Migraine

Topic Highlights

●    Migraine ranks 15th among the most disabling health conditions, it causes suffering and impairs quality of life.

●    Symptoms of migraine include headache, nausea, vomiting, and sensitivity to light.

●    This visual presentation describes a migraine, its types, its causes and symptoms.

●    This visual presentation also highlights methods of treatment such as monotherapy and combinational therapy.

Transcript

Migraine ranks 15th among the most disabling health conditions. Migraine imposes a recognizable burden on sufferers, including substantial personal suffering, impaired quality of life and financial cost. Repeated attacks (and often the constant fear of the next attack) damages family life, social life and employment.

Migraine derives its name from the Greek word 'hemikranion,' meaning pain affecting one side of the head. Migraine headache is usually throbbing, one sided and severe. Migraine is often associated with nausea, stomach upset, and visual disturbances.

Migraine is broadly classified into migraine with aura and migraine without aura. In the case of migraine with aura, the aura may begin before or after the actual onset of the headache. Most auras are visual and are described as bright shimmering lights. Auras may also be zigzag lines, wavy images, or hallucinations. Some people may even experience temporary vision loss. Patients may experience tunnel vision or blind spots. Patients may also feel numbness and pins-and-needles. They may experience difficulty in speaking. These symptoms may last for an hour and will usually go away when the headache begins.

Migraine without aura is the most prevalent type. The headache may occur on one or both sides of the head. The pain is pulsating and may be of moderate to severe intensity and may impair daily functioning. The pain may be aggravated by physical activity. The patient may experience fatigue or mood changes before the attack. Nausea, vomiting, and sensitivity to light or sound are often seen in migraines without aura.

Migraine attacks can have four phases. Prodrome is the initial phase, which may occur hours or days before an attack. Many physical and psychological symptoms such as fatigue, irritability and depression are characteristic of the prodrome phase. Those who suffer from migraine usually experience a consistency in their symptoms. But the type of symptoms experienced may vary from person to person. This phase may be followed by aura and then the actual headache. During the last stage, the postdrome, patients may experience symptoms such as tiredness, irritability and mood swings.

Migraines may be caused by certain changes occurring in the trigeminal nerves. The trigeminal nerve is a major pathway for head pain. Brain chemicals such as serotonin are responsible for regulating pain along this pathway. Any imbalance in these brain chemicals may cause the trigeminal nerve to fire. A drop in the level of serotonin may trigger the trigeminal nerve to release substances such as neuropeptides on the outer cover of the brain and cause the dilation of arteries. The area around the arteries and nerve endings become inflamed and irritated. This dilation and irritation may account for the pain experienced during a migraine attack.

Migraine may be triggered by a number of factors. Certain foods or preservatives may trigger migraine. These include caffeine withdrawal, alcohol, preserved foods and artificial sweeteners. Stress is also believed to trigger migraines. Bright light, cigarette smoke, lack of sleep, changes in weather, certain medications, birth control pills and menstrual cycles, and strong odors and fatigue are some of the other factors that may trigger migraines.

Migraine headaches are different from other types of headaches and can be diagnosed by the location and characteristics of the pain. A family history of migraines, age when the first attack occurred, and frequency and duration of headaches will also help to determine whether an individual is suffering from migraines or not.

It is important to rule out other causes of headache such as tension headache, sinus inflammation, or complications of other brain disorders. Sometimes a Magnetic Resonance Imaging (or MRI) or Computerised Tomography (or CT scan) is necessary to rule out other causes. If the migraine is complicated, an Electroencephalogram or EEG may be required to rule out seizures. Occasionally, a lumbar puncture, or spinal tap, may be required.

Initially, aspirin was the main treatment available. Now a variety of drugs are available to treat migraines. Mild, infrequent migraines may be treated using over-the-counter medication. Pain relieving medications include non-steroidal anti-inflammatory drugs such as ibuprofen. Triptans such as sumatriptan mimic the action of serotonin at its receptors, causing the blood vessels to constrict and blocking pain transmission. Ergots such as ergotamine are also used. These medications provide relief from headache and need to be taken at the first sign of a migraine. They are most effective for infrequent migraines. Medications such as metoclopramide are used for nausea.

Preventive medications help reduce or prevent a migraine headache. Preventive medications are prescribed for people who experience frequent attacks that do not respond to abortive medication. These reduce the severity, frequency and duration of migraines and also improve the benefit of acute treatment. Cardiovascular drugs such as beta-blockers and calcium channel blockers, antidepressants such as amitriptyline, anti-seizure drugs such as divalproex sodium, and antihistamines such as cyproheptadine are also used. Monotherapy (use of one medication) is tried first but a combination of medicines may be necessary.

Changes in lifestyle may help patients reduce the severity and frequency of migraine attacks. A healthy lifestyle including adequate sleep, regular meals and avoiding triggers may be helpful. Regular exercise may also help. It is important to warm up before exercise or to avoid rigorous exercise as these may trigger migraine. Estrogen containing medications should be carefully monitored. Avoid smoking and exposure to tobacco smoke.

It's helpful to keep track of the pattern and occurrence of migraine. It's a good idea to record events, foods consumed, and other trigger factors before an attack. When migraine is imminent it is important to rest away from glaring lights and noise. Cold compresses and drinking lots of fluids may also help. Learn to manage stress and supplement medications with a nutritious diet and relaxation.