Migraine | symptoms, causes, risk factor, test, treatment
1) An overview
Literally, Migraine means pain/ discomfort felt partly or fully in the head. Primary headaches are discomforts lying in the head that are caused directly by the over activity or the structural problems in the head which are pain sensitive. These include the blood vessels, muscles, nerves in the head and the neck. They may also result from changes in the chemical activity. Although, popularly it is called headache, but in fact it is not pain in the head (or in the brain). The brain just sends message when other parts of the body hurt. Most of the headaches appear in the blood vessels or muscles or nerves covering the head (or neck).
To well explain the severity of the headache, sometimes instance is given like- ‘2 big spikes are being hammered into the brain from both the sides’. Metaphorically, any discomforts/ sufferings afflicting a baby (who has not yet grown enough to speak or complain except crying at the top of the voice) may itself be a severe headache to the loving parents.
Headaches are of many types. And one of them is ‘Migraine’ (others being: tension headache/ sinus headache / preeclampsia headache). Migraine is an intense headache triggered by the host of factors (such as , stress/ noise/exertions/ certain foods and medications/ sensitivity to light or sound or even touch). A migraine is a type of headache that results in intense throbbing/sensation in one part of the head. It may arrive with the feeling of nausea or vomiting.
2) Migraine vs. headache
Usually, pain from normal headache (arising out of tension) will be mild to moderate . However, in migraine, pain will be moderate to severe. Some patients with migraine will experience nausea and vomiting as well as sensitivity to light, sound and even touch.
3) Migraine complications
Migraine headache can invite many problems even when efforts are made to control it.
3.1) Abdominal problems: Certain pain relievers (such as Ibuprofen) may result in abdominal pain and bleeding ulcers, especially if taken in large doses and for a long period of time.
3.2) Serotonin syndrome: Although, it rarely occurs, but it is potentially a life threatening condition. The risk gets higher with too much of nervous system chemicals called Serotonin. The medication SNRI ( Serotonin and Nor- epinephrine Rupture Inhibitor) may increase the risk of serotonin syndrome.
3.3) Chronic neurological disorder: For many, migraine remains a chronic neurological disorder which totally worsens the quality of life that interferes with the smooth performance of daily home and job responsibilities.
4) Migraine aura
4.1) Definition: Migraine aura (also known as classic migraine or ocular migraine) invites visual disturbance with flashing or shimmering light. Additionally, it may create a blind spot in the field of vision.
4.2) Food that triggers aura: These include cheese/ caffeinated drinks / red wine/ smoked meat/ chocolate.
4.3) Advice: When migraine with aura arrives, it is well advised to stay in a quiet and dark room. Compression or pressure may be tried on the painful areas. Counter pain medication (For instance, Aspirin / Acetaminophen / Non- steroidal anti inflammatory drug, such as Ibuprofen or Naproxen) may help.
4.4) Aura symptoms
4.4.1) Tingling or numbness that spreads or moves from one part of the body to another part.
4.4.2) Odd sensations in the hand.
4.4.3) Discomfort/ pain in the arm
4.4.4) Pain / discomfort on one side of the head
4.4.5) Weird (supernatural) feeling in the face.
4.4.6) Sensation of numbness in the tongue.
4.4.7) Food cravings.
4.4.8) Getting cranky.
4.4.9) Be fatigued and yawn frequently.
4.4.10) Feeling stiff, especially in the neck.
4.4.11) Feeling the need to urinate frequently.
4.4.12) Having constipation or diarrhea.
4.4.13) Aphasia (Impaired ability to understand as well as trouble in finding appropriate word to speak on account of brain damage)
Conclusively, migraine aura often starts about an hour or so before the discomfort in the head arrives.
4.5) Aura causes
According to theory, a wave of nerve cells activity spreads across the brain and excites the trigeminal nerve (It is the 5th and the largest cranial nerve which is responsible for sensation and function in the face, such as grasping/ biting / chewing). The excitation causes the release of variety of neurotransmitters ( neurotransmitter is an endogenous chemical that enable neurotransmission. It is a type of chemical messenger which transmits signals across a chemical synapse, such as neuromuscular junction from one neuron to another. And synapse is a structure in the nervous system that permits a neuron or nerve cell to pass an electrical or chemical signal to another neuron.) which result in the change in size of blood vessels releasing more neurotransmitters and ultimately causing inflammatory process and pain.
Conclusively, the medical scientists are not yet confirmed about the actual cause of migraine aura (which covers around 25% of total migraine attack).
