Migraine (Migraine Headache) – Causes, Symptoms, Treatment

Approximately 15% of the global population suffers from migraine, a neurological condition which includes a number of symptoms and one of the symptoms is severe headache. The other symptoms include nausea, vomiting, sensitivity to light and sound, pain, numbness and tingling.

People having migraine suffer from recurrent, painful and severe headaches which can last from hours up to days and may be preceded by an aura which is a visual disturbance and a warning sign that headache will occur soon.

Any kind of headache is a condition which is intolerable and irritable.  Having a headache even for 15 minutes to half an hour is such a traumatizing experience.  Having a migraine which may occur repeatedly and that too lasting for hours along with other associated symptoms is very traumatizing and painful for the person.  Thus, it is very important to known more about this condition to help deal with it in a better way.

What Causes Migraines

The exact cause of migraine is not yet known. Migraine occurs when there is a drop in the level of a brain chemical called serotonin.  Serotonin is a chemical released by the brain which is said to regulate the pain in our nervous system.  The drop in the serotonin level causes the trigeminal nerve (the fifth cranial nerve) to release something called neuropeptides that travel to the outer covering of the brain resulting in migraine attack.

Two factors are said to be the cause, one is genetic or familial and the other is environmental. A person is more prone to have a migraine if it runs in his/her family and it is genetic.

The environmental factors that may trigger migraines are :

1. Stress :  Physical and mental stress
2. Skipping meals :  Not eating meals at regular intervals, skipping breakfast, eating less
3. Certain foods :  High salt food, processed foods, foods containing MSG or other additives
4. Light sensitivity :  Bright lights, sunlight
5. Sound sensitivity :  Loud sounds like in movie theatres, loudspeakers
6. Smell sensitivity :  Strong smell of perfumes, smoke etc.
7. Depression, anxiety
8. Alcohol and caffeine intake
9. Sleep :  Too little or too much sleep
10. Changes in weather
11. Medications :  Oral contraceptives, nitroglycerin
12. Hormonal Changes :  Decrease in estrogen levels, before and after periods.

Who Is Affected?

• Migraine starts at puberty up until the age of 30 to 40 years, although may occur even before puberty
• Occurs more in women than in men
• Decreases after menopause or after middle age.

Types Of Migraine

• Common migraine – Migraine that is not preceded with aura
• Classic migraine – Migraine preceded by aura
• Silent migraine (acephalic) – Migraine with aura and other symptoms but without headache
• Retinal migraine – Temporary vision loss in one eye, indicates a serious underlying medical problem
• Hemiplegic migraine – Resembles stroke symptoms, one-sided body weakness, pins and needles sensation, loss of sensation
• Chronic migraine – Migraine lasting for more than 15 days in a month.

Migraine Symptoms

Migraine symptoms are divided into four stages.

1. Prodrome Stage

This occurs one to two days before the headache and the symptoms seen in this stage are

• Depression
• Irritability
• Tiredness
• Neck stiffness
• Increase in urination and thirst
• Constipation
• Craving for food

2. Aura Stage

Aura starts after prodrome stage.  Many people may not experience aura.  People who experience aura have these symptoms:

• Vision changes, seeing shapes, bright spots and flashes of light
• Difficulty speaking
• Numbness and tingling in face, arms, legs
• Temporary loss of vision
• Weakness in legs

3. Attack Stage

Headache starts and may last from 4 hours to 72 hours.  The symptoms and the intensity of headache vary from person to person.  The symptoms in this stage include:

• Pulsatile or throbbing headache
• One-sided headache in any region, left, right, front or back
• Nausea
• Feeling dizzy
• Vomiting

4. Post-Drome Stage

This is the final stage of migraine and it occurs after the headache attack.  The symptoms include:

• Confusion
• Fatigue, feeling drained out
• Happiness or moodiness
• Light and sound sensitivity

Migraine Treatment

1. Medications

• Over-the-counter analgesics like paracetamol and ibuprofen
• Prescription analgesics, triptans like sumatriptan (Imitrex, Treximet), rizatriptan(Maxalt), eletriptan (Relpax), zolmitriptan (Zomig), naratriptan (Amerge), almotriptan (Axert), frovatriptan (Frova)
• Antiemetics may be prescribed to reduce nausea and vomiting

2. Changes In Lifestyle And Natural Remedies

• Relaxation with yoga, meditation, deep breathing exercises
• Regular eating habits, not skipping meals, eating healthy meals
• Working in less stressful conditions
• Avoid alcohol and caffeine
• Avoid foods containing additives if these trigger the attacks
• Maintain a proper sleep-wake cycle, sleep for at least 7 to 8 hours at night
• Lying in dark and quiet room
• Applying cold compresses on the forehead, temple region
• Gentle massage in the forehead, temple region
• Lavender Oil :  Applying lavender oil to the temples and forehead is said to relieve the pain.  It can also be inhaled
• Acupressure :  Applying pressure on specific points of the fingers and hands relieves the headache and nausea
• Feverfew, a flowering herb is said to prevent migraines
• Peppermint oil – The menthol in the peppermint oil relieves migraine headache
• Ginger – Using ginger powder decreases the severity of migraine
• Magnesium – Increasing magnesium in your diet helps as low magnesium is one of the reasons for migraine.  Magnesium is found in milk, eggs, nuts, oatmeal, sesame seeds and sunflower seeds.

