What is Migraine?
Migraine is a severe type of headache. It is usually accompanied by other symptoms such as nausea, dizziness, sensation of pins and needles and vision disturbances. Migraine is a severe headache which greatly disturbs an individual's daily life. Migraine headache can occur with or without 'aura.' Aura is one or more of the symptoms which commonly occur before the actual migraine headache starts. Aura is a warning signal of the impending migraine. Chronic sufferers of migraine learn to perceive this as a warning signal.
There Are 5 Stages Of Migraine-However, Not Everyone Has Them:
- Prodromal Stage: This is a 'pre-headache' stage comprising of symptoms such as tiredness, loss of appetite and mood swings. This stage can start a few hours or several days before the actual migraine sets in.
- Aura Stage: This is the where the patient feels an 'aura' just before the migraine headache episode. Aura can be any of the symptoms such as floaters in the vision or flashing lights, nausea or dizziness, irritability etc.
- Headache Stage: This is the actual headache stage where migraine sets in. Pain is commonly felt as a throbbing pain on one side of the head. Sensitivity to light and sound is also present. Patient usually likes to lie down in a dark room, isolated. This stage can last anywhere from 6-72 hours.
- Resolution Stage: In this stage, the symptoms gradually start decreasing. Sleeping helps in resolving of the symptoms.
- Postdromal Stage: This is the stage where the migraine is completely resolved. Patient feels weak, tired, confused and sometimes nauseous after the headache has abated.
Causes of Migraine
Migraines are believed to be caused by changes in the level of serotonin. Decreased serotonin levels cause constriction of the blood vessels in the brain which leads to 'aura'. The constricted blood vessels expand again causing increased blood rush to the brain and resulting in a severe headache.
Other Triggers of Migraine Are:
- Sleep disturbances.
- Fasting and dehydration.
- Hormones (before menstruation or during menopause).
- Bright or flashing lights.
- Certain odors.
- Smoking and cigarette smoke.
- Alcohol consumption.
- Extreme tiredness.
- Muscle spasm.
- Chocolate consumption.
- Certain medications.
- Caffeine consumption.
Symptoms of Migraine
- Acute throbbing pain, usually on one side of the head. Pain can also be around the eye, at the back of the head or forehead.
- In more than half of the patients, the pain is unilateral. Few patients experience bilateral pain.
- The migraine headache is aggravated by activity.
- Accompanying symptoms are nausea, vomiting, facial pallor, cold hands, cold feet, diarrhea, and sensitivity to sound and light.
- Prodromal symptoms are: Irritability, sleepiness, depression or euphoria, fatigue, increased thirst, fluid retention, and increased urine output, change in bowel habits (constipation or diarrhea), lethargy, confusion and cravings for salty or sweet foods.
- Some patients experience aura. This includes: Visual disturbances or floaters in the field of vision, flashing lights, pins-and-needles sensations in the arm, hand, around the mouth and the nose and on one side of the body. There may be change in smell and taste and auditory hallucinations.
Treatment of Migraines
- Painkillers such as paracetamol are helpful in alleviating the headache.
- If headache is not relieved by paracetamol, stronger painkillers are prescribed by the doctor.
- For moderate to severe migraines, migraine-specific abortive medications are used such as triptans and ergot preparations.
- Narcotics and medications containing butalbital can also be used but they can be addictive.
- Medicines like ibuprofen and naproxen which are also called nonsteroidal antiinflammatory drugs are also effective in some patients.
- Anti-nausea medications should be taken for nausea.
- Patient suffering from severe headache with nausea may be given prochlorperazine (Compazine) or metoclopramide (Reglan) which is a combination of triptan and anti-nausea medication.
- Sleep helps a lot in relieving the migraine headache.
- Relaxation techniques and biofeedback are helpful in easing the symptoms.
- The best solution for migraines is preventing them by avoiding the known triggers such as making lifestyle changes by quitting smoking, exercising regularly, eating a balanced diet, getting adequate sleep, avoiding stress, certain foods, coffee and alcohol.
- Prophylactic medications help in reducing the frequency and duration of the headache and should be taken daily. Some of the prophylactic medications are beta blockers, calcium-channel blockers, anti-serotonin agents, anticonvulsants, and tricyclic antidepressants.
- Some patients benefit from therapies such as acupuncture.
- For persistent migraine headache, tests such as CT, MRI or blood tests should be done to rule out other medical conditions such as tumor.
- Hormonal migraines can be treated using contraceptive pills and estrogen patches to balance the level of hormones.
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