to be a common headache or weakness. The duration of migraine varies between individuals. Most of the attacks last for a minimum of 4 hours. If an attack of a migraine lasts longer than three days, it has to be treated in a hospital setting.

What does Migraine feel like?

Migraine feels different to different people

• A one-sided headache
• Pulsating or throbbing pain
• Moderate to severe pain
• Worsening of pain during movement (walking, climbing stairs)
• Sensitivity to sound and light
• Nausea with or without vomiting or diarrhea

Migraine usually lasts for about four hours. If they are not treated it can last for a week. 

What are the types of Migraines?

• Classic Migraine/Migraine with Aura: This occurs with specific warning signs before the attack begins. It is seen in 25% of people with migraine. It is also termed a complicated migraine. An aura is the initial phase of the migraine attack accompanied by distinct symptoms like flashing lights, loss of vision, dizziness, confusion, and weakness.
• Migraine without aura:  This occurs without any warning signs and is the most common type.
• Migraine without headache: The symptoms of aura occur but the person does not develop a headache. This is also known as silent migraine.
• Hemiplegic migraine: The onset of this kind of migraine is marked by hemiplegia or temporary paralysis. The person can experience temporary numbness, weakness, tingling sensation, or dizziness.
• Retinal Migraine: Also called ocular migraine. The person may feel a partial or complete loss of vision in one of the eyes, which can last from a few minutes to a few months, in worst cases. It is imperative to approach a doctor if one is experiencing this. 
• Chronic Migraine:  A chronic migraine is one that occurs 10 to 15 days a month. The severity of pain may differ on different days. 
• Migraine with brainstem aura: This migraine shows symptoms like slurred speech, loss of balance, and double vision before the onset of the headache. Usually, the headache appears on the backside of one’s head and with an inability to speak properly. 
• Status migrainosus: This is a relatively rare migraine that lasts for more than 72 hours with extremely bad nausea and headache. This migraine is usually caused by some medications or as a withdrawal effect of medications.

What is an Aura?

Aura refers to a set of symptoms or warning signals which can occur before the onset of a migraine. These can be sensory, motor, or speech symptoms which can last for 10 to 60 minutes. Aura symptoms include blind spots in vision, speech changes, temporary loss of vision, changes in smell or taste, tingling sensation etc. Studies report that aura symptoms are experienced by 15 to 20 percent of people with migraines and are reversible/ be healed.

The causes of migraine headaches aren’t fully understood, but genetics and environmental factors play a role. Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, may be involved.  The causes may differ from person to person.x

Perhaps there might be imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system. Although there are several migraine triggers, including: 

• Hormonal changes in women such as fluctuations in estrogen before or during menstrual periods, pregnancy, and menopause. 
• Hormonal medications such as oral contraceptives and hormone replacement medications can worsen the headaches.  
• Drinks like alcohol, especially wine, with high amounts of caffeine.  
• Stress at work or home.  
• Bright flashing lights and loud sounds.  
• Strong smells from perfume, paint thinner, and passive smoking.  
• Missing sleep or excessive sleep.  
• Intense physical exertion of any kind.  
• A change in weather.  
• Aged cheeses and salty and processed food. 
• Food additives like sweetener aspartame and preservative monosodium glutamate (MSG) are found in many foods. 
• Skipping meals can also trigger the attack

In addition to the above mentioned, an imbalance in the chemicals in the brain such as serotonin plays an important role in the cause of a migraine attack. Research is still conducted to find the connection between migraine attacks and serotonin. In migraine attack, there is a drop in the level of serotonin, causing the trigeminal nerves to release substance called neuropeptide – travels to the outer covering of the brain. Thus, resulting in a headache.

The predominant symptom of a migraine is a headache. Often, people describe the pain as pounding or throbbing. It can begin as a dull pain that further develops into pulsing pain that is mild, moderate, or severe.  

If left untreated, the headache may become moderate to severe. Pain can shift from one side of the head to the other, or it can affect the front or back of the head. It may also affect the whole head. Some people also feel pain around their eyes or temple. 

