Migraine

Overview:

About Migraine

A migraine is a severe type of headache that consists of a throbbing pain on one side of the head. Some people experience auras (signs such as seeing light-flashes, zigzags, waves, or stars) before onset of their migraine as a warning sign. Migraines are common, particularly in women. They can last from four hours to three days. The frequency of migraines varies in each individual, from only occasionally to several times a week. Migraines can have an impact on your quality of life, therefore it is important to treat migraines effectively and take preventative measures.

Phases of migraines

1. Prodromal phase. This involves changes in mood, behaviour, energy levels and appetite. This phase occurs from a few hours to days before a migraine attack.

2. Aura phase. This phase occurs from 5 minutes to an hour before a migraine attack. It involves visual effects such as flashing lights, zig zags or blind spots in the vision.

3. Headache phase. This is the migraine. It involves the typical migraine symptoms such as a throbbing headache, sensitivity to light and sound, and nausea and vomiting. This phase can last from a few hours to a few days.

4. Resolution stage. Once the symptoms of the migraine get better, you may notice yourself feeling tired and drained for a few days after the migraine attack.

Migraine treatment options

Migraines cannot be cured, so treatment aims to alleviate symptoms. The main treatments used to alleviate the symptoms of migraines are painkillers, anti sickness medications and a class of medication known as triptans.

Painkillers such as paracetamol, ibuprofen and aspirin can help reduce the throbbing pain associated with migraines. You should take painkillers as soon as you feel a migraine coming on, do not wait until it is painful. Soluble painkillers may be more effective and in some cases stronger painkillers may be required. It is important not to overuse painkillers or take them regularly as this can cause headaches and make migraines worse.

One common symptom of migraines is nausea and vomiting, which can be alleviated by taking anti sickness medication. Like painkillers, anti sickness medication is more effective the earlier you take it.

Triptans cause the blood vessels in the brain to contract. It is believed that some of the trigger factors of a migraine involve the widening of blood vessels in the brain, therefore triptans reverse this effect, alleviating migraine symptoms. Each triptan works in a very similar way, you should try at least 3 triptans on 3 separate occasions before deciding which is the most suitable for you. Triptans are available in different formulations, such as tablets, nasal sprays and wafer melts.

Preventing migraines

The most effective way to treat migraines is to prevent them in the first place. This is done by avoiding known trigger factors. To find your trigger factors, you should keep a detailed migraine diary, this includes noting down the following:

• Date and time of the migraine
• What you were doing at the time
• If there were any potential trigger factors
• The symptoms of the attack
• Any medication that was taken and if it was effective
  
  Once you know your trigger factors, it is best to try and avoid them. If you experience more than 5 days of migraines in a month you may benefit from prescribed preventative treatment from your doctor. Contact your doctor if you think this applies to you.

References:

https://www.nhs.uk/conditions/migraine/

https://www.nhs.uk/conditions/migraine/causes/

https://www.nhs.uk/conditions/migraine/treatment/

https://www.nhs.uk/conditions/migraine/prevention/

https://bnf.nice.org.uk/treatment-summary/migraine.html

https://migrainetrust.org/understand-migraine/types-of-migraine/medication-overuse-headache/

https://migrainetrust.org/understand-migraine/

Causes:

The exact cause of migraines is unknown. However, they are believed to be caused by abnormal brain activity that affects nerve signals, chemical transmitters and blood vessels within the brain. There are a number of trigger factors that may cause the abnormal brain activity such as:

• Emotional triggers - stress, anxiety, shock, depression and excitement.
• Physical triggers - tiredness, jet lag, poor posture and strenuous exercise.
• Dietary triggers - alcohol, missed/irregular meals, dehydration, caffeine or certain foods such as cheese, chocolate or citrus fruits.
• Environmental triggers - bright lights, flickering lights, screens, loud noises, smoking, strong smells or changes in temperature.
• Medicinal triggers - certain sleeping tablets, contraceptive pills or hormone replacement therapies.
• Hormonal triggers - hormonal changes during menstruation.

Symptoms:

The most common symptoms of a migraine attack include:

• Nausea & vomiting
• Headache with throbbing pain at the front or side of the head
• Photosensitivity - increased sensitivity to light
• Sensitivity to sound
• Sweating
• Difficulty concentrating
• Seeing flashing lights or patterns

Some people experience migraines with aura, this includes other symptoms as well as the ones listed above. Migraines with aura include:

• Blind spots in the vision
• Tingling and numbness in the hand moving up towards the face
• Dizziness
• Difficulty speaking
• Headache behind the eyes