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Migraines – Signs, Symptoms, Treatment

A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.

Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, might help.

Symptoms

Migraines, which affect children and teenagers as well as adults, can progress through four stages: prodrome, aura, attack and post-drome. Not everyone who has migraines goes through all stages.

Prodrome

One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including:

  • Constipation
  • Mood changes, from depression to euphoria
  • Food cravings
  • Neck stiffness
  • Increased urination
  • Fluid retention
  • Frequent yawning

Aura

For some people, an aura might occur before or during migraines. Auras are reversible symptoms of the nervous system. They’re usually visual but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes and can last up to 60 minutes.

Examples of migraine auras include:

  • Visual phenomena, such as seeing various shapes, bright spots or flashes of light
  • Vision loss
  • Pins and needles sensations in an arm or leg
  • Weakness or numbness in the face or one side of the body
  • Difficulty speaking

Attack

A migraine usually lasts from 4 to 72 hours if untreated. How often migraines occur varies from person to person. Migraines might occur rarely or strike several times a month.

During a migraine, you might have:

  • Pain usually on one side of your head, but often on both sides
  • Pain that throbs or pulses
  • Sensitivity to light, sound, and sometimes smell and touch
  • Nausea and vomiting

Post-drome

After a migraine attack, you might feel drained, confused and washed out for up to a day. Some people report feeling elated. Sudden head movement might bring on the pain again briefly.

When to see a doctor

Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which could indicate a more serious medical problem:

  • An abrupt, severe headache like a thunderclap
  • Headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body, which could be a sign of a stroke
  • Headache after a head injury
  • A chronic headache that is worse after coughing, exertion, straining or a sudden movement
  • New headache pain after age 50

Causes

Though migraine causes aren’t fully understood, genetics and environmental factors appear to play a role.

Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. So might imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system.

Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).

Migraine triggers

There are a number of migraine triggers, including:

  • Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.Hormonal medications, such as oral contraceptives, also can worsen migraines. Some women, however, find that their migraines occur less often when taking these medications.
  • Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.
  • Stress. Stress at work or home can cause migraines.
  • Sensory stimuli. Bright or flashing lights can induce migraines, as can loud sounds. Strong smells — such as perfume, paint thinner, secondhand smoke and others — trigger migraines in some people.
  • Sleep changes. Missing sleep or getting too much sleep can trigger migraines in some people.
  • Physical factors. Intense physical exertion, including sexual activity, might provoke migraines.
  • Weather changes. A change of weather or barometric pressure can prompt a migraine.
  • Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
  • Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skipping meals.
  • Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods.

Migraine Types

There are several kinds of migraines. The most common are migraine with aura (also known as a classic migraine) and migraine without aura (or common migraine).

Other types include:

  • Menstrual migraine. This is when the headache is linked to a woman’s period.
  • Silent migraine. This kind is also known as an acephalgic migraine. You have aura symptoms without a headache.
  • Vestibular migraine. You have balance problems, vertigo, nausea, and vomiting, with or without a headache. This kind usually happens in people who have a history of motion sickness.
  • Abdominal migraine. Experts don’t know a lot about this type. It causes stomach pain, nausea, and vomiting. It often happens in children and may change into classic migraine headaches over time.
  • Hemiplegic migraine. You have a short period of paralysis (hemiplegia) or weakness on one side of your body. You might also feel numbness, dizziness, or vision changes. These symptoms can also be signs of a stroke, so get medical help right away.
  • Ophthalmic migraine. This is also known as an ocular or retinal migraine. It causes short-lived, partial, or total loss of vision in one eye, along with a dull ache behind the eye, which may spread to the rest of your head. Get medical help right away if you have any vision changes.
  • Migraine with brainstem aura. Dizziness, confusion, or loss of balance can happen before the headache. The pain may affect the back of your head. These symptoms usually start suddenly and can come along with trouble speaking, ringing in your ears, and vomiting. This type of migraine is strongly linked to hormone changes and mainly affects young adult women. Again, get these symptoms checked out by a doctor right away.
  • Status migrainosus. This severe type of migraine can last more than 72 hours. The pain and nausea are so intense that you may need to go to the hospital. Sometimes, medicines or medication withdrawal can cause them.
  • Ophthalmoplegic migraine. This causes pain around your eye, including paralysis of the muscles around it. This is a medical emergency because the symptoms can also be caused by pressure on the nerves behind the eye or by an aneurysm. Other symptoms include a droopy eyelid, double vision, or other vision changes.

Migraine Frequency

Doctors divide migraine into three levels of frequency.

Episodic migraine means you get migraine now and then. High-frequency episodic migraine means you get eight to 14 headache days per month. This condition also makes you more likely than others to develop chronic migraine.

Chronic migraine means you have headache on more than 15 days of the month and eight of those days have migraine features such as:

  • Moderate to intense head pain
  • Pain is on side of head (one or both)
  • Pain throbs or pulsates
  • Pain gets worse when you move
  • You have nausea or vomiting
  • You’re sensitive to light and sound

About 12% of Americans get migraine from time to time, but only about a third of those have chronic migraine.

Chronic and even high-frequency episodic migraine can be disabling conditions. And the higher the pain intensity of each headache, the more disabling it can be. That’s why it’s especially important to work closely with your doctor on a treatment plan.

Are Migraines Curable?

There’s no cure for migraines yet. But medications can help prevent or stop them, or keep your symptoms from getting worse.

You can also avoid things that trigger your migraines. Lifestyle changes like easing stress and having good sleep habits can help, too.

Are Migraines Fatal?

Most migraines don’t cause lasting harm.

Rarely, you can have a complication called migrainous infarction. That’s when you have a stroke while you’re having a migraine. But there’s no evidence migraine can trigger a stroke.

It’s extremely rare, but a hemiplegic migraine can sometimes lead to a coma or other serious complications.

A very intense headache that starts suddenly can be a sign of another, more serious condition, like a stroke or aneurysm. Get medical help right away if this happens.

Risk factors

Several factors make you more prone to having migraines, including:

  • Family history. If you have a family member with migraines, then you have a good chance of developing them too.
  • Age. Migraines can begin at any age, though the first often occurs during adolescence. Migraines tend to peak during your 30s, and gradually become less severe and less frequent in the following decades.
  • Sex. Women are three times more likely than men to have migraines.
  • Hormonal changes. For women who have migraines, headaches might begin just before or shortly after onset of menstruation. They might also change during pregnancy or menopause. Migraines generally improve after menopause.

Complications

Taking painkillers too often can trigger serious medication-overuse headaches. The risk seems to be highest with aspirin, acetaminophen and caffeine combinations. Overuse headaches may also occur if you take aspirin or ibuprofen (Advil, Motrin IB, others) for more than 14 days a month or triptans, sumatriptan (Imitrex, Tosymra) or rizatriptan (Maxalt, Maxalt-MLT) for more than nine days a month.

Medication-overuse headaches occur when medications stop relieving pain and begin to cause headaches. You then use more pain medication, which continues the cycle.

Migraine Treatment and Home Remedies

There’s no cure for migraine headaches. But many drugs can treat or even prevent them. Common migraine treatments include:

  • Pain relief. Over-the-counter (OTC) drugs often work well. The main ingredients are acetaminophen, aspirin, caffeine, and ibuprofen. Never give aspirin to anyone under the age of 19 because of the risk of Reye’s syndrome. Be careful when