Other symptoms of migraine headaches include:

• Sensitivity to light, noise, and smell
• Nausea and vomiting, upset stomach, and abdominal pain
• Loss of appetite
• Feeling very warm or cold
• Pale skin color
• Feeling tired
• Dizziness and blurred vision
• Tender scalp
• Diarrhea
• Fever

Most migraine headaches last about four hours, although severe ones may last much longer.

Each phase of the migraine attack can come with different symptoms:

Prodromal Symptoms:

The symptoms arise one or two days before the attack, certain warning signals an upcoming migraine, include:

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

Aura Symptoms:

• Numbness and tingling
• Visual disturbances similar to a kaleidoscope, view blurry spots or see sparkles or lines
• Temporary loss of sight
• Weakness on one side of the body
• Speech changes

Headache Symptoms:

• Neck pain, stiffness
• Depression, giddiness and anxiety
• Sensitivity to light, smell, and sound
• Nasal congestion
• Insomnia
• Nausea and vomiting

Post-Drome

After the attack, a person may feel drained or tired for a day. However, some report to feel elated. But sudden head movement can bring back the pain.

When To See a Doctor?

Migraine headaches are often undiagnosed and untreated. If there are regular signs and symptoms of migraine, make an appointment with the doctor to discuss treatment and ways to manage migraine.  It is important to get medical help immediately if a person has a family and the headache feels different from the usual migraine headaches.

Seek medical expertise immediately if you are experiencing any of the following signs and symptoms, which could indicate a more serious medical problem: 

• An abrupt, severe headache  
• Headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body 
• Headache after a head injury 
• A chronic headache that is worse after coughing, exertion, straining or a sudden movement 
• New headache after the age of 50

Request an appointment at Apollo Hospitals

Migraines can occur due to several factors. Some of the factors associated with migraine include:

• Family History: Migraines can be genetic and hence if one person in a family suffers from migraine, there is an increased probability for others in the family to have it too.
• Age: Migraines begin at any age. The first attack of migraine is usually experienced during adolescence. Migraines tend to peak in a person’s life during his 30s and gradually tend to be less severe in the following decades.
• Sex: Women are three times more likely to have migraine than men.  Among children, the headaches are more common in boys than girls. But by puberty, girls are more affected. This could be due to the fluctuations in the hormonal levels for a menstrual cycle to occur. In later stages, conditions like pregnancy, menopause, etc. become a reason for migraine attacks in women.
• Hormonal Changes: Many women complain of a headache at the onset on menstruation. Menopause is known to improve migraines. For some women, migraine attacks increase during pregnancy. However, the attacks may be absent in the later stages of pregnancy and return during the postpartum period.

A doctor diagnoses a migraine in a person by analyzing the symptoms. Tests may be done to detect unusual, complex or severe conditions. The doctor might recommend the following tests.

• Blood Tests: These tests are used to identify problems in blood vessels and also to diagnose infections in spinal cord and brain.
• Magnetic Resonance Imaging (MRI): A strong magnetic field and radio waves are used in MRI test to produce detailed images of the brain and blood vessels. MRIs can diagnose tumours, strokes, bleeding in the brain, infections and other neurological conditions.
• Computerized Tomography (CT) Scan: A CT scan uses a series of x-rays to create detailed cross-sectional images of the brain. Using a CT scan, a doctor can identify infections, brain damage, bleeding in the brain and spinal tumors, and other issues that cause headaches.
• Spinal Tap (Lumbar Puncture): This test may be recommended if an individual is suspected to have an infection or bleeding in the brain. This procedure involves the insertion of a thin needle between two vertebrae in the lower back to draw a sample of the cerebrospinal fluid (brain fluid) for further laboratory analysis.

Are Migraines Misdiagnosed?

Migraines are misdiagnosed when a person and the healthcare providers assume that pain can be due to headache or a tension-type headache. It is important to show the healthcare provider the migraine journal, if any, to shed more light on the unique situation.

What are the devices for migraines?

