Migraine is an intense, throbbing or pulsating headache often accompanied by nausea, vomiting and extreme sensitivity to light and noise. Migraine attacks can cause intense pain for hours or even days, and they can be so severe that the patient may look for a dark and quiet place to lie down and find relief. Some migraines are preceded or accompanied by sensory premonitory symptoms, known as auras, characterized by the perception of light flashes, blind spots in the visual field, or tingling of the arm or leg.
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Symptoms
Migraines, often begin in childhood, adolescence or early adulthood. It can progress through four stages: prodrome, aura, attack and post-drome. Not everyone who has migraines goes through all stages.
Prodrome. One or two days before a migraine, you might notice subtle changes that may warn you of an upcoming migraine, including:
- Constipation
- Depression
- Diarrhoea
- Food cravings
- Hyperactivity
- Irritability
- Stiff neck
Aura. Most people experience migraine without auras. Auras are usually visible, but they can also be sensory, motor or verbal disturbances. Each symptom usually begins gradually, builds up over several minutes, and lasts for 10 to 30 minutes. Examples of migraine aura include:
- Visual phenomena, such as seeing various shapes, bright spots or flashes of light
- Vision loss
- Pins and needles sensations in an arm or leg
- Difficulty speaking
- Less commonly, aphasia or weakness of the limbs (hemiplegic migraine)
Attack. A migraine usually lasts from 4 to 72 hours if untreated, but the frequency of migraines varies from person to person. Migraines might occur rarely or strike several times a month. During a migraine, you might have:
- Pain, usually on one side of your head
- Throbbing pain
- Sensitivity to light, sound, and sometimes smell
- Nausea and vomit
- Blurred vision
- Diarrhoea
- Dizziness, sometimes followed by fainting
Postdrome. The last stage, known as postdrome, occurs after a migraine attack, and may cause you to feel empty and confused, even if some people report feeling slightly euphoric.
When to see a doctor
Migraines are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine, keep a record of your attacks, their symptoms, their evolution, and how you treated them. Speak to a neurologist about all aspects that characterize your migraine attacks.
See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which could indicate a more serious medical problem:
- A sudden, severe headache like a thunderclap
- Headache with fever, stiff neck, skin rashes, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
- Headache after a head injury, especially if the headache worsens
- A chronic headache that is worse after coughing, exertion, straining or a sudden movement
Causes
Although migraine causes aren’t yet fully understood, genetics and environmental factors appear to play a key role. Migraines can be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway. Imbalances in brain neurotransmitters, including serotonin, which helps regulate pain in the nervous system, may also be involved in migraine aetiology. In fact, serotonin levels decrease during migraine attacks. This may cause the trigeminal system to release substances called neuropeptides, which move inside the external lining of the brain, the meninges. This results in migraine pain.
Migraine triggers
Regardless of the exact mechanism causing headaches, several things can trigger them. Common triggers include:
- Hormonal changes in women. Fluctuations in oestrogen seem to trigger headaches in many women. Women with a history of migraines often report episode of migraine before or during periods, when the level of oestrogens decrease. Others have a tendency to develop migraines during pregnancy or menopause. Hormonal medications, such as oral contraceptives and hormone replacement therapy, can worsen migraines, even if some people find that they improve them.
- Food. Some forms of migraine seem to be triggered by certain foods. Common migraine triggers include alcohol, especially beer and red wine, aged cheeses, chocolate, aspartame, an excessive consumption of caffeine, and monosodium glutamate, a key ingredient for many Asian dishes, savoury and processed foods. Skipping meals or fasting can also cause migraines.
- Stress. Stress at work or at home can cause migraines.
- Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Unusual smells, including perfume or bad smells, such as paint thinner, secondhand smoke and others, can trigger migraines.
- Sleep-wake cycle alterations. Both a lack and an excess of sleep can increase the risk of migraine.
- Physical factors. Intense physical exertion, including sexual activity, might provoke migraines.
- Weather changes. A change of weather or barometric pressure can prompt a migraine.
- Medications. Some drugs, such as oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
Risk factors
Several factors make you more prone to having migraines, including:
- Family history. Up to 90% of people with migraines have a family history of migraine. If one or both parents suffer with migraines, there is a high chance to develop it.
- Age. Migraines can start at any age, even if in most people it starts during teenage years. At age 40, most people with migraine will have had their first attack.
- Sex. Women are three times more likely to suffer from migraines. During childhood, migraine can be more common in boys, but after puberty the trend is reversed.
- Hormonal changes. Migraine often affects women immediately before and after menstruation.
Complications
Abdominal problems. Some painkillers can cause abdominal pain, bleeding, and ulcers, especially if taken in large amounts or for extended periods of time.
Rebound headaches. Taking over-the-counter or prescription medications for more than nine days a month or in high doses may cause migraines known as rebound migraines. A rebound migraine occurs when taking medication no longer relieves the pain, but rather it makes it worse. This often leads people to increase doses and extend treatments, causing the pain to get even worse.
Serotonin syndrome. This potentially life-threatening drug interaction can occur if you take migraine drugs called triptans in association with antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs).
Tests and diagnosis
If you suffer from normal migraine or have a family history of migraines, your doctor may diagnose the condition based on a clinical evaluation. However, if your migraine is atypical, sever, or sudden, your doctor may recommend a series of tests to exclude other possible causes of the headache.
Computerised tomography (CT). This imaging procedure provides a cross-section of the brain. This helps doctor diagnose tumours, infections, and other medical issues which may be causing the headache.
Magnetic resonance imaging (MRI). Magnetic resonance uses radio waves and a powerful magnet to produce detailed section-views of the brain. MRI helps doctor diagnose tumours, strokes, aneurysms, neurological conditions and other brain anomalies. Magnetic resonance can also be used to examine blood vessels supplying the brain.
Spinal tap. If your doctor suspects the presence of an underlying condition such as meningitis, which is an inflammation of the membrane (meninges) and cerebrospinal fluid surrounding the brain and spinal cord, he or she can recommend a lumbar puncture (spinal tap). This procedure consists in inserting a thin needle between two vertebras in the lumbar region of the spine, to collect a sample of cerebrospinal fluid for laboratory testing.
