Migraine is the third most common disease in the world. It costs American employers $20 billion each year and considering how widespread and the suffering it causes, it’s safe to say research funding is meager at best.
Migraines are a kind of headache that is severe and often accompanied by nausea, vomiting, and light sensitivity. There is no limit to how long it can last.
A sign of classic migraine is a headache is severe: One-sided, pulsing or throbbing, accompanied by severe pain and discomfort with normal lights, sounds, or smells, not to mention nausea and vomiting. It typically lasts four to 72 hours, during which the scalp can be extremely sensitive to the touch.
So it’s not unusual for migraine sufferers — also known as migraineurs — to withdraw from the outside world to lie down without moving in a dark, quiet room. But the truth is, the realities of life often prevent this form of relief.
Familiarizing yourself with causes, symptoms, and treatment can help you identify the problem, and then hopefully start feeling some relief. Here’s everything you need to know.
Causes Of Migraine
The fundamental causes of migraine headaches are not known and likely are complex. The most accepted theory postulates an imbalance of nerve and blood flow interactions in the brain.
It is now believed that this can contribute to the pain, but not the cause.
Currently, it is believed that it is caused by overactive nerve cells sending signals that trigger the trigeminal nerve, which gives feeling to the head and face. In response, your body releases chemicals including serotonin and calcitonin gene-related peptide (CGRP). The CGRP causes swelling of the blood vessels in the lining of your brain. As a result, neurotransmitters cause inflammation and pain.
What Triggers Migraine
Often migraine sufferers can identify triggers that suggest an onset is likely to follow.
The Most Common Triggers Are:
- Stress
- Missing meals
- Intense physical activity
- Lack of sleep
- Dehydration
- Hormonal changes, especially in females around the menstrual cycle. (menstrual migraine)
Many other triggers may initiate migraine in some people but not others and the onset of is more likely when multiple triggers combine, such as stress with missed meals and lack of sleep. And these days, isn’t that everyone?
Types Of Migraine
The most people with migraine experience it without aura (about 75 percent of patients) and migraine with aura (about 25-30 percent of patients).
But it is uncommon for someone to have migraine with aura exclusively; usually, attacks are without aura, with occasional episodes with aura.
Migraine is about three times more common in females, almost always runs in the family, and affects over 35 million Americans. It becomes more common at puberty, peaks around 30-40 years of age, and usually (hopefully) decrease thereafter. And in one study, researchers found that it was more frequent with lower household income.
Retinal migraines are characterized by temporary, partial or complete loss of vision in one of your eyes as well as a dull ache behind the eye that may spread throughout your head.
Symptoms
With or Without Aura, The Typical Migraine Symptoms Are Similar That Include:
- Being sensitive to light, smells, sound, motion, and touch
- Blurred vision
- Pain that’s usually on one side of the head and worse when you move
- An upset stomach and throwing up
- Stiffness in your shoulders and neck
- Yawning
- Crankiness
Aura
Aura is usually a short episode of altered vision of around 15-minutes duration, that moves slowly in the field of view, making it hard to see and drive. After the visual symptoms disappear, severe migraine comes on after about 10 minutes.
It typically takes 5 to 20 minutes for an aura to set in. There may be an hour-long delay. It often precedes any pain by acting as a warning. However, it can also happen during migraines.
Migraine with Aura Can Include:
- Seeing flashing and bright lights
- Sensitivity to light
- Blind spots
- Double vision
- Difficulty focussing on things
- Balance and coordination problems
- Weakness
- Stiffness
- Tingling in the neck
The aura less commonly affects speech, hearing, skin sensation, or muscle power, but these symptoms are also short-lived and all warn of an upcoming migraine, hence the term aura or warning.
These types of aura can occur in other conditions. Visual aura in older people is quite common and unrelated to migraine, without any subsequent headache, and often without any previous migraine history as experienced by both co-authors. Without any warning or knowledge, this can be alarming, but is considered a benign event of aging, and is usually not a warning of stroke or other “doom”.
