Broadly Understanding Migraine - I

Dr. Tasaduk Hussain Itoo
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27 Oct 2023

HEALTH AWARENESS

A migraine is a strong headache that often comes with nausea, vomiting, and sensitivity to light. It can last hours or days.

SIGNS AND SYMPTOMS

Migraines are different in everyone. In many people, they happen in stages. These stages may include:

PRODROM

Hours or days before a headache, about 60% of people who have migraines notice symptoms like:

Being sensitive to light, sound, or smell.
Food cravings or lack of appetite.
Mood changes.
Severe thirst.
Constipation or diarrhoea.

AURA

These symptoms stem from one's nervous system and often involve one's vision. They usually start gradually, over a 5 to 20 minutes period, and last less than an hour. One may experience:

Black dots, wavy lines, flashes of light, or things that aren’t there (hallucinations).
Have tunnel vision.
Not be able to see at all.
Have tingling or numbness on one side of body.
Not be able to speak clearly.
Have a heavy feeling in arms and legs.
Have ringing in one's ears.
Notice changes in smell, taste, or touch.

ATTACK

A migraine headache often begins as a dull ache and grows into throbbing pain. It usually gets worse during physical activity. The pain can move from one side of one's head to the other, can be in the front of one's head, or can feel like it's affecting one's entire head. About 80% of people have nausea along with a headache, and about half vomit. One may also be pale and clammy or feel faint. Most migraine headaches last about 4 hours, but severe ones can go for more than 3 days. It is common to get two to four headaches per month. Some people may get migraine headaches every few days, while others get them once or twice a year.

POSTDROME

This stage can last up to a day after a headache. Symptoms include:

Feeling tired, wiped out, or cranky.
Feeling unusually refreshed or happy.
Muscle pain or weakness.
Food cravings or lack of appetite.

MECHANISM OF CAUSATION

Migraine headaches are a symptom of a condition known as migraine. Although the exact cause remains unknown, migraine headaches seem to be related to changes in one's brain and genes. For many years, scientists thought migraines occurred because of changes in blood flow in the brain. Most now think this can contribute to the pain. However, current thinking is that a migraine likely starts when overactive nerve cells send out signals that trigger trigeminal nerve, which gives sensation to head and face. This stimulates the body to release chemicals like serotonin and calcitonin gene-related peptide (CGRP) -- CGRP makes blood vessels in the lining of brain swell. Then, neurotransmitters cause inflammation and pain.

RISK FACTORS OF MIGRAINE

Sex: Women have migraines three times more often than men.
Age: Most people start having migraine headaches between ages 10 and 40. But many women find that their migraines get better or go away after age 50.
Family history: Four out of five people with migraines have other family members who get them. If one parent has a history of these types of headaches, their child has a 50% chance of getting them. If both parents have them, the risk jumps to 75%.
Other medical conditions: Depression, anxiety, bipolar disorder, sleep disorders, and epilepsy can raise the chances of getting migraine headaches.

TRIGGERS OF MIGRAINE

Hormonal triggers

Many women notice that they have headaches around their period, while they’re pregnant, or when they’re ovulating. Symptoms may also be tied to menopause, birth control measures that uses hormones, or hormone replacement therapy.

Emotional triggers

▪Stress-- when one is stressed, it causes the brain to release chemicals that can cause blood vessel changes that might lead to a migraine.

▪Anxiety

▪Tension

▪Shock

▪Depression

▪Excitement

Physical triggers

▪Tiredness.

▪Poor-quality sleep -- changes in sleep pattern -- one might get headaches when one sleep too much or not enough.

▪Shift work schedule.

▪Poor posture.

▪Neck or shoulder tension.

▪Low blood sugar (hypoglycaemia).

▪Strenuous exercise, if one is not used to it before.

▪Physical activity ---this includes exercise and sex.

Dietary triggers

▪Missed, delayed or irregular meals.

▪Skipping meals.

▪Dehydration.

▪Alcohol consumption.

▪Caffeine products, such as tea and coffee -- getting too much or not getting as much as one is used to can cause headaches. Caffeine itself can be a treatment for acute migraine attacks.

▪Specific foods, such as chocolate and citrus fruit.

