What is Migraine?
The pain of a migraine headache is often described as an intense pulsing or throbbing pain in one area of the head. However, it is much more; the International Headache Society diagnoses a migraine by its pain and number of attacks (at least 5, lasting 4-72 hours if untreated), and additional symptoms including nausea and/or vomiting, or sensitivity to both light and sound.
If you suffer from migraine headaches, you’re not alone. About 12 percent of the U.S. population experience migraines, one form of vascular headaches. Migraine headaches are characterised by a buildup of throbbing and pulsating pain caused by the activation of nerve fibers within the wall of brain blood vessels of the meninges. Migraine headaches are recurrent attacks of moderate to severe pain that is throbbing or pulsing and often strikes one side of the head. Untreated attacks last from 4 to 72 hours. Other common symptoms are increased sensitivity to light, noise, and odour , as well as nausea and vomiting. Routine physical activity, movement, or even coughing or sneezing can worsen migraine pain.
What do you feel in migraine?
Roughly one-third of affected individuals can predict the onset of a migraine because it is preceded by an “aura,” visual disturbances that appear as flashing lights, zig-zag lines or a temporary loss of vision. People with migraine tend to have recurring attacks triggered by a number of different factors, including stress, anxiety, hormonal changes, bright or flashing lights, lack of food or sleep, and dietary substances.
Migraines occur most frequently in the morning, especially upon waking. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work. Many people feel exhausted orweak following a migraine but are usually symptom-free between attacks.
Caffeine (or caffeine withdrawal) is one of many triggers for migraine headaches.
A number of factors can increase the risk of having a migraine and trigger the headache process. Although migraine triggers vary from person to person, they include sudden changes in weather or environment, too much or not enough sleep, strong odours or fumes, emotion, stress, overexertion, loud or sudden noises, motion sickness, low blood sugar, skipped meals, 7 tobacco, depression, anxiety, head trauma, hangover, some medications, hormonal changes, and bright or flashing lights.
Overusing analgesic medication or missing doses of preventive medications may also cause headaches.
In some 50 percent of migraine sufferers, foods or ingredients can induce headaches. These include aspartame, caffeine (or caffeine withdrawal), wine and other types of alcohol, chocolate, aged cheeses, monosodium glutamate, some fruits and nuts, fermented or pickled goods, yeast, and cured or processed meats. Keeping a diet journal can help identify food triggers.
Who Gets Migraines?
Migraines occur in both children and adults, but affect adult women three times more often than men (perhaps due to hormonal triggers). There is evidence that migraines are genetic, with most migraine sufferers having a family history of the disorder. They also frequently occur in people who have other medical conditions. Depression, anxiety, bipolar disorder, sleep disorders, and epilepsy are more common in individuals with migraine than in the general population. Migraine sufferers—in particular those individuals who have pre-migraine symptoms referred to as aura—have a slightly increased risk of having a stroke.
Migraine in women often relates to changes in hormones. The headaches may begin at the start of the first menstrual cycle or during pregnancy. Most women see improvement after menopause, although surgical removal of the ovaries usually worsens migraines. Women with migraine who take oral contraceptives may experience changes in the frequency and severity of attacks, while women who do not suffer from headaches may develop migraines as a side effect of oral contraceptives.
Phases of Migraine
A migraine is divided into four phases, all of which may or may not be present during the attack:
Symptoms occur up to 48 hours prior to developing a migraine. These include food cravings, unexplained mood changes (depression or euphoria), uncontrollable yawning, fluid retention, or increased urination.
Some people will see flashing or bright lights or what looks like heat waves 10-12 minutes prior to or during the migraine, while others may experience muscle weakness or the sensation of being touched or grabbed.
Headache pain usually starts gradually and builds in intensity. It is associated with increased sensitivity to light and/or noise. It is possible, however, to have migraine without a headache.
(following the headache). Individuals are often exhausted or confused following a migraine. The postdrome period may last up to a day before people feel healthy.
