• Shruti GOCHHWAL

Migraine

Migraine is a neurological illness that is often accompanied with several associated symptoms. It’s usually characterized by intense, tiring headaches. A migraine can last anywhere between a few hours to 3 days. In severe cases, it may last even longer.

Its symptoms include vomiting, nausea, numbness or tingling, difficulty speaking, and sensitivity to sound and light. Migraines can affect all ages and often run in families.

The diagnosis of migraine is decided based on reported symptoms, clinical history, and by eliminating other causes.

The most typical categories of migraine include those without aura (common migraines) and those with aura (classic migraines).

Migraines can start from childhood or may not occur until initial adulthood. Women usually experience more migraine symptoms than men. Family history is a common risk factor for having migraines.

Migraines are usually different from common headaches.

What are the Symptoms of a Migraine?

Migraine symptoms can start one or two days before the headache itself. This is called the prodrome stage. Symptoms during this stage are:

  1. food cravings

  2. depression

  3. fatigue or low energy

  4. frequent yawning

  5. hyperactivity

  6. irritability

  7. neck stiffness

In migraine with aura, the aura occurs after this stage. During an aura, you can experience problems with your sensation, vision, movement, and speech. Examples of these problems include:

  1. difficulty speaking clearly

  2. feeling a tingling or prickling sensation in your arms, face, or legs

  3. seeing light flashes, shapes, or bright spots

  4. temporary loss of vision

The next stage is called the attack stage. This is the most severe or acute stage when the actual migraine pain begins. For some people, this may overlap or occur during an aura.

Attack stage symptoms can range between hours to days. They can vary from person to person. Some symptoms include:

  1. increased sensitivity to sound and light

  2. nausea

  3. feeling faint or dizziness

  4. throbbing and pulsing head pain

  5. vomiting

After the attack stage, a person will usually experience the postdrome stage. In this stage, there occur changes in mood and feelings. These may range from feeling very fatigued and apathetic to feeling euphoric and extremely happy.

A dull, mild headache may persist.

The intensity and length of these stages may occur to different degrees in different people. At times, a stage is skipped and a migraine attack occurs without causing a headache.

What Causes Migraines?

Scientists haven’t found a definitive cause for migraines. But they have found a few contributing factors that can trigger the illness. This consists of fluctuations in brain chemicals, such as a decrease in levels of serotonin, a brain chemical.

Caption: An extremely hot day in Holland Credits: Commons wikimedia

Other factors that may cause migraine are:

  1. bright lights

  2. extreme weather conditions

  3. dehydration

  4. changes in barometric pressure

  5. hormone changes in women

  6. excess stress

  7. loud sounds

  8. intense physical activity

  9. skipping meals

  10. changes in sleep patterns

  11. use of certain medications, such as nitroglycerin or oral contraceptives

  12. unusual smells

  13. certain food items

  14. smoking

  15. alcohol use

  16. travelling

What are the Types of Migraine?

There are several types of migraines. Two of the most typical types are migraine with aura and migraine without aura. Some people may have both types.

Migraine Without Aura

This type of migraine is also called common migraine. Most people with migraine don’t contact an aura.

Usually, individuals who have migraine without aura experience at least five attacks that have these traits:

Headache attacks typically last from 4 to 72 hours if not treated.

  1. The headache has two or more of these features:

  2. occurs only on one side of the head

  3. throbbing or pulsating pain

  4. moderate or severe pain

  5. pain getting worse when you move

  6. Headache has at least one of these features:

  7. sensitivity to light (photophobia)

  8. sensitivity to sound (phonophobia)

  9. nausea with or without diarrhoea or vomiting

Migraine with Aura

Caption: A zig-zag visual disturbance that one having migraine with aura experiences. Credits: Commons wikimedia

This type of migraine is also called classic migraine, hemiplegic migraine or complicated migraine. It usually occurs in 25 percent of people who have migraines.