4.6) Aura treatment
Drugs that are proved effective in migraine aura include: Valpolic acid /Lamotrigine. Among non-medications, important procedures are : Biofeedback (It is a technique that is used to control the body functions, such as heart rate) / Cognitive Behavior Therapy (It is a form of psychotherapy that treats the problems affecting happiness )
5) Migraine during pregnancy
Many women are found to complain of headache during pregnancy. Reportedly, (among women) 15% of migraine sufferers get their 1st migraine headache during pregnancy period. While the exact cause of migraine remains unknown. It is believed that the increased flow of blood in the brain contributes to the onset and creation of the headache.
Migraine usually appears during the 1st trimester (Pregnancy period is divided into 3 trimesters—the 1st trimester: duration from the 1st week to the 12th week, 2nd trimester: duration from the 13th week to the 26th week and the 3rd trimester: duration from the 27th till the end of the pregnancy period). But it can also occur during the 2nd trimester pregnancy period and onwards. This type of migraine can cause moderate to severe throbbing, typically on one side of the head. The headache can last up to 72 hours that tends to be triggered by physical activity. During the pregnancy period, migraine headache may invite nausea and vomiting.
Again there are some who complain that migraine headache arrives to stay throughout the pregnancy period with equal severity.
Conclusively, the AHS (American Head Society) reveals the fact that 8% of total American population having age 12 years and above suffer from migraine headache. And among those migraine sufferers, 75% are female.
6) Migraine symptoms
Since migraine headache in general also includes ‘’Migraine Aura’, so symptoms in both the cases appear mostly the same. Migraine aura symptoms include:
6.1) Pain in one or both the sides of the head.
6.2) Pain feeling with throbbing as well as pulsing.
6.3) Sensitivity to light and sound and sometimes to smell and even touch.
6.4) Nausea: Nausea is a feeling of sickness with an inclination to vomit at the sight or smell of detestable food or non food item or on account of headache.
6.5) Blurred vision: It is a loss of sharpness of eyesight making the targeted object appear hazy and out of focus. The primary cause of blurred vision is refractive error or nearsightedness or farsightedness. Blurred vision can affect one or both the eyes.
6.6) Lightheadedness: It is a common and typically unpleasant sensation which can be short-lived, prolonged or rarely recurring. Often it is felt as if the head is weightless.
7) Migraine Diagnosis:
For effective and successful treatment procedure, the doctor will initially record family and personal history, ask about symptoms experienced by the patient and then conduct various physical and neurological examinations.
7.1) Blood test
7.2) MRI (Magnetic Resonance Imaging)
The doctor may advise the test for ascertaining the problems in the blood vessel, detecting infection in the spinal cord or brain and toxins in the system.
7.3) CT (Computerized Tomography) scan
The procedure uses a series of X- rays to create detailed cross sectional image of the brain. This helps the doctor diagnose tumors (It is an abnormal; growth of cells that serves no purpose. When a benign tumor deteriorates to malignancy , it is called cancer), infection (It is the invasion and multiplication of micro organisms, such as bacteria / virus / parasites that are normally not present in the body. An infection may or may not cause any symptom), brain damage (The severity of brain damage can vary with the type of brain injury.
A mild brain injury may be temporary when it causes headache / confusion / nausea and memory problem. In moderate brain injury, symptoms can last longer and be more pronounced), bleeding in the brain (In general bleeding anywhere in the skull is called intracranial hemorrhage. When the bleeding occurs within the brain itself it is known as intra-cerebral hemorrhage. Bleeding can also occur between the covering of the brain and the brain tissue itself referred to as subarachnoid hemorrhage.) and other possible medical problems that may be causing migraine headache.
7.4) Spinal tap (lumber or puncture)
The doctor may carry a test if infection is suspected. In the procedure, a thin needle is inserted between 2 vertebrae (in the lower back) to remove a sample of cerebrospinal fluid (It is a clear colorless fluid found in the brain and the spinal cord. It is produced by the special ependymal cells in the choroid plexuses of the ventricles of the brain and is absorbed in the arachnoids granulations) for analysis in the laboratory
8) Migraine causes and risk factors
As a matter of fact, causes are the agents directly responsible for the occurrence of the disease. On the other hand, a risk factor is not necessarily a cause. A risk factor may be anything that increases the likelihood to develop the disease (For instance, aging is a risk factor to invite most of the diseases including migraine headache. But it is not a cause)
8.1.1) Genetic/Environmental factors: Although, migraine causes are mysterious, still genetic / environmental factors are considered to play a pivotal role. Also changes in the brain storm and its interactions with the trigeminal nerve—a major pair, causes the migraine headache.
