Migraine

Symptoms

Migraines affecting children, teenagers, and adults may advance in four stages, which include prodrome, aura, attack, and post-drome. However, not all people with migraines experience these phases.

Prodrome

A day or two before the onset, you may notice slight changes signaling an impending migraine, such as:

• Constipation
• Mood swings that range from depression to euphoria
• Food cravings
• Increased urination
• Neck stiffness
• Fluid retention
• Frequent yawning

Aura

For others, an aura may happen before or even during a migraine. Auras refer to reversible nervous system symptoms, often visual, yet could be accompanied by other disturbances. Every symptom tends to start gradually, intensifies within several minutes, and might last up to 60 minutes.

Cases of migraine auras are:

• Visual phenomena like seeing different shapes, flashes of light, or bright spots
• Vision loss
• A sense of needles and pins in an arm or leg
• Numbness or weakness in the face or on a section of the body
• Speaking difficulty

Attack

If not treated, a migraine can persist from 4 to 72 hours, with frequency of occurrence varying among individuals. They may also happen infrequently or strike a few times in a month.

During a migraine attack, you may experience:

• Pain, mostly on one but sometimes both sides of the head
• Throbbing or pulsing pain
• Sensitivity to sound, light, and, at times, smell or touch
• Nausea and vomiting

Post-drome

One may feel confused, drained, or washed out following a migraine attack for up to a day. Some individuals also claim to feel elated. Sudden head movement may briefly trigger the pain again.

Causes of Migraines

The exact cause of migraines is unknown. However, having a close family member with migraines increases your likelihood of experiencing them. Certain triggers can also provoke migraines, including:

• The onset of their period
• Stress and exhaustion
• Anxiety and depression
• Irregular eating habits or skipping meals
• Excessive caffeine intake
• Lack of sufficient exercise

Overall, keeping a migraine diary might be helpful in identifying the potential triggers of your headaches.

Migraine Triggers

Various factors can trigger migraines. They are:

• Women’s hormonal changes: Changes in oestrogen, particularly before or during menstrual periods, pregnancy, or menopause, can trigger migraines in women. Moreover, hormonal medications like oral contraceptives may worsen migraines. However, some women experience less common migraines occurrences while using these drugs.
• Drinks: Alcohol, particularly wine, and excessive caffeine (like coffee) can trigger migraines.
• Stress: Work-related or at-home stress can lead to migraines.
• Sensory stimuli: Lights that flash or are too bright, loud sounds, and strong smells like paint thinner, perfume and second-hand smoke can cause migraines for some individuals.
• Sleep pattern changes: Not sleeping or sleeping too much could induce migraines.
• Physical strain: Extreme physical exertion, such as sexual activity, may trigger migraines in some people.
• Weather changes: Fluctuations in weather or barometric pressure could provoke migraines.
• Medications: Sometimes, oral contraceptives, and vasodilators including nitroglycerin, can exacerbate migraines.
• Foods: Salty and processed foods and aged cheeses may provoke migraines. Also, skipping meals increases the possibility of headaches.
• Food additives: Sweeteners such as aspartame and preservatives like monosodium glutamate (MSG) present in various foods can trigger migraines.

You should consult a GP if:

• Your migraines are intense, worsening, or enduring longer than usual
• You experience headaches more than once per week
• You find it challenging to manage your migraines

Risk factors

Some factors that can increase the likelihood of experiencing migraines are:

• Family history: Having a family member who suffers from migraines makes you more likely to develop them as well.
• Age: Migraines could start at any age but often begin during adolescence. They usually peak in the 30s and slowly become less frequent, and intense in the next decades.
• Sex: Unlike men, women are 3 times more likely to experience migraines.
• Hormonal changes: Headaches may start before or just after the start of menstruation in women with migraines. Also, they can change during pregnancy or menopause. Generally, the condition gets better post menopause.

Complications

Too much use of painkillers can lead to severe medication-overuse headaches. This risk is highest with combinations of acetaminophen (Tylenol and others), aspirin, and caffeine.