Types of Migraine
The two major types of migraine are:
• Migraine with aura ,
previously called classic migraine, includes visual disturbances and other neurological symptoms that appear about 10 to 60 minutes before the actual headache and usually last no more than an hour. Individuals may temporarily lose part or all of their vision. Other classic symptoms include trouble speaking; an abnormal sensation, numbness, or muscle weakness on one side of the body; a tingling sensation in the hands or face, and confusion. Nausea, vertigo, loss of appetite, and increased sensitivity to light, sound, or noise may precede the headache.
• Migraine without aura
or common migraine, is the more frequent form of migraine. Symptoms include headache pain that occurs without warning and is usually felt on one side of the head, along with fatigue and associated symptoms seem in classic migraine.
The four phases of a migraine headache are premonitory, aura, headache, and postdrome. However, all of the phases may not be present during a migraine attack.
Other types of migraine include:
• Abdominal migraine
mostly affects young children and involves moderate to severe pain in the middle of the abdomen lasting 1 to 72 hours with little or no headache. Additional symptoms include nausea, vomiting, and loss of appetite. Many children who develop abdominal migraine will have migraine headaches later in life. Cyclic vomiting syndromes (CVS) also occur in children, half of whom develop migraine later in life. Children with CVS have attacks of vomiting that last hours to days.
• Basilar-type migraine
mainly affects older children and adolescents. Symptoms include partial or total loss of vision or double vision, dizziness and loss of balance, poor muscle coordination, slurred speech, a ringing in the ears, and fainting. The throbbing pain may come on suddenly and is felt on both sides at the back of the head. Symptoms of basilar-type migraine are more frightening than harmful. There is no evidence that people with basilar-type migraine have a greater risk of stroke.
• Hemiplegic migraine
is a rare but severe form of migraine that causes temporary paralysis— sometimes lasting several days—on one side of the body prior to or during a headache. Symptoms such as vertigo, a pricking or stabbing sensation, and problems seeing, speaking, or swallowing may begin prior to the headache pain and usually stop shortly thereafter. When it runs in families the disorder is called Familial Hemiplegic Migraine (FHM). Though rare, at least three distinct genetic forms of FHM have been identified. These genetic mutations make the brain more sensitive or excitable, most likely by increasing brain levels of a chemical called glutamate.
• Menstrually-related migraine affects women around the time of their period, although most women with menstrually-related migraine also have migraines at other times of the month. Symptoms may include migraine without aura (which is much more common during menses than migraine with aura), pulsing pain on one side of the head, nausea, vomiting, and increased sensitivity to sound and light.
- Migraine aura without headache is characterised by visual problems or other aura symptoms, nausea, vomiting, and constipation, but without head pain.
- Headache specialists have suggested that fever, dizziness, and/or unexplained pain in a particular part of the body could also be possible types of headache-free migraine.
• Retinal migraine is a condition characterized by attacks of visual loss or disturbances in one eye plus the pain phase of a migraine attack. The attacks are very similar in either eye. These attacks, like the more common visual auras, are usually associated with migraine headaches.
• Status migrainosus is a rare and severe type of acute migraine in which disabling pain and nausea can last 72 hours or longer. The pain and nausea may be so intense that sufferers need to be hospitalised.
Who does Migraine affect more?
Migraine is three times more common in women than in men and affects more than 10 percent of people worldwide.
Migraine in Women-
Migraine in some women may relate to changes in hormones and hormonal levels during their menstrual cycle. For many years, scientists believed that migraines were linked to the dilation and constriction of blood vessels in the head. Investigators now believe that migraine has a genetic cause.
There is no absolute cure for migraine since its pathophysiology has yet to be fully understood. There are two ways to approach the treatment of migraine headache with drugs: prevent the attacks, or relieve the symptoms during the attacks. Prevention involves the use of medications and behavioural changes. The U.S. Food and Drug Administration (FDA) has approved erenumab (Aimovig) to prevent migraine in adults. The drug works by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks. The FDA also has approved lasmiditan (Reyvow) for short-term treatment of migraine with our without aura. The FDA also has approved ubrogepant tablets (Ubrelvy) for immediate treatment of migraine with or without aura. Drugs originally developed for epilepsy, depression, or high blood pressure to prevent future attacks have been shown to be extremely effective in treating migraine. Botulinum toxin A has been shown to be effective in prevention of chronic migraine.
