A migraine is generally a moderate or severe headache felt as a throbbing pain on one side of the head (unilateral). Most people with migraine have associated symptoms such as feeling sick and increased sensitivity to light and sound. Migraine is a frequent health problem, affecting 1 in 5 women and 1 in 15 men. Migraines generally start in youth.
When to ask the doctor’s advice
About Migraine
Migraines can significantly influence your quality of life and prevent you from carrying out your normal daily activities. Some people need to stay in bed for a few days until the migraine goes away. Migraine attacks worsen over time, but for most people, they can improve after many years.
There are several types of migraine, such as:
- Migraine with aura – there are specific warning signs just before the onset of the migraine, such as bright flashes
- Migraine without aura – is the most common type, in which migraine occurs without specific warning signs
- Migraine with aura without headache, known as silent migraine – aura or other migraine symptoms are experienced, but the headache does not occur
- Some people have frequent migraines, up to several a week, while others have occasional migraines. It is possible to pass several years between migraine attacks
How do we recognize migraine?
Migraines can cause throbbing pain, usually on one side of the head. It is frequently accompanied by nausea, vomiting and extreme sensitivity to light and sounds. Migraine attacks can last from a few hours to a few days, and the pain can be so severe that it interferes with your usual activities.
In the case of some people, an alarm symptom known as an aura occurs before or together with the headache. Aura can mean visual disturbances, numbness of half of the face, arm, or leg, or difficulties in speaking.
When to ask the doctor’s advice
Migraines are frequently underdiagnosed and remain untreated. If you present the signs and symptoms of a migraine, keep a diary of these episodes, in which you note the treatment you are taking. Afterward, make an appointment with the doctor to discuss these issues. Even if you have a history of headaches, go to the doctor if the symptoms change or you feel them suddenly differently.
Go to your family doctor if you have frequent migraines (more than 5 days a month) or severe migraine symptoms.
Simple pain relievers such as acetaminophen or ibuprofen can be effective for migraine. Try not to use the maximum dose as usual, because it will be more difficult for you to treat the headache over time.
When to call emergency
Call 911 or ask someone to do so if:
- You experience paralysis or weakness in one or both arms or on one side of the face
- You start speaking indistinctly
- You have a sudden headache that results in severe pain that you have never felt before
- You have a headache accompanied by high temperature (fever), stiff neck, mental confusion, convulsions, double vision and erythema.
- You have a headache after a head injury, especially if the headache worsens
- You face a chronic headache, which worsens after you cough, upon exertion, or after sudden movements
- You have a new headache after the age of 50
- These symptoms can be a sign of a more serious condition, such as stroke or meningitis, and you should see your doctor as soon as possible to establish a correct diagnosis and correct treatment
Causes
The exact cause of migraines is unknown, but they are believed to be the result of abnormal brain activity that temporarily affects the nerve signals, chemicals and blood vessels in the brain. It is not known exactly what exactly determines these changes in brain activity, but your genes may predispose you to migraines, as a result of a specific trigger, but also as a consequence of some environmental factors.
There are ongoing studies on the role of serotonin (the hormone of happiness) in migraines. Other neurotransmitters may also play a role in triggering pain, including calcitonin gene-related peptide (CGRP).
About half of the people who have migraines also have a close relative who has the condition, which suggests that genes also play a role in the occurrence of the condition.
Some people believe that migraine attacks are associated with certain triggers, which can be:
- The onset of the menstrual period
- The stress
- Fatigue
- Consumption of certain foods or drinks
Risk factors
Certain factors predispose you to migraines. They can be:
- Family history. If you have a relative in the family who suffers from migraines, there is a possibility that you will also develop migraines
- Age. Migraines can start at any age, although they most frequently appear in adolescence and reach a peak around the age of 30, then, gradually, they become less severe.
- Kind. Women are three times more likely to suffer from migraines
- Hormonal changes. In the case of women who have migraines, the headache can start right before or immediately after the onset of menstruation. Migraines generally improve after menopause
Complications
Administration of combined analgesics for more than 10 days per month for a period of three months or in large doses can trigger a headache as a result of drug abuse. The same thing happens if you take aspirin or ibuprofen more than 15 days a month or triptans, sumatriptans or rizatriptans for more than 9 days a month. The abuse of drugs that relieve headaches can create a vicious circle, triggering migraines.
Migraines are associated with an increased risk of ischemic attacks (stroke) and a decreased risk of mental health problems (depression, bipolar disorder, anxiety, panic disorder).
Symptoms
The main symptom of a migraine is usually intense pain on one side of the head. The pain is usually moderate or severe with a throbbing sensation, which worsens with movement and prevents you from carrying out your normal activities. In some cases, the pain can occur on both sides of the head and affect your face or neck.
Migraines, which frequently start in childhood, adolescence or early youth, can progress in four stages: prodrome, aura, attack and post-drome. Not everyone who experiences migraine goes through all the stages.
Other symptoms
Other symptoms commonly associated with migraine are:
- Bad feeling
- Bad condition
- Increased sensitivity to light and sound, that’s why many people with migraine want to rest in a quiet and dark room
Some people occasionally experience symptoms such as:
- Sweating
- Difficulty concentrating
- The sensation of being too hot or too cold
- Abdominal pain
- Diarrhea
Not all people with migraine experience these symptoms, and some people can experience them without having a headache.