▪Foods containing the substance tyramine, which include cured meats, pickled herrings, smoked fish, and certain aged cheeses.

▪Foods that have been stored at room temperature, rather than being refrigerated or frozen, can have rising levels of tyramine.

▪Food additives like nitrates and monosodium glutamate may be responsible in some people.

Environmental triggers

▪Bright lights.

▪Flickering screens, such as a television or computer screen.

▪Smoking (or smoky rooms).

▪Loud noises.

▪Changes in climate/weather, such as changes in humidity or very cold temperatures, storm fronts, changes in barometric pressure, a stuffy atmosphere, strong winds, or changes in altitude can all trigger a migraine.

▪Strong smells.

Medication triggers

▪Vasodilators, which often widens one’s blood vessels, can trigger migraines.

▪Frequent use of over-the-counter pain killers can cause medication overuse headache, called rebound headache.

TYPES OF MIGRAINE

There are several kinds of migraines. The most common are migraine with aura (also known as a classic migraine) and migraine without aura (or common migraine). Other types include:

Menstrual migraine: This is when the headache is linked to a woman’s period.
Silent migraine: This kind is also known as an acephalgic migraine. One having aura symptoms without a headache.
Vestibular migraine: One may have balance problems, vertigo, nausea, and vomiting, with or without a headache. This kind usually occurs in people who have a history of motion sickness.
Abdominal migraine: Experts don’t know a lot about this type. It causes stomach pain, nausea, and vomiting. It often happens in children and may change into classic migraine headaches over time.
Hemiplegic migraine. One may have a short period of paralysis (hemiplegia) or weakness on one side of body. One might also feel numbness, dizziness, or vision changes.
Ophthalmic migraine. This is also known as an ocular or retinal migraine. It causes short-lived, partial, or total loss of vision in one eye, along with a dull ache behind the eye, which may spread to the rest of one's head.
Migraine with brainstem aura. Dizziness, confusion, or loss of balance can occur before the headache. The pain may affect the back of one's head. These symptoms usually start suddenly and can come along with trouble speaking, ringing in one's ears, and vomiting. This type of migraine is strongly linked to hormonal changes and mainly affects young adult women.
Status migrainosus. This severe type of migraine can last more than 72 hours. The pain and nausea are so intense that one may need to go to the hospital and seek immediate medical attention. Sometimes, medicines or medication withdrawal can cause them.
Ophthalmoplegic migraine. This causes pain around one's eye, including paralysis of the muscles around it. This is a medical emergency because the symptoms can also be caused by pressure on the nerves behind the eye or by an aneurysm. Other symptoms include a droopy eyelid, double vision, or other vision changes.

MIGRAINE FREQUENCY

Episodic migraine means one get migraine now and then. High-frequency episodic migraine means one get 8 to 14 headache days per month. This condition also makes one more likely than others to develop chronic migraine -- chronic migraine means one have headache on more than 15 days of the month and eight of those days have migraine features such as:

Moderate to intense head pain.
Pain is on side of head (one or both).
Pain throbs or pulsates.
Pain gets worse when you move.
Nausea or vomiting.
Sensitivity to light and sound.

MIGRAINE COMPLICATIONS

Most migraines don't cause lasting harm. Rarely, one can have a complication called migrainous infarction. That's when one has a stroke while having a migraine. But there's no evidence migraine can trigger a stroke. It's extremely rare, but a hemiplegic migraine can sometimes lead to a coma or other serious complications. Moreover, a very intense headache that starts suddenly can be a sign of another, more serious condition, like a stroke or aneurysm -- that warrants emergency medical attention.

MIGRAINE DIAGNOSIS

Getting migraine headaches diagnosed correctly is crucial to start the right treatment plan. It is based on a proper history, thorough physical exam, proper deliberation of signs and symptoms -- how often they occur, their onset, duration, progression, deliberation of associated risk/triggering factors etc. And it is important to be as complete as possible with these descriptions. In many cases, it is recommended to do few investigations -- blood tests, imaging tests like CT scans, MRI, EEG to rule out neural causes or other factors associated with the headaches.

(To be continued…)

(Author is a medical doctor, health columnist and public speaker. He can be reached at: drtasadukitoo@gmail.com)