Migraine treatment is aimed at relieving symptoms and preventing additional attacks. Quick steps to ease symptoms may include napping or resting with eyes closed in a quiet, darkened room; placing a cool cloth or ice pack on the forehead, and drinking lots of fluid, particularly if the migraine is accompanied by vomiting. Small amounts of caffeine may help relieve symptoms during a migraine’s early stages.
Drug therapy for migraine is divided into acute and preventive treatment. Acute or “abortive” medications can relieve pain and restore function when taken as soon as symptoms occur. Preventive treatment involves taking medicines daily to reduce the severity of future attacks or occurrence. The U.S. Food and Drug Administration (FDA) has approved a variety of drugs for these treatment methods. Headache drug use should be monitored by a physician, since some drugs may cause side effects.
Acute treatment for migraine may include any of the following drugs.
• Triptan drugs increase levels of the neurotransmitter serotonin in the brain. Serotonin causes blood vessels to constrict and lowers the pain threshold. Triptans—the preferred treatment for migraine— can ease moderate to severe migraine pain and are available as tablets, nasal sprays, and injections.
• Ergot derivative drugs bind to serotonin receptors on nerve cells and decrease the transmission of pain messages along nerve fibers. They are most effective during the early stages of migraine and are available as nasal sprays and injections.
• Non-prescription analgesics or over-the-counter drugs such as ibuprofen, aspirin, or acetaminophen can ease the pain of less severe migraine headache.
• Other non-prescription analgesics or over-the- counter drugs involve a mix of drugs such as acetaminophen plus caffeine and/or a narcotic for migraine that may be resistant to simple analgesics.
• Prescription or nonprescription non-steroidal anti- inflammatory drugs (NSAIDS, including ibuprofen and naproxen) can reduce inflammation and alleviate pain.
• Nausea relief drugs can ease queasiness brought on by various types of headache.
Narcotics are prescribed briefly to relieve severe pain and should not be used to treat headaches.
Quick steps to ease symptoms of a migraine include placing a cool cloth or ice pack on the forehead and drinking lots of fluids.
Taking headache relief drugs more than three times a week may lead to medication overuse headache (previously called rebound headache), in which the initial headache is relieved temporarily. For example, taking triptan or analgesic drugs (including over the counter analgesics) too often can actually make your headache condition worse. Taking more of the drug to treat a new headache leads to progressively shorter periods of pain relief and results in a pattern of recurrent chronic headache. This kind of headache pain ranges from moderate to severe and may occur with nausea or irritability. It may take weeks for these medication overuse headaches to dissipate once the drug is stopped.
Preventive medications should be considered if migraines are frequent (occur two or more times weekly) or if migraines are disabling, regardless of frequency. Preventive medicines are also recommended for individuals who take symptomatic headache treatment more than three times a week. The doctor and patient will work together to find what type of preventive medicine works best (which means testing each medication for 2-3 months, unless intolerable side effects occur).
Several preventive medicines for migraine were initially marketed for conditions other than migraine.
• Anticonvulsants such as valproate and topiramate were originally developed for treating epilepsy, but these drugs can help prevent migraine because they increase levels of certain brain chemicals) and decrease the excitability of the brain. They may also be helpful for people with other types of headache.
• Beta-blockers are drugs used to treat high blood pressure and are often effective for preventing episodic migraine.
• Calcium channel blockers are medications that are also used to treat high blood pressure treatment and help to stabilize blood vessel walls. These drugs are often used to treat prolonged aura.
• Antidepressants may be helpful for individuals with other types of headaches because they increase the production of serotonin and may also affect levels of other chemicals, such as norepinephrine and dopamine. The effectiveness of antidepressants in treating migraine is not directly related to their effect on mood. The types of antidepressants used for migraine treatment include selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants (which are also used to treat tension-type headaches). The effectiveness of antidepressants in treating migraine is not directly related to their effect on mood.
Natural treatments for migraine include riboflavin (vitamin B2), magnesium, and coenzyme Q10.
Non-drug therapy for migraine also includes biofeedback and relaxation training, both of which help individuals cope with or control the development of pain and the body’s response to stress.
