Migraine 

Overview

Migraine is a type of headache usually on one side of the head with severe to moderate throbbing, debilitating, pounding, nailing and pulsating pain. It may also occur on both sides as well or may shift too. It may also be associated with nausea, vomiting, difficult speaking and sensitivity to slightest sound and light. Migraine can remain for few hours to days. Pain reoccur periodically. Pain could be so intense that it may interfere with doing day to day activities.

Sometimes Aura also known as warning symptoms are experienced by the person before or with the initiation of headache. An aura may include flashes of light or blind spot, tingling on one side of face or arm etc.

Symptoms

Migraine can begin at any age but it has four stages. Not all individual pass through all the stages.

1. Prodrome– This stage occurs one or two days before the attack of migraine. An individual may notice some changes that signals of upcoming pain.

• Some special type of food craving
• Constipation
• Increased thirst or urination
• Neck stiffness, muscle tension
• Changes in mood like depression or hyperactivity or euphoria or irritability.
• Frequent yawning, fatigue and low energy
• Loss of appetite

2. Aura – This phase is seen in some people but not all who have migraine. The symptoms are temporary and reversible at this stage. There are wide range of symptoms but visual disturbances occur the most. The symptoms steadily build up and last for few minutes to an hour. The symptoms might be-

• Visualizing different shapes, wavy lines, flashes of light, black or bright spots, shimmering lights etc. Sometimes temporary loss of vision may also occur
• Tingling or pricking sensation in arms, hands or legs
• Numbness and tingling in the face or any side of the body.
• Hearing loud noises or whistling or ringing in the ear.
• Difficulty in speaking and talking clearly
• Loss of balance
• Weakness of limbs
• Confusing thoughts

3. Attack – The duration and frequency of attack stage varies from person to person depending upon the severity of attack, type of treatment and severity of the disease. It may last for few hours or few days in some cases. It may occur few times in a month or may occur just once in few months. During the attack the individual might have-

• Throbbing, pulsating pain either on one side of the head or both sides
• Extreme sensitivity to light and sound
• Person like to stay in quiet, dark room and lie down and sleep
• Sensation of nausea and vomiting
• Unable to do anything, incapacitating
• Dizziness, vertigo

4. Post- Drome – This stage occurs after the attack. The person feels exhausted, drained out, apathetic and confused.

Causes

The cause of migraine is not fully known but genetics and environmental factors play a major role. Some researchers suggest that an imbalance in brain chemicals like serotonin may play a role.

Some propose the involvement of interaction of brain stem with trigeminal nerve leading to severe pain. The nerve drives impulses to and from the brain to all parts of the body. When stimulated, the nerve may liberate chemicals that leads to inflammation in blood vessels and tissues of the brain that is painful. This inflammation leads to all the symptoms like headache, sensitivity to sensory stimulus, nausea and vomiting.

Triggering Factors include

• Hormonal changes in women – Variation and fluctuation in estrogen level in women before and during menstrual cycle, puberty, menopause or pregnancy may be one of the triggering factors. Intake of hormonal medication like oral contraceptives, estrogen therapy, hormonal replacement therapy or nitroglycerin may provoke migraine especially in women who have aura with migraine.
• Emotional triggers – Workplace stress or home stress may lead to migraine. Anxiety, depression, excitement and shock are also some of the triggering factors.
• Excessive Sensory stimuli – Bright, strong lights, flashing lights, sun glare, loud noises, strong perfumes, unusual smell, paint smell, stuffy room or even smoke from other people smoking may trigger migraine.
• Physical reasons – Too much physical activity, overexertion, travelling and tiredness may start a migraine. Head injury, neck tension, cervical pain, wrong or poor posture may sometime trigger migraine.
• Sleep disturbances– Changes in sleep pattern due to work or jet lag, too much sleep or lack of sleep or insomnia may trigger headaches.
• Change in Weather – Sometimes change in temperature especially barometric pressure may trigger migraine. Severe heat may also cause migraine.
• Food and Drinks –Different foods may trigger migraine in different people. Skipping food, dehydration or even fasting may trigger migraine. Processed foods, sometimes too much oily or fried foods, food having nitrates like hot dogs and lunch meat, food comprising monosodium glutamate like fast foods, spices and broths, food having tyramine like soy products, fish, nuts aged cheese etc. can also trigger migraine. Alcohol especially Red wine can trigger migraine in some cases. Intake of too much caffeine (in coffee or even in chocolate) can also cause migraine.

Risk Factors

• Family History – Migraine may run in families. Having a family history of migraine increases the risk of having it
• Age – Migraine can occur at any age but usually starts during adolescence and peaks in young adulthood. After 50 years of age migraine usually decreases and becomes less severe.
• Sex – Females are almost three times more prone to have migraine.
• Hormonal changes – Women having migraine may have an attack before or at the onset of menses. During pregnancy as hormones change, women may experience migraine. Migraine usually improves after menopause.
• Sensitive people – Individuals whose nervous system is more sensitive cause stimulation of nerve cells easily. This produces electrical activity that extends over the brain disturbing numerous functions of the brain like vision, muscle coordination, sensations etc. These symptoms usually occur before the attack, known as Aura.

Prevention

• Avoid triggers if known
• Stay hydrated and drink plenty of water
• Don’t skip meals
• Quit smoking and drinking
• Have good, quality sleep
• Exercise regularly and adopt relaxation skills to reduce stress
• Avoid certain foods that trigger the pain