Doctors do not recommend surgery for migraine. However there are certain medical tools that have been studied and endorsed for assisting in lessening the migraine attacks – either decreasing or increasing nervous system activity. Currently, there are four FDA approved neuromodulation treatments: 

• Single-pulse transcranial magnetic stimulator: it is a handheld device producing magnetic impulses that in turn affects the electrical signaling in the brain. 

• Transcutaneous vagus nerve stimulator: This targets the vagus nerve in the neck through an electrical stimulation
• Transcutaneous supraorbital nerve stimulator: It simulates the supraorbital nerves with electrical stimulation.
• Multi-channel brain neuromodulation system: A headset that can target multiple nerves in the head.

Note, it is crucial to talk to the doctor about the best neuromodulation treatment for the specific type of migraine.

What is a migraine in children?

Migraines in children can have similar types as adults. Children may more likely have symptoms on both the sides of the head – until they are older. The attacks lasts for 2 to 72 hours and it is rare for them to have headaches at the back of the head. One of the more common variants is abdominal migraine.

What is abdominal migraine?

In this, children with abdominal migraine may have a stomachache instead of a headache. The pain can be moderate or severe. Usually, children experience pain is in the middle of the stomach, around the belly button. But the pain may not be in this specific area. The belly may just feel ‘sore.’

Apart from headaches, the child may also experience other symptoms such as:

• lack of appetite
• nausea with or without vomiting
• sensitivity to light or sound

Children with abdominal migraine are likely to develop more typical migraine symptoms as adults.

What is migraine attacks in pregnancy?

The migraine attack for many pregnant women improve during pregnancy. But there are chances that can worsen following delivery as there is sudden hormonal shifts. Attacks during pregnancy needs to be taken seriously and ensure the cause of the attack is understood.

Research is ongoing, but a recent  small study showed that women with migraine during pregnancy experienced a higher rate of having:

• Preterm or early labor 
• preeclampsia
• a baby born with low birth weight 

Aspirin is one of the medications that is considered safe during pregnancy. If you have migraine during pregnancy, talk to your doctor to find ways to treat your migraine that won’t harm your developing baby.

Treatment of migraine is required to relieve the symptoms and prevent attacks in the future. The medications that are used to treat migraine are classified into two broad categories:

• Pain-relieving medications
• Preventive medications
• Pain-relieving medications are also known as acute or abortive treatment. The drugs falling under this category are taken during the migraine attack and are designed to minimize or eliminate the symptoms.

Common pain-relieving medications include:

• Pain Relievers: used in migraine include aspirin, ibuprofen and paracetamol. These drugs may be taken as combinations with caffeine. These drugs are however not effective for severe migraines.
• Triptans: Triptans make blood vessels contract and block pathways of pain in the brain. These drugs are effective in relieving pain and other symptoms associated with migraines. They are available in the form of a pill, nasal spray and injection. Triptan medications include sumatriptan, rizatriptan, etc.
• Ergots: Less effective than triptans are ergots, which are a combination of ergotamine and caffeine. Ergots are more effective when taken soon after an attack of migraine starts.
• Anti-nausea Medications: Chlorpromazine, metoclopramide and other medications are frequently prescribed for nausea in combination with other medications.
• Opioid Medications: These medications contain narcotics, primarily codeine. These are used to treat migraine pain in patients who cannot take triptans and ergots.
• Glucocorticoids: A glucocorticoid is used in combination with other medications to improve pain relief.

Preventive medications are drugs that have to be taken regularly to reduce the severity or frequency of migraine attacks. Preventive medication is recommended if a patient suffers from four or more debilitating attacks in a month and if the attacks last longer than 12 hours.

The most common preventive medications for a migraine include:

• Cardiovascular Drugs: Beta-blockers like propranolol, metoprolol and timolol and calcium channel blocker can prevent migraines.
• Antidepressants: Tricyclic antidepressants can reduce the frequency of migraine by affecting the level of serotonin and other brain chemicals.
• Anti-Seizure Drugs: To reduce the frequency of migraine attacks, certain anti-seizure drugs like valproate and topiramate are used.
• Onabotulinum Toxin A (Botox): Botox treatment is also helpful in treating chronic migraines in adults.
• Pain Relievers: NSAIDs or non-steroidal anti-inflammatory drugs like naproxen may prevent migraines and minimize symptoms.