In March 2014 the FDA approved the Cefaly device— a battery-powered plastic headband worn across the forehead that uses a self-adhesive electrode to deliver a low electric current through the skin—for migraine prevention. The current stimulates the trigeminal nerves.
You can buy CEFALY devices at:- https://www.cefaly.com
Lifestyle changes that reduce or prevent migraine attacks in some individuals include exercising, avoiding food and beverages that trigger headaches, eating regularly scheduled meals with adequate hydration, stopping certain medications, and establishing a consistent sleep schedule. Obesity increases the risk of developing chronic daily headache, so a weight loss program is recommended for obese individuals.
What can you do to prevent Migraine?Behaviorally, stress management strategies, such as exercise, relaxation techniques, biofeedback mechanisms, and other therapies designed to limit daily discomfort, may reduce the number and severity of migraine attacks. Making a log of personal triggers of migraine can also provide useful information for trigger-avoiding lifestyle changes, including dietary considerations, eating regularly scheduled meals with adequate hydration, stopping certain medications, and establishing a consistent sleep schedule.
Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle. A weight loss program is recommended for obese individuals with migraine.
Relief of symptoms, or acute treatments, during attacks consists of sumatriptan, ergotamine drugs, and analgesics such as ibuprofen and aspirin. The sooner these treatments are administered, the more effective they are.
Responsive prevention and treatment of migraine is incredibly important. Evidence shows an increased sensitivity after each successive attack, eventually leading to chronic daily migraine in some individuals With proper combination of drugs for prevention and treatment of migraine attacks most individuals can overcome much of the discomfort from this debilitating disorder. Women whose migraine attacks occur in association with their menstrual cycle are likely to have fewer attacks and milder symptoms after menopause.
New Research Development:-
1.Hypersensitivity to calcitonin gene-related peptide in chronic migraine
Chronic migraine patients are hypersensitive to calcitonin gene-related peptide. The potency of calcitonin gene-related peptide as a migraine inductor is increased in chronic migraine patients with ongoing headache. We suggest that calcitonin gene-related peptide, besides being a migraine trigger also acts as a modulator of nociceptive transmission in the trigeminal system.
“Iljazi A, Ashina H, Zhuang ZA, Lopez Lopez C, Snellman J, Ashina M, Schytz HW. Hypersensitivity to calcitonin gene-related peptide in chronic migraine. Cephalalgia. 2020 Dec 15:333102420981666. doi: 10.1177/0333102420981666. Epub ahead of print. PMID: 33322922.”
2.Demographic and clinical characteristics of prevention-eligible patients with migraine in the US: A linked national survey and administrative claims database study.
Prevention-eligible patients experience greater burden due to migraine, including more headache days, worse health-related quality-of-life, and greater work and activity impairment than prevention non-eligible patients.
“Foster SA, Balkaran BL, Cambron-Mellott MJ, Samaan K, Mason O, Ye W, Rowland JC, Jaffe DH. Demographic and clinical characteristics of prevention-eligible patients with migraine in the US: A linked national survey and administrative claims database study. Curr Med Res Opin. 2020 Dec 17:1. doi: 10.1080/03007995.2020.1865749. Epub ahead of print. PMID: 33331205.”
Society for Head-Ache and Migraine
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New York, NY 10021
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Tel: 312-274-2650; 888-NHF-5552 (643-5552)
1.National Institute of Health/NINDS
2.Foster SA, Balkaran BL, Cambron-Mellott MJ, Samaan K, Mason O, Ye W, Rowland JC, Jaffe DH. Demographic and clinical characteristics of prevention-eligible patients with migraine in the US: A linked national survey and administrative claims database study. Curr Med Res Opin. 2020 Dec 17:1. doi: 10.1080/03007995.2020.1865749. Epub ahead of print. PMID: 33331205.
3. Iljazi A, Ashina H, Zhuang ZA, Lopez Lopez C, Snellman J, Ashina M, Schytz HW. Hypersensitivity to calcitonin gene-related peptide in chronic migraine. Cephalalgia. 2020 Dec 15:333102420981666. doi: 10.1177/0333102420981666. Epub ahead of print. PMID: 33322922.
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The information in this website has been sourced from National Institute of Health .
Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
Updated on 22/12/2020