Overview of migraine headache
A migraine headache is classified as a form of vascular headache. It is caused by the enlargement of blood vessels.
This phenomenon is known as vasodilatation and it causes the nerve fibres that coil around the large arteries of the brain to release chemicals. The release of chemicals is mainly because of the enlargement of the blood vessels that stretches the nerves that coil around them. The release of chemicals causes inflammation, pain, and further enlargement of the artery. This enlargement of the arteries further magnifies the pain.
These headaches typically last from 4 to 72 hours. The frequency of occurrence varies from daily to less than once per year. Migraine affects approximately 15% of the population. It affects the women population more than men. More than 80% of people suffering from migraine (called migraineurs) have other members in the family with the same ailment.
Types of migraine headache
- Classic migraine: People suffering from classic migraines experience an aura before their headaches, which is a visual disturbance (outlines of lights or jagged light images).
- Common migraine: This accounts for 80% of migraine cases. The patient does not experience any aura before a common migraine. It is less severe than classic migraines.
- Status migrainosus: This is a rare type of migraine. It causes intense pain that usually lasts longer than 72 hours. Usually, the patient requires hospitalization.
Apart from these, migraine can also be classified according to the symptoms they produce.
- Abdominal migraine: This is usually found in children with a family history of migraine. This type of migraine causes symptoms like abdominal pain without a gastrointestinal cause, which may last up to 72 hours. It also causes nausea, vomiting, and flushing or paleness (pallor).
- Basilar artery migraine: This type of migraine involves a disturbance of the basilar artery in the brainstem. Basilar artery migraine primarily occurs in young people. The symptoms manifested are: severe headache, vertigo, double vision, slurred speech, and poor muscle coordination.
- Carotidynia: This type is also known as lower-half headache or facial migraine. It produces deep, dull, aching, and sometimes piercing pain in the jaw or neck. Moreover, tenderness and swelling of the carotid artery in the neck is observed. This type is primarily prevalent in older people. Carotidynia migraine attacks usually occur several times weekly and last a few minutes to hours.
- Headache-free migraine: This type is characterized by the presence of aura without headache.
- Ophthalmoplegic migraine: This type of migraine attack begins with a headache in the eye that is accompanied by vomiting. With time, the headache progresses, the eyelid droops (ptosis) and nerves responsible for eye movement become paralyzed. Ptosis caused by this migraine may last for days or even weeks.
Till date, the cause behind migraine is unknown. It can be caused by a series of reactions in the central nervous system due to changes in the body or in the environment. Often it is found in multiple members with a family history of the disorder. This suggests that migraine sufferers may inherit sensitivity to triggers that causes a migraine attack.
A migraine trigger is any stimulus that initiates a migraine attack. Commonly identified migraine triggers include:
- Environmental factors:
- Time zone changes
- Foods items that contain:
- Caffeine (e.g., coffee, chocolate)
- Monosodium glutamate (MSG; used to enhance flavour in several processed foods and in Chinese preparations)
- Nitrates (found in processed foods)
- Artificial sweeteners (e.g., aspartame)
- Glare, contrasting patterns
- Hormonal changes in women
- Lack of sleep
- Medications (over-the-counter and prescription)
Symptoms of migraine headache
The symptoms associated with migraine differ from person to person. It also depends on the type of migraine. However, five phases of symptoms have been identified:
Prodrome: This is the phase before the migraine attack. This phase is characterised by symptoms like –
- Change in mood (feeling "high", irritable, or depressed)
- Subtle change of sensation (a funny taste or smell)
- Muscle tension
Aura: This phase precedes the headache phase. This phase is characterised by visual disturbances. The different types of visual disturbances are –
- Occurrence of a hole (scotoma) in the visual field, also known as a blind spot
- Occurrences of geometric patterns or flashing, colourful lights
- Lose vision on one side (hemianopsia)
Headache: Usually, during the migraine attack, the pain appears on one side of the head. However, 30-40% of migraines occur on both sides. The headaches are at times accompanied by a throbbing. Almost 80% of migraineurs feel nauseated and some vomit. Approximately, 70% of migraineurs become sensitive to light (photophobia) and sound (phonophobia). This phase last from 4 to 72 hours.
Headache termination: In case if the headache is left untreated, the pain subsides with sleep.
Postdrome: After the disappearance of the pain, symptoms like inability to eat, problems with concentration or fatigue may remain for some time.
When to Seek Medical Care
A patient should seek medical help if any of the following symptoms occur:
- Headache with dizziness, room spinning, or falling to one side
- Headache from an injury or blow to the head
- Headache with fever (over 100.4°F or 38°C when taken by mouth)
- Headache with a stiff neck or neck pain, or if light hurts the eyes
- Severe pain
- Pain that develops very rapidly
- Altered speech
- Weakness, numbness, or difficulty in walking
- Changes in vision
- A change in concentration or ability to think
- A change in level of alertness
A patient should also consult a physician under the following circumstances:
- If the patient suffers from chronic medical illness such as
- high blood pressure
- heart disease
- heart attack or stroke
- liver problems
- If the pain does not subside with over-the-counter pain medications
- If the patient consumes any other prescription or non-prescription medications
- A change in the normal pattern of the headache
- A new type of headache
Diagnosis of migraine headache
The diagnosis of migraine is based on the history of symptoms, physical examination, and neurological tests. However, some tests like blood testing, brain scanning (either CT or MRI), and a spinal tap are performed to rule out the presence of other neurological and cerebrovascular conditions like:
- Inflammation of the membranes of the brain or spinal cord (meningitis)
- Low level of cerebral spinal fluid (CSF)
- Nasal sinus blockage
- Postictal headache, which occurs after a stroke or seizure
- Intracranial haemorrhage or bleeding within the skull
- Blood clot within the membrane that covers the brain (cerebral venous sinus thrombosis)
- Cerebral stroke (infarct)
- Dilated blood vessel in the brain (cerebral aneurysm)
- Excess cerebrospinal fluid in the brain (hydrocephalus)
Treatment of migraine headache
Non-medication therapies for migraine
The non-medication therapies for migraine provide symptomatic and preventative therapy. The non-medication therapies used by migraineurs to manage mild-to-moderate attacks at home are:
- Using a cold compress to the area of pain.