Usually, individuals who have migraine with aura experience at least two attacks that have these traits:

  1. The aura that goes away is fully reversible, and has at least one of these features:

  2. visual difficulties

  3. sensory difficulties of the face, body, or tongue, such as tingling, numbness, or dizziness

  4. language or speech difficulties

  5. difficulties moving

  6. brainstem traits, which are:

  7. difficulties talking

  8. vertigo (a spinning feeling)

  9. ringing in the ears or tinnitus

  10. hyperacusis (difficulties hearing)

  11. diplopia (double vision)

  12. inability to control body movements

  13. decreased consciousness

  14. eye problems, like blind spots, flashes of light, or temporary blindness.

  15. The aura that has at least two of these features:

  16. One or more symptoms spread gradually over a few minutes

  17. each symptom lasting between five to sixty minutes

  18. one or more symptom where the aura is only on one side of the head, including speech, vision, or language difficulty

  19. aura occurs before the headache begins or with the headache

  20. Headache which is not due to another health problem and transient ischemic attack not being a cause.

An aura typically occurs before the headache pain starts; however, it may continue once the headache starts. It can also start at the same time as the headache does.

Vestibular migraine

Vestibular migraine is also called migraine-related vertigo. Almost 40 per cent of those who have migraines have few vestibular symptoms. These symptoms can cause dizziness, affect balance, or both. People of any age, including children, can have vestibular migraines.

Neurologists usually treat people who have problems managing their migraines, including vestibular migraines. Medications for vestibular migraine are similar to the ones used for other types of migraine.

Also, vestibular migraines are sensitive to food items that cause migraines. Thus, you may be able to ease or prevent vertigo and other symptoms by changing your diet.

Your doctor may suggest you see a vestibular rehabilitation therapist. They teach exercises to help you stay balanced when your symptoms are at their worst.

Migraines in Children

Usually, children may have the same type of migraines as adults. Children and teenagers, like adults, may also experience anxiety and depression disorders together with their migraines.

Until they’re teenagers, children are likely to experience symptoms on both sides of the head. However, it’s rare for them to have headache pain in the back of the head. Their migraines usually last from 2 to 72 hours.

Some migraine variants are more common in children. These are abdominal migraine, cyclic vomiting and benign paroxysmal vertigo.

Abdominal Migraine

Children with abdominal migraine can experience stomach ache instead of a headache. The pain can be severe or moderate. Usually, it is in the stomach, around the belly button. However, the pain may not be confined to this specific area. The stomach may just feel sore.

Your child can also experience a headache. Other symptoms are:

  1. lack of appetite

  2. nausea with or without vomiting

  3. sensitivity to sound or light

Children who experience abdominal migraine are most likely to have more common migraine symptoms as adults.

Migraine Treatment

Migraines can’t be completely cured; however, you can take steps to manage them so that you don’t get them often and treat symptoms when they occur. Treatment can help make migraines less severe.

Your treatment method depends on:

  1. your age

  2. frequency of migraines

  3. type of migraine

  4. how severe it is, based on how much pain you have, how long they last, and how often they keep you from working

  5. whether you have nausea or vomiting, including other symptoms

  6. other medications you may take and other health conditions you have

Your treatment method can include a combination of:

  1. self-care migraine methods

  2. lifestyle changes, like stress management and preventing migraine triggers

  3. OTC pain or migraine medications, like acetaminophen (Tylenol) or NSAIDs

  4. prescription migraine medications for every day to reduce how often you have headaches and help prevent migraines

  5. prescription migraine medications that you take when a headache begins, to ease symptoms and to prevent it from becoming severe

  6. prescription medications to avoid vomiting or nausea

  7. hormone therapy if migraines occur with your menstrual cycle

  8. counselling

  9. alternative care, like meditation, biofeedback, acupuncture or acupressure

Medications for relief

Caption: A picture illustrating migraine headache pain relievers Credits: Pixabay

Medications that are used to ease migraine pain work best when taken at the initial stage of migraine as soon as symptoms and signs of a migraine starts. Medications that may be used to treat it are:

· Pain relievers

They are prescription or over-the-counter pain relievers like ibuprofen (Motrin IB, Advil) or aspirin. If taken for a long time, they can cause medication-overuse headaches, and possibly bleeding in the gastrointestinal tract and ulcers.

