Causes, Symptoms, Treatments & Prevention of Migraines
What is migraine?
Migraine is one of the most common primary headache types, followed by cluster and tension headache. Migraine is most common in women as compared to men, with a ratio of 3:1 in gender differences and has a genetic component. Hence, the risk of having migraine headaches is higher in an individual with family members having a similar problem.
Causes of migraine
Up till now, the physiology component of migraine is still largely unknown. However, the triggering causes have been identified among 50% of migraine patients.
Migraine can arise from factors such as:
Food & Drinks:
Coffee and caffeinated chocolates as well as tea
Tyramine- containing food: Cheese, yogurt, nuts
Exposure to bright lights such as computer screens or TV or direct sunlight
Strong odors for example perfumes and detergents
Sedatives or sleeping pills
Medications containing hormone substances
“Weekend migraines” - occurs due to a change in routine
Fasting or skipping meals
In addition, this type of headache is closely related to obesity and genetic inheritance.
Symptoms happen in stages. However, symptoms differ for each person and not everyone goes through every stage of migraines.
1) Prodromal stage – This phase occurs a day or two before the migraine attacks. Patients will notice slight physical changes. Complaints include:
Cravings for a particular type of food
Fluctuating mood changes
Thirsty and frequent urination
2) Aura phase- This phase can occur prior to or during a migraine attack. It can be divided into 2 categories:
Migraine with aura
Migraine without aura – most patients belongs to this category.
Patients having migraine along with aura will experience visual disturbances or disturbance in their speech, movement even sensory perception.
Visual disturbances – Patients usually experience aura in their eye sights in the form of blurry vision, an arc or band of absent vision with a shimmering or glittering zigzag border.
Somatosensory – Tingling, numbness or pins and needles in the fingers spreading to the face.
Motor – Speech difficulties (Dysarthria), unable to stand due to imbalance (ataxia), weakness of the eye muscles (ophthalmoplegia) or weakness in certain body parts (Hemiparesis).
Language – Unable to comprehend language (Dysphasia) or making unintended utterances (Paraphasia).
3) Attack – It is the phase where migrainous headache occurs, described as a unilateral throbbing type of headache. In small cases, migraine can occur on both sides of the headache. Patients will also be experiencing heightened sensitivity towards lights, sound, smells, and sensory perception. Besides that, migraine can bring about nausea, vomiting and temporary loss of consciousness. This phase can last for 72 hours if left untreated. There have been instances where patients also complaints of decreased pain threshold towards other than painful stimuli, also known as allodynia. When experiencing with allodynia, certain actions such as combing the hair or shaving can cause pain.
4) Postdrome stage – Exhaustion and lethargy ensue after migraine subsides. Meanwhile, selected patients will experience a sense of elation during this stage. Other symptoms that can occur within 24 hours of recovery include confusion, feeling depressed, dizziness, weakness dan increased sensitivity towards bright lights and sound.
Diagnosis of Migraine
Migraine can be diagnosed based on the patient’s history and physical examination. Aura is one of the diagnostic criteria. Without the symptom of aura, migraine is diagnosed in a patient who is having:
5 episodes or more headaches lasting for 4 to 72 hours + nausea or vomiting or heightened sensitivity towards lights or sounds + 2 of the symptoms listed below:
Throbbing type of headache
Activities of daily living are affected or worsening symptoms with ongoing activities
Doctors should inquire as many details from patients and run physical examinations including neurology tests, blood tests or imaging techniques if needed to ensure a patient’s headache is not due to life-threatening underlying causes.
Treatment and Prevention of Migraine
Oral Triptan tablets are taken in combination with NSAIDS or Paracetamol. Please note that Triptan is not suitable for patients with heart disease or uncontrolled hypertension. It can also cause drug interactions with medications such as pyschiatric prescriptions. Therefore, this medication can only be taken with a doctor’s prescription.
Anti-emetics – Helps to alleviate symptoms even if the patient is not having nausea or vomiting.
For women with migraine due to premenstrual syndrome, you are allowed to take the medications above upon identifying the onset of symptoms based on your menstrual cycle.
- Non- medication:
A hot or cold compress on head
Breathing into paper bags to increase carbon dioxide helps to reduce symptoms
Taking Riboflavin supplements
For patients unresponsive towards medication, general practitioners also encourage treatment with acupuncture to overcome migraine.
Female patients experiencing side effects of migraines due to contraceptives are advised to change the choice of contraception only after consulting with your doctor.
Preventive measures of migraine:
Propanolol, Topiramate, Amitriptyline
These medications have side effects which can possibly affect the fetus in pregnancy such as Topiramate. Hence, take the medications only after consulting with a doctor.
Identify and avoid factors which can trigger your migraine.
Ensure that migraine is not due to overdosage on pain medications. If yes, you should stop taking it for a month or consult with a doctor to change your choice of pain medications.
Aside from the stated side effects, there are other side effects which rarely occurs:
Migraine in the form of stomach ache ongoing for a few hours, common in children.
Headaches of this type take place in the eye causing partial or complete loss of eyesight. Patients have also complained of weakness in eye muscles, bring about blurry vision.
This migraine is characterized by headache and weakness on one side of the body. It can be confused with an attack of stroke.
Basilar type migraine
Headache symptoms focusing on the back of the head and abnormal aura symptoms for instance temporary loss of hearing or tinnitus, seeing double image, vertigo and speech problems.
Written by: SASHINI A/P SEENIVASAGAM
MBBS (Melaka-Manipal)18 Aug 2018