- Resting with pillows comfortably supporting the head or neck.
- Resting in a room with little or no sensory stimulations like light, sound and odour.
- Withdrawing from stressful surroundings.
- sleep is the best medicine if it is possible.
- Avoiding caffeine as well as certain foods especially those high in tyramine such as sharp cheeses or those containing sulphites (wines) or nitrates (nuts, pressed meats).
Medication therapies for migraine
The medical treatment for migraine can be of two types, abortive and preventive.
The abortive therapy aims at preventing a migraine attack or to stop it once it starts. The prescribed medications aim at stopping the headache during its prodrome stage. The medication can also be taken as a self-injection into the thigh or as a wafer that melts on the tongue. These forms of medication are especially useful for people who vomit during a migraine.
The medications used for abortive treatment include the triptans, which specifically target serotonin. The triptans are used only to treat headache pain. They do not relieve pain from other problems like arthritis, menstruation, or other conditions.
- Sumatriptan (Imitrex)
- Zolmitriptan (Zomig)
- Eletriptan (Relpax)
- Naratriptan (Amerge, Naramig)
- Rizatriptan (Maxalt)
- Frovatriptan (Frova)
- Almotriptan (Axert)
The other medications include:
- Ergotamine tartrate (Cafergot)
- Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
- Acetaminophen-isometheptene-dichloralphenazone (Midrin)
The drugs used for nausea are:
- Prochlorperazine (Compazine)
- Promethazine (Phenergan)
The preventive therapy aims at lessening the frequency and severity of the migraine attacks. This therapy is mainly used if the patient suffers from an attack more than once per week. These medications are usually administered on a daily basis to prevent migraine attack.
The preventive treatment medications include:
Medications used to treat high blood pressure
- Beta-blockers like propranolol (Inderal)
- Calcium channel blockers like verapamil (Covera)
- Amitriptyline (Elavil)
- Nortriptyline (Pamelor)
- Gabapentin (Neurontin)
- Valproic acid (Depakote)
- Topiramate (Topamax)
Some antihistamines and anti-allergy drugs
- Diphenhydramine (Benadryl)
- Cyproheptadine (Periactin)
Some herbs can be used to treat migraine. The herbs used for this purpose are:
- Peppermint (Mentha piperita)
- Passionflower (Passiflora alata)
- Ginko (Ginko biloba)
- Cayenne (Capsaicin)
- Butterbur extract
Though use of herbs is an alternative line of treatment, they should never be consumed without adequate medical supervision. Some herbs like Ginko cause serious side effects when consumed with headache medications like aspirin and lithium.
The homeopathic medications for migraine are:
- Belladona: Used for the treatment of right-sided headaches and migraine.
- Bryonia alba: Used for treating pulsating throbbing centralized near or into the left eye.
- Cimicifuga: Used for migraine and throbbing headache.
- Cocculus indicus: Used for headaches or migraine resulting from worrisome behaviour or insomnia.
- Cyclamen: Used for migraine attacks associated with dizziness, blurred or dimmed vision, or eye spasm.
- Iris versicolor: Used in the treatment of headaches or migraine that typically comes during the weekend or during rest periods. It is also a remedy for migraine with aura.
- Lachesis: Used in the treatment of left-sided migraine.
- Ranunculus bulbosis: Used in the treatment of migraine attacks triggered by weather change.
The other alternative course of treatment
- Acupuncture – During this course of treatment, a practitioner inserts many thin, disposable needles into several areas of the skin at defined points. This line of treatment reduces headache pain.
- Biofeedback - This line of treatment is also effective in relieving migraine pain. Through this relaxation technique, a patient uses special equipment to monitor and control certain physical responses related to stress, such as muscle tension.
- Massage - Massage helps in reducing the frequency of migraines. It also improves the quality of your sleep, which can, in turn, help preventing migraines.
Prevention of migraine headache
The severity as well as frequency of migraine headaches can be reduced through lifestyle changes.
Some of the preventive measures that can be adopted by migraine patients are:
- Avoid triggers: As discussed before, certain food items as well as ambiance triggers a migraine attack. A person suffering from migraine attacks should try to avoid these triggers as much as possible.
- Healthy routine: A healthy routine with adequate and regular meals should be followed. Moreover, stress should also be controlled.
- Exercise regularly: Regular aerobic exercises reduces tension and help in preventing migraines. Any aerobic exercise like walking, swimming or cycling on a regular basis may be helpful. However, sudden, intense exercise may cause headaches by increasing stress.
- Reduce the effects of estrogen: In females suffering from migraine, estrogen acts like a trigger. A female patient should always reduce the intake of estrogen by avoiding medications that contain estrogen. Such medications include birth control pills and hormone replacement therapy pills.
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Written by: Saptakee sengupta
Date last updated: April 17, 2015