8.1.2)) Imbalances in brain chemicals: Serotonin is one of the brain chemicals that helps to regulate nervous system. Too much or too few amount of this brain chemical can trigger migraine headache. Usually, the level of serotonin drops during migraine attack. This may cause the trigeminal nerve to release the substance called neuroprobtides (These are small protein like molecules used by neurons to communicate with each other. These are neuronal signaling molecules that influence the activity of the brain and the body in specific ways) which travel to meninges (Brain’s outer covering). The ultimate result is migraine pain. Other neurotransmitters play a role in the migraine attack.
8.2) Risk factor:
A number of risk factors may trigger the arrival of migraine attack.
8.2.1) Hormonal changes (in case of women):
Fluctuation in estrogen (It is a primary female sex hormone which is responsible for the development and regulation of female reproductive system and secondary sex characteristics.) seems to trigger migraine attack in many women. Women having previous history often report migraine headache immediately before or during their period, when they face a major drop in estrogen. Besides tendency of migraine attack rises during pregnancy or menopause (This is the time in most women’s lives when menstrual period stops permanently. And they are no longer able to bear children. It occurs mostly during the age 49- 52 years)
8.2.2) Hormonal medications:
Oral contraceptives, and hormone replacement may also invite migraine attack.
8.2.3) Foods: Aged cheese / salty and processed foods / skipping meals/ fasting may also trigger migraine attack.
8.2.4) Drinks: Alcohol and highly caffeinated beverages may increase the likelihood of migraine attack.
8.2.5) Stress: It is a major risk factor for most of the diseases including migraine headache. Stress, if paired with shock / grief / anxiety / trauma/ overwork / irregular and unhealthy diets, can trigger the symptoms to arrive in full swing.
8.2.6) Sensory stimuli: Bright light and sun glare (in addition to loud sound and strong smell) can also trigger the arrival of migraine symptoms in case of some people.
8.2.7) Inadequate sleep or insomnia and even oversleep may increase the likelihood of the occurrence of migraine attack.
8.2.8) Physical factors: Intensive physical exertion, such as excessive physical activity may provoke migraine attack.
8.2.9) Weather: Changes in weather condition and atmospheric pressure can prompt migraine attack.
8.2.10) Family history: If there is a family member, particularly among the parents or brothers or sisters, then risk of migraine attack becomes higher.
8.2.11) Age: Migraine can arrive at any age. But still the fact remains that as one ages, the risk of falling prey to migraine attack becomes higher.
8.2.12) Gender: As compared to males, females are more likely to develop migraine attack
9) Migraine prevention (without medication)
9.1) Research study reveals the fact that TSNS (Transcutaneous Supra-orbital Nerve Stimulation) is an effective preventive therapy (similar to headband with attached electrodes) against migraine attack.
9.2) Further it is recommended to develop a consistent lifestyle (It includes meticulously following regular food and sleep pattern at the right time and of right amount without any stress. Additionally, regular aerobic exercise can reduce the tension and help to cope with the migraine attack)
10) Migraine treatment
Effective migraine treatment can stop symptoms and prevent the attack. Many medications are designed to treat and reduce migraine symptoms, while some other drugs are often used to treat the conditions causing migraines. Medications used to fight migraine attack mainly fall into 2 categories as stated below.
10.1) Pain relieving medications
It is also known as acute treatment. These type of drugs are taken during migraine attack and are designed to stop the symptoms. The doctor shall recommend what medicine will suit which patient.
Advice : As soon as the migraine attack is experienced, it is advised to sleep or rest in a dark room after taking the following me
10.1.1) Aspirin or Ibuprofen may help to relieve the migraine pain. In some cases, Acetaminophen or Tylenol may also help.dications.
10.1.2) Specific drugs (such as, combination of acetaminophen / aspirin /caffeine) may also help ease moderate migraine pain, particularly while feeling nausea. However, if taken alone, they will not be effective to treat severe migraine. The drug is also available in suppository form.
Caution: If the drug is taken too often or for a long time, then it may invite ulcer (ulcer is a break or discontinuity in a body membrane and membrane is a part of an organ. The break impedes the organ in performing normal function) and gastrointestinal bleeding (It is also known as gastrointestinal hemorrhage. It includes all types of bleeding in the gastro-intestine)
The drug makes the blood vessels constrict so as to prevent pain ( from traveling to brain). As such the drug is quite effective to reduce the symptoms associated with migraines. The drug is available in the form of pill / nasal spray / injection.