Migraine symptoms usually last between 4 hours and 3 days, although you may feel very tired up to 1 week after the migraine episode.
Migraine stages
Migraines generally develop in distinct stages, although not all people go through all of these stages:
1. Prodromal stage (before the headache) – changes in mood, energy level, behavior and appetite occur for several hours or days before the migraine attack. You may also experience increased thirst, increased need to urinate or constipation.
2. Aura stage – vision problems usually occur, such as bright flashes or spots, lasting between 5 minutes and 1 hour. See the aura effects below.
3. The headache stage – there is usually a throbbing pain on one side of the head, frequently accompanied by nausea, vomiting, or extreme sensitivity to light and loud sounds, which lasts between 4 and 72 hours.
4. Resolution stage (post-dromal) – occurs when the headache and other symptoms subside, although you feel tired for many days afterward. Sudden movements of the head can bring back the pain for a short time.
Symptoms of aura
Around 1 in 3 people with migraine have temporary warning symptoms, such as aura, before the migraine. These can be:
- Vision problems, such as bright flashes, zigzag patterns, or spots.
- Numbness or a tingling sensation – usually starts in one of the arms and goes up until it affects the face, lips, and tongue
- Dizziness or lack of balance
- Speech difficulties
- Loss of consciousness – unusual
- Aura symptoms usually develop within 5 minutes and last up to 1 hour
Some people may experience the aura followed by only a mild headache or no headache at all.
Trigger factors
There are numerous possible triggers – hormonal, emotional, physical, food, environmental and medical. These triggers are individual, but it can be helpful to keep a journal to identify a particular trigger.
Hormonal changes
Some women experience migraines around their menstrual period, possibly due to changes in estrogen hormone levels during this period. This type of migraine usually occurs 2 days before menstruation and 3 days after the end of menstruation. Some women experience migraines only during this period, hence the name exclusively menstrual migraine.
But the vast majority of women also experience them at other times, hence the name migraine with menstrual association.
Many women have noted that migraines subside after menopause, although menopause can trigger migraines or worsen them in some women.
Emotional triggers:
- stress
- anxiety
- tension
- shock
- depression
- enthusiasm
- Physical triggers:
- fatigue
- poor sleep
- working in shifts
- wrong posture
- tension in the neck or shoulders
- time zone change
- hypoglycemia
- intense exercises (if you are not used to them)
- Food triggers:
- delayed or irregular meals
- dehydration
- alcohol
- caffeine-based products, such as tea or coffee
- certain foods, such as chocolate and citrus fruits
- foods that contain a substance called tyramine, which is found in smoked meat, moldy products, pickled herring, smoked fish and certain cheeses (such as cheddar, stilton and camembert)
Also, foods that have been stored at room temperature and not refrigerated or frozen have high levels of tyramine.
Environmental triggers:
- strong light
- flashing screens such as TV or computer screens
- smoking (or the rooms where smoking was done)
- loud noises
- climatic changes, such as changes in humidity or very low temperatures
- strong smells
- charged atmosphere
- Medicines:
- Some medications for insomnia
- Combined contraceptive pills
- Hormone replacement therapy, is sometimes used to relieve symptoms associated with menopause
Diagnostic
There is no specific test to diagnose migraines. In order to establish the proper diagnosis, the doctor must identify the patterns of recurrent headaches along with the associated symptoms. Migraines can be unpredictable; they can occur in the absence of other symptoms. Getting the correct diagnosis can take time.
Treatment
The treatment is specific to the different forms of migraine, there are therapeutic schemes both for migraine attack episodes and for the simpler forms – acute medication and maintenance medication. Among the drugs that relieve the symptoms, they can be:
- Analgesics
- Triptans (5-HT1 receptor agonists)
- Antiemetics
- During a migraine attack, many people say that sleeping or standing horizontally in a dark room is helpful
Other treatments can be:
Transcranial magnetic stimulation – involves applying a device to the head, which transmits magnetic pulses through the skin. It is not known exactly how TMS works in treating migraines, but studies show that using this method at the onset of a migraine can reduce its severity.
Regarding the treatment for pregnant and lactating women, anti-migraine drug treatment should be limited as much as possible. Ask the doctor about the effective methods in your case.
Prevention
There are several methods by which you can reduce the risk of experiencing migraines. One of the best is recognizing the trigger and avoiding it. The migraine diary can be helpful – to establish the diagnosis, it can be helpful to keep a diary for a few weeks in which you record your migraine attacks. Write down details that include:
- Date
- Hour
- What were you doing when the migraine started?
- How long did the attack last?
- The symptoms you experienced
- What medicines did you take (if any)
- If you suspect that a certain trigger is causing your migraines – it can be stress or a certain food or drink – avoiding it can reduce the risk of migraines
Maintaining a healthy lifestyle, which includes regular physical exercise, sufficient sleep and proper nutrition, as well as optimal hydration and limiting the intake of caffeine and alcohol, are also helpful.
If the migraines are severe or you have tried to avoid the possible triggers (triggering factors) and you still experience migraine symptoms, go to a consultation to receive the appropriate treatment to prevent further attacks.
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