Other presentations of migraine include altered balance or dizzy spells that last for some hours to days. These may be accompanied by migraine symptoms, but can occur alone, referred to as ‘vestibular migraine’.
Many other episodic conditions — co-morbid conditions — occur more commonly in sufferers of migraine, which suggests they share an underlying mechanism (unknown as yet).
Migraine Comorbidities
- anxiety (often with panic attacks),
- depression
- irritable bowel syndrome
- gastroparesis (stomach not emptying well)
- painful bladder syndrome
- asthma
- allergies
- fibromyalgia
Two conditions that are usually recognized as benign heart murmurs in childhood are also comorbid with migraine: patent foramen ovale (the common “hole in the heart”) and mitral valve prolapse.
Other Less Common Forms Of Migraine “Variants” Include:
- Cluster headaches (very severe, short-duration headaches that are clustered over a short period)
- Migraine with other “autonomic” changes that might be misinterpreted as sinus headaches, eye infections, etc.
A “retinal” migraine is much less common and is more often a feature of aura generated by the brain, not the retina.
Diagnosis and Treatment
Surprisingly, the medical literature tells us that a third of those with migraine do not know they have it. This seems remarkable given that those of us without migraine cannot imagine not seeking a diagnosis for such a disabling condition.
Treatment for migraines aims to stop symptoms and prevent attacks from occurring in the future. Diagnosis of migraine will be done by a neurologist who will assess your family history, history of migraine attacks, and other underlying symptoms.
In Cases Of Unusual, Complex, or Severe Headache or Sudden Pain, The Following Tests May Be Recommended:
- Magnetic resonance imaging (MRI). MRI scans produce detailed images of the brain and blood vessels by using powerful magnetic fields and radio waves. Doctors use MRI scans to diagnose tumors, strokes, bleeding in the brain, infections, and other conditions affecting the nervous system and brain.
- Computerized tomography (CT) scan. An X-ray scan creates a cross-sectional image of the brain using a series of X-rays. Using this test, doctors can diagnose tumors, infections, brain damage, bleeding in the brain, as well as other possible medical conditions causing headaches.
Medications for Migraine
Migraines Can Be Treated With A Variety Of Medications. There Are Two Broad Categories Of Medications:
- Pain-relieving medications. This type of drug is commonly referred to as acute or abortive treatment, and it is taken during migraine attacks to stop the attacks. Examples include OTC medications (Advil, Motrin B, others), Triptans, Dihydroergotamine (Migranal), and Antiemetic drugs like Chlorpromazine or Metoclopramide and others. Your doctor will prescribe you medication based on your condition and type of migraine.
Some medications should not be taken during pregnancy. Consult your doctor before taking any of these medications if you are pregnant or trying to become pregnant.
- Preventive medications. The purpose of these medications is to reduce the severity or frequency of migraine attacks by taking them regularly. Examples include:
- Beta-blockers
- Antidepressants
- Antiseizure drugs
- Botox injections
- CGRP monoclonal antibodies
Lifestyle and Home Remedies
Whenever migraine symptoms begin, head to a dark, quiet place. Sleep or rest if you need to. Drink lots of water and place an ice pack or cool cloth on your forehead.
These Practices Might Also Soothe Migraine Pain:
- Try relaxation techniques. You might be able to reduce the number of migraines you experience with biofeedback and other types of relaxation training.
- Develop a sleeping and eating routine. Make sure you get enough sleep. Make sure you follow a consistent schedule for sleeping and waking each day. Maintain a regular eating schedule.
- Drink plenty of fluids. Drinking water might help you stay hydrated.
- Keep a headache diary. An effective migraine treatment can be determined by recording your symptoms in a headache diary. Additionally, it will allow your doctor to diagnose your condition and track your progress between appointments.
- Exercise regularly. The benefits of regular aerobic exercise include reducing tension and preventing migraines. Walking, swimming or cycling are all aerobic activities you might enjoy if your doctor agrees. To prevent headaches, however, warm up slowly before exercising.
- In addition to losing weight or maintaining a healthy body weight, exercise can also prevent migraines.