Medication-overuse headaches happen when pain relievers stop alleviating pain and instead start causing headaches. This leads to increased pain medication use, which perpetuates the cycle.

Diagnosis

If you experience migraines or have a family history of the condition, a neurologist (an expert in treating headaches) will possibly detect migraines depending on your symptoms, medical history, and neurological and physical exam.

For uncommon, intricate or suddenly severe conditions, additional diagnostic tests may be conducted to rule out other potential reasons for your pain, including:

• MRI scan: Magnetic resonance imaging (MRI) utilizes strong magnetic fields plus radio waves to create in-depth images of the blood vessels and brain. MRI scans are useful in diagnosing strokes, tumors, brain bleeding, infections, and neurological (nervous system and brain) conditions.
• CT scan: Computerized tomography (CT) involves a range of X-rays to generate in-depth cross-sectional pictures of the brain. It helps detect tumors, brain damage, infections, bleeding in the brain, or other potential medical issues that could be provoking headaches. 

Treatment for Migraines

The treatment options for migraines are:

• Painkillers, including ibuprofen and paracetamol
• Triptans medications
• Drugs that prevent one from being sick or feeling sick

It might take some trialling before finding the right combination of medications that works for you. Furthermore, a GP might suggest lifestyle changes to help manage migraines including having regular eating times and reducing caffeine intake.For severe migraines, you may receive additional helpful solutions like relaxation methods and acupuncture.

When these treatments are ineffective, a new form of medication known as gepant may be prescribed. Gepant works differently from other medicines for treating migraine; hence, it might be more helpful to you.

If the symptoms persist or worsen despite these treatments, your provider may refer you to a professional for further evaluation and treatment.

What migraine treatments are available during pregnancy?

For pregnant women or those planning to become pregnant and have migraines,it’s important to consult your healthcare provider. You may be advised to avoid migraine medications during pregnancy or if you wish to conceive. This is because drugs can have adverse effects on fetal development.

Your doctor may also suggest alternative treatments such as acetaminophen painkillers, to help with migraines.

How to deal with a migraine as it happens

When a migraine attack occurs, the following tactics can help improve the condition:

• Resting in a cool, dark, and quiet room.
• Apply a cold or warm compress or put a washcloth on the forehead or the back of your neck.
• Scalp massaging.
• Circularly applying pressure to the temples.
• Practicing meditation (maintaining a calm state).

Prevention

Can you prevent a migraine?

While not all migraines are preventable, you can minimize their frequency and symptoms severity by taking preventive medications prescribed by your healthcare provider. In addition, it’s important to work with your doctor in order to understand, and avoid the potential triggers.

Lifestyle and home remedies

When migraine symptoms begin, you should go to a quiet, dark room, close your eyes, and nap or rest. Put an ice pack enclosed in a towel or cool piece of cloth on your forehead and hydrate by drinking plenty of water.

The following helpful practices might also ease migraine pain:

• Relaxation methods: Biofeedback as well as other relaxation training solutions, educate you on methods of dealing with stress, potentially reducing the number of migraines you experience.
• Consistent eating and sleeping routine: Try to avoid too much or too little sleep. Instead, create and stick to a consistent sleeping and waking up schedule every day. Also, eat your food at the same time daily.
• Drinking a lot of fluids: Stay hydrated by drinking plenty of water, as this can help with your migraines.
• Have a headache diary: Keeping a diary where you record your symptoms will assist you in learning about the triggers and effective treatments. Moreover, it will help the doctor diagnose the problem and monitor progression between check-ups.
• Regular exercise: Regular aerobic activities can minimize tension and prevent migraines. If your doctor recommends them, you can consider exercises you enjoy like swimming, walking or cycling. Warm up gradually to avoid triggering headaches with abrupt, intense workouts.

In addition, exercising regularly can assist in losing or maintaining a healthy weight since obesity is linked to migraines occurrence.

What questions should I ask my healthcare provider?

• Will I outgrow migraines?
• Which drugs do you recommend for me?
• Can I prevent migraines?
• What kind of migraine do I have?
• Are my migraines chronic?