The treatment strategy depends on the frequency of a headache and its severity. It also depends upon the degree of disability caused by the attack and other underlying health conditions of the patient.

Treatment varies in certain conditions like pregnancy and breastfeeding. The doctor should be informed of such conditions, as some medicines aren’t recommended during these stages.

What are the complimentary and alternative medicines?

In addition to traditional medical treatment, some people opt for relief with therapies. This is called complementary or alternative treatments such as:

1. Biofeedback: This helps to keep note of stressful situations that can trigger symptoms. If the headache begins slowly, biofeedback can stop the attack before it is full-blow.
2. Cognitive behavioural therapy (CBT): A trained healthcare provider can teach the different ways how actions and thought affects the sense of pain. 
3. Supplements: There are research that recommends inclusion of some vitamins, minerals, and herbs to prevent or treat migraine. These include riboflavin, coenzyme Q10, and melatonin. Butterbur may head off migraines, but it can also affect your liver enzymes.
4. Body wor: Treatment such as chiropractic, massage, acupressure, acupuncture, and craniosacral therapy might ease headache symptoms.

It is important to talk to a doctor before trying any of the above mentioned complementary or alternative treatments.

What are migraine home remedies?

The following home remedies can also help relieve the pain from migraine.

1. Find a dark room to quietly lie down
2. Massage scalp or temples
3. Place a cold cloth over your forehead or behind the neck. 

Identifying the pattern of migraine is a good way to prevent its repetition. Maintaining a journal of activities and keeping a track of symptoms that are experienced each time will help an individual understand the triggers of a migraine attack. Abstaining from such tasks will eventually help the individual to prevent attacks in the future.

Apart from this, the following lifestyle modifications may help prevent migraines

• Regular schedule for eating
• Regular schedule for sleeping
• Avoiding foods that trigger migraine
• Drinking plenty of water and keeping oneself hydrated
• Exercise may promote muscle relaxation and help manage pain during migraine.
• Relaxation strategies
• Prompt medication schedule
• Some foods are known to trigger migraine. Avoiding them can also help prevent migraines
• Red wine
• Aged cheese
• Preserved, smoked meat foods
• Monosodium glutamate
• Aspartame and artificial sweeteners
• Chocolate
• Dairy products
• Alcoholic beverages
• Highly-caffeinated beverages

Apart from these, daily use of medications and being stress-free are effective tips in the prevention of migraine. Apart from medications prescribed by the doctor, hot packs and heating pads can help relax tense muscles. Having a warm bath can also soothe a migraine attack.

Conclusion

Migraine attacks can happen anytime, anyway. These attacks makes it close to impossible to complete our daily chores. However, the attacks can be easily managed through medication, natural, and home remedies. Sometime, a migraine can minic a stroke or if the symptoms are severe it is advisable to immediately contact your doctor. It’s time to take control over migraine.

How often do migraines happen?

It is a chronic condition that can be effectively controlled with various treatment measures. The frequency of a migraine attack could be either once a year, a week, or any amount of time in between. The most common is having two to four migraine headaches a month.

Are migraines hereditary?

Yes, migraines are hereditary. Close to four out of five people with migraine have a family history.  If one parent has a history of migraine, then the chances of the child having migraine is 50%. And if both the parents have a history of migraine, the risk increase to 75% for the child.

Do migraines cause permanent brain damage? If I have migraines, does that mean I’ll get another disease?

No, migraines do not cause permanent brain damage. However, there is a tiny chance of stroke in people who gets migraine with aura.

Are Migraines Fatal?

It is unlikely to be fatal. However there may be an increased chances of cardiovascular events with migraine and an increased risk of stroke in people with migraine with aura.

Are migraines curable?

Currently, there is no cure for migraines. But it is manageable with the correct treatment plan. Talk to your doctor about the best treatment option that best suits you.