What is a migraine?
What causes migraines?
It is unclear what causes migraines. It’s believed that the nerves, chemicals, and blood vessels in the brain are affected by changes in brain activity, which leads to headaches.
Some factors that can offset migraines include –
- Fluctuations in hormone levels during menstruation, pregnancy etc.
- Not eating on time or skipping meals
- Changes in weather
- Inadequate sleep
- Strong scents
- Certain preservatives in food
- Sexual activity
- Bright and flashy lights
- Certain medicines (birth control pills, medicines that dilate blood vessels like nitroglycerine etc.)
What are the symptoms of a migraine?
Four phases have been identified for migraine attacks. However, not everyone with a migraine goes through all these phases. These phases are –
- Prodrome – This starts 24 to 48 hours before the onset of the headache. The symptoms at this phase include –
– Changes in mood
– Stiffness of the neck
– Sensitivity to light
– Sensitivity to sound
– Blurring of vision
– Food cravings
– Increased thirst
– Feeling cold
- Aura – It can occur before the onset of the headache or occur simultaneously. It usually lasts for around 60 minutes and occurs gradually over time. The symptoms include –
– Visual symptoms – Areas of absent vision, bright spots, flashes, seeing shapes etc.
– Tingling sensation of arms and legs
– Weakness and loss of sensation on only one half of the body
– Difficulty in speaking
– Loss or a decrease in hearing capacity on one side
All these symptoms go away as the migraine resolves.
- Headache – The headache in migraine is –
– Usually restricted to one side
– Throbbing or pulsating in nature
– More severe during the first hour
– Accompanied by nausea, vomiting, tearing of the eyes, runny nose, increased sensitivity to light, sound, odours and sometimes increased sensitivity to touch in which even non-painful contact becomes painful (allodynia)
– Relieved on sleeping
- Postdrome – In this phase, the patient is unable to concentrate and feels tired, exhausted, drained and depressed. Some people experience a sense of intense elation (euphoria). Sudden head movements can also cause pain during this phase
Can migraines affect children?
How are migraines diagnosed?
What is the treatment for migraine?
There are two treatment approaches to migraine –
- Acute or abortive treatment – This is aimed at stopping the progression of the headache. These medicines are effective when they are taken within the first hour of the onset of the symptoms while the pain is still mild. Examples of these medicines are:
- NSAIDs –these are medications that are mainly used to reduce or relieve pain.
Eg: ibuprofen, paracetamol, naproxen, diclofenac etc.
- Triptans –These are prescription drugs that help block the pain by acting on the blood vessels involved in migraine. They provide fast action for severe migraines.
Eg: sumatriptan, zolmitriptan etc.
- Antiemetics – These medicines are given in addition to other tablets to relieve nausea and vomiting
Eg: metoclopramide, chlorpromazine etc.
- CGRP inhibitors – This category of drugs inhibit the CGRP (calcitonin gene-related peptide) pathway. Oral CGRP antagonists ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) have been licensed for the treatment of acute migraine in adults, either with or without aura. In clinical studies, medications in this family were superior to placebo in reducing migraine pain and other symptoms such as nausea and sensitivity to light and sound two hours after administration. The usual adverse effects include extreme drowsiness, nausea, and dry mouth
- Ergots – This medication, which comes in the form of a nasal spray or an injection, works best when administered soon after the onset of migraine symptoms in situations where the attack lasts more than 24 hours. Side effects include worsening of nausea and vomiting.
Eg. ergotamine and dihydroergotamine
People with coronary artery disease, high blood pressure and kidney or liver disease should avoid dihydroergotamine
Tablets containing a combination of these medicines are available in the Indian market. Talk to your doctor to know which medicine you should take.
- Preventive or prophylactic treatment – The aim is to reduce the frequency and duration of migraine attacks and minimise the disability caused as a result of it. Medicines used for this purpose include –
– Beta blockers – These are also known as beta-adrenergic blocking agents. They mainly function by obstructing the actions of the hormone epinephrine, normally referred to as adrenaline and also reduce blood pressure by causing the heart to beat more gradually and gently. While their exact mechanism of action in migraine prevention is still unknown, they are highly effective. eg: propranolol, metoprolol
– Antidepressants – These categories of drugs mainly reduce clinical depression but can be useful in migraine treatment by modulating serotonin levels. eg: amitriptyline and venlafaxine
– Calcium channel blockers – Used to reduce blood pressure, they function by inhibiting calcium entry. They help the muscles of the blood vessels to relax Eg: verapamil, topiramate
– CGRP inhibitors – These drugs inhibit the protein called calcitonin gene-related peptide (CGRP). People who suffer from migraines may have discomfort and inflammation in their nervous system as a result of CGRP. The use of CGRP as a migraine medication may assist in preventing and decreasing the intensity of migraine attacks.
Other treatment options also include –
- Transcutaneous supraorbital nerve stimulation – A small electrical current is given to the supraorbital nerve using a stimulator device that is positioned on the patient’s forehead or beneath the skin of the forehead. This is proven to help patients who suffer from regular migraines
- Transcranial magnetic stimulation – Electromagnetic pulses are delivered to your brain through a device placed on your scalp close to your forehead. This is useful in people with long-standing frequent migraines. However, people with seizures are not suitable candidates
- Peripheral nerve block – This involves injecting an anaesthetic to certain nerve regions in the brain to relieve and block the headache
Can I continue taking migraine medicines while I am pregnant?
Are there any alternative treatment options for migraine?
- Rest in a dark and quiet place
- Apply cold packs to your forehead and the back of your neck
- Massage your temples and scalp
- Biofeedback – Biofeedback is a technique which employs devices strapped or attached to your body to monitor changes such as the tension of muscles, blood pressure, body temperature etc. The device alerts you about such changes so that you can deliberately alter your response and minimise stress.
How do I prevent migraines?
The occurrence of migraine episodes can be prevented to a certain extent by lifestyle modifications. These include –
- Regular exercise
- Stress management
- Cognitive behavioural therapy
- Avoiding triggers such as loud music and flashing lights
- Proper sleep
What are the complications of migraines?
- Status migrainosus – These are migraine attacks lasting for up to 72 hours. The headache, nausea and vomiting last over 3 days and can disrupt your sleep, make you dehydrated and leave you exhausted
- Migrainous infarction (Migrainous stroke) – This is a condition in which blood vessels to your brain are narrowed resulting in some parts of your brain being cut off from oxygen. This is an emergency condition and patients require immediate medical care
- Migraine aura-triggered seizures
- Persistent aura – Sometimes the aura can linger for a week or more after a migraine attack
- Inability to work
- Vertigo, dizziness or a loss of balance
- Mental health problems – Depression, anxiety, bipolar disorder etc.
- Medication-overuse headaches – Regular use of over-the-counter medicines for treating migraines may lead to rebound headaches. As the name suggests, the overuse of medicines for relief ends up becoming the cause of your headache. The headache typically begins when you wake up, is relieved after you take the painkiller, but returns once the effect of the medicine wears off