Migraine pain relievers like acetaminophen, aspirin, and caffeine (like Excedrin Migraine) can be helpful against mild migraine pain.

· Triptans

They are prescription drugs like rizatriptan (Maxalt) and sumatriptan (Tosymra, Imitrex). It is used against migraine because it blocks the pain pathways in the brain.

They are usually taken as shots, pills, or nasal sprays, and can ease several symptoms of migraine. However, they might not be safe for those at risk of a heart attack or stroke.

· Dihydroergotamines (Migranal or D.H.E. 45)

They are usually available as an injection or nasal sprays and are most effective when taken shortly after the migraine symptoms begin and tend to last longer than 1 day. Its side effects may include worsening of migraine-related nausea and vomiting.

People with high blood pressure, coronary artery disease, or liver or kidney disease should avoid dihydroergotamine.

· Lasmiditan (Reyvow)

This is a new oral tablet which is approved for the treatment of migraine without or with aura. In drug trials, lasmiditan drastically improved nausea, pain, and sensitivity to sound and light.

However, lasmiditan can have a sedative effect and may cause dizziness, thus people taking it are advised not to operate machinery or drive for a minimum of eight hours. It should also not be taken with other drugs or alcohol that affect the central nervous system.

· Ubrogepant (Ubrelvy)

Ubrogepant is approved for the treatment of acute migraine of all types in adults. It acts against oral calcitonin gene-associated peptide receptor. It’s the first drug of this type to be approved for migraine treatment.

In drug trials, ubrogepant was more productive than placebo in easing pain and other migraine symptoms like sensitivity to light and sound and nausea, two hours after taking it.

Typical side effects experienced are nausea, dry mouth, and excessive sleepiness. Ubrogepant shouldn’t be taken with strong CYP3A4 inhibitor drugs.

· Opioid medications

Narcotic opioid medications, especially those that consist of codeine can help people who have migraines but can’t take other migraine medications. As they are highly addictive, they are usually used only if no other medications are effective.

· Anti-nausea drugs

Anti-nausea drugs may help if your migraine with aura is accompanied by vomiting and nausea. They include metoclopramide (Reglan), chlorpromazine, or prochlorperazine (Compro). These drugs are usually taken with pain medications.

Excedrin Migraine

Caption: A bottle of Excedrin’s migraine formula Credits: Commons wikimedia

Excedrin Migraine is a prescription-based pain relief medication. It’s usually used to treat pain caused by migraine headaches. Excedrin Migraine is a combination of medication. It consists of three different drugs namely aspirin, acetaminophen, and caffeine. These three drugs work in separate ways to help ease your migraine pain. Forms and Dosage Excedrin Migraine is usually taken by mouth as a caplet. Each caplet consists of 250 mg aspirin, 250 mg acetaminophen, and 65 mg caffeine. The suggested dosage is listed below by age. You can also find this dosage details on the product’s packaging. Adults 18 years and older They are advised to take two caplets with a glass of water. Also, the maximum dosage is two caplets in 24 hours. Children and teens (below 18 years) Excedrin Migraine contains aspirin; thus, you should be very careful when giving it to children and teenagers. This is because aspirin is related to Reye’s syndrome, a rare yet serious illness. Never provide medications that contain aspirin to a child below 12 years of age. Also, don’t give aspirin to a teenager if they’re recovering from a viral illness like flu or chickenpox. Always consult with your child’s doctor before giving your child Excedrin Migraine. Conclusion Migraine can be debilitating, severe, and uncomfortable. Multiple treatment options are available, thus be patient while finding the one that’s best for you. Also, keep track of your symptoms and headaches to identify migraine causes. Knowing how to avoid migraines is often the initial step in handling them. It’s crucial to seek immediate medical attention if you or a loved one has a headache. Schedule an appointment to visit your doctor if your headaches start to affect your daily life. Tell them if you have pain around your ears or eyes, or if you experience multiple headaches that last for several hours or days.

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