Treatment Of Migraine In Children

Migraine can occur in children also. Medication is similar to as given in adults, but in smaller dosages. Acetaminophen, ibuprofen and triptans dosages as prescribed by the healthcare provider.

Investigations for Migraine

• The healthcare provider will take a thorough medical history, family history and the symptoms which the patient is having.
• Thorough physical examination
• CT scan, MRI, EEG may be done to rule out other causes for the migraine like tumour, stroke etc.

Surgeries to Treat Migraine

1. Neurostimulation Procedure

Electrodes are inserted underneath the skin to deliver electrical stimulation to certain nerves.

2. Migraine Trigger Site Decompression Surgery (MTSDS)

The nerves around the head and neck region which are responsible to trigger the migraine attacks are injected with Botox injections to release and decompress them.

The above two surgeries, however, are not yet approved by the FDA or American Headache Society.  These might be done in severe cases of migraine which do not respond to any other type of treatment.

Differentiation Between Migraine And A Headache

Nowadays, when somebody is having a headache, they say that they are having a “migraine.”  A headache is not a migraine, as discussed above. To know whether you are having a migraine or a headache due to other causes, it is a good idea to maintain a record diary of your headache.

The below details can be recorded in the diary :

• Time of onset
• Frequency
• Severity
• Duration
• Triggers
• Exacerbating and relieving factors

Maintaining this diary by the patient or caretaker of the patient helps the healthcare provider in diagnosing whether the patient is suffering from migraine headache or headache due to other causes.

The 5, 4, 3, 2, 1 Criteria by International Headache Society

This criteria is set for diagnosis of migraines without aura :

• 5 or more attacks
• 4 hours to 3 days duration
• 2 of any of these qualities:  occurs on one side of head, aggravated by routine activity, moderate-to-severe pain, pulsatile or throbbing in nature
• 1 additional symptom such as nausea, vomiting, light or sound sensitivity.

If the patient meets the above criteria, then he/she might be having a migraine.

Complications Of Migraine

1. Medication Overuse Headache :  Taking more amounts of painkillers to relieve the headache may cause rebound headache, which means, pain is not relieved by the analgesics and instead becomes more severe.  Hence, if the migraine is not relieved by the analgesics, stop taking them and visit your healthcare provider.
2. Abdominal Pain and Bleeding :  Some NSAIDs (non-steroidal antiinflammatory drugs) cause abdominal pain, bleeding and ulcers if taken for a longer period of time.
3. Serotonin Syndrome :  Since migraine is caused due to low levels of serotonin, certain drugs are given that increase serotonin levels to help reduce the severity of migraine.  These drugs if taken in combination can cause high levels of serotonin.  The drugs are triptans, SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin and norepinephrine reuptake inhibitors).  High serotonin level is a life-threatening condition.  Hence, taking the exact dosage of medications prescribed by the healthcare provider is very important and regular monitoring should be done when a combination of these drugs are given.
4. Chronic Migraine :  It lasts for more than 15 days in a month
5. Status Migrainosus :  Migraine may last for more than 3 days
6. Persistent Aura without Infarction :  The aura does not go away after the migraine attack and may last for more than a week.  The symptoms are similar to a stroke but without the signs of bleeding in brain.
7. Migrainous Infarction :  Aura lasting for more than an hour mean loss of blood supply to the brain and should be evaluated by the healthcare provider immediately.

Difference Between Migraine and Tension Headache

• While migraine can be pulsatile and throbbing, tension headache is more of a tightness and pressure sensation.  Both can be bilateral or unilateral though.
• With tension headache, the pain can be mild to moderate and not disabling in nature, it does not increase in severity with physical activity whereas migraine is severely disabling and increases with physical activity.
• There is also no associated nausea, vomiting, aura, light and sound sensitivity in tension headache.
• Tension headache is relieved by milder analgesics or by rest.

CBD Oil For Migraine

CBD oil (cannabinoid) is said to relieve all kinds of chronic pain including migraine.  Research is still going and limited due to the restrictions of use of cannabinoid in certain countries.

Prognosis (Outlook)

Migraine is a debilitating condition.  It affects severely the quality of life and the activities of daily living.  When a person suffers from migraine attack, he/she might want to just stay in the bed and is not able to do anything until it stops.

Although migraine is severely disabling when it occurs, there are a number of treatments which effectively treat migraine and reduce the symptoms.  There are many effective medications which reduce the symptoms and improve the quality of life of a patient suffering from migraine.

After the age of 45 or 50 (postmenopause in women) it gradually decreases in frequency and may stop occurring.