Trip-tan medicines include: Sumatriptan (Imitrex) /Rizatriptan (Maxalt) /Almotriptan (Axert) /Naratriptan (Amerge) /Zolmitriptan (Zomig) / Frovartriptan (Frova) / Eleptriptan (Relpex).
Caution: Trip-tans are not recommended for patients at risk of stroke and heart attack Side effects include: reaction at injection site/ nausea/dizziness/ drowsiness/ muscle weakness.
10.1.4) Ergots: The drug is highly effective in case of those patients where the migraine pain lasts for more than 48 hours.
10.1.5) Anti-nausea medications: Medication usually involves the combination of several drugs to treat the symptom of nausea. Frequently prescribed medicines include: Chiorpromazine /Metoclopramide (Regian) /Prochiorperazine (Compro).
10.1.6) Opioid medications: The drug (containing narcotics, particularly Cordeine) is sometimes used to treat migraine pain for the patients who can take neither Trip-tans nor Ergots. Narcotics are the only option if no other drug proves effective.
10.1.7) Gluco -corticoids: The drug may be used with other medications to provide pain relief.
Caution: The drug should not be used frequently to avoid side effect.
10.2) Preventive medications
It is the doctor who will recommend preventive medication to be taken on regular basis (For instance, when a predictable symptom triggers, such as impending menstruation). The preventive medications include:
10.2.1) Cardio-vascular drugs: The drugs include:
Beta Blockers (It is commonly used to prevent severe migraine headache. It is also used to treat high blood pressure as well as coronary artery disease).
Another cardiovascular medication (Calcium Channel Blocker) is used to prevent migraine attack in addition to treating high blood pressure.
Additionally, Angiotensin Converting Enzyme Inhibitor Lisinopril (Zestril) may be used in reducing length and severity of migraine attack.
10.2.2) Anti-depressants: Anti-depressants are drugs used for the treatment of major depressive disorder and other conditions, such as chronic pain conditions.
Typical side effects include dry mouth, weight gain, sexual disability etc.
Conclusively, these type of medications are taken often on a daily basis to minimize the severity or frequency of migraine attack. However, the choice and the effectiveness of the preventive medicines to a large extent, depend on the severity as well as frequency of the migraine headache / extent of disability caused by the migraine headache and other medical conditions
11) Key global information
11.1) Migraine is the 6th most disabling illness worldwide
11.2) Migraine aura accounts for 25% of all migraines.
11.3) Migraine is a traumatically prevalent neurological disorder affecting I billion population worldwide and 30 million people in USA..
11.4) During migraine attack, more than 90% of sufferers are unable to do normal work.,
11.5) In USA in every 10 seconds someone goes to the emergency room with complain of migraine and other head pains.
12) Concluding remark
12.1) Insomnia or sleeplessness is considered a major risk factor for migraine attack. But excess of anything is bad. Also oversleep (sleeping for a long time) can become a great risk factor to trigger migraine headache. Just as under-dose or overdose will not cure a disease.
12.2) Regular physical exercise is always recommended to reduce the symptoms of most of the diseases including migraine headache. But sudden intense exercise can trigger migraine headache. Because, health rule suggests to warm up slowly and speed up body movement gradually during physical workout.
- M= MIGRAINE (is one type of headache)
- I= IMBALANCE (in brain chemical is a major cause of migraine)
- G= GENETIC (factor often plays a pivotal role in migraine)
- R= REGULAR (aerobic exercise can prevent and cope with migraine)
- A= AURA (is an ocular migraine that involves visual disturbance)
- I = INSOMNIA (can trigger migraine in some cases)
- N= NAUSEA (is one of migraine symptoms)
- E= EXCESSIVE ( physical exertion may trigger migraine headache)
- H= HEADACHE (mostly springs from the blood vessels / muscles / nerves)
- E= EFFECTIVE (treatment depends on age, gender and severity or frequency of migraine)
- A= AGING (is a great risk factor for all diseases including migraine headache)
- D= DURING (migraine attack 90% of sufferers are unable to do normal work)
- A= ABDOMINAL(pain is one of the complications arising from migraine attack)
- C= CONSISTENT(life style, healthy foods, drinks and physical activity can tackle migraine)
- H= H0RMONAL(change in women can be a great risk factor for migraine)
- E= EXERCISE( is indispensable to reduce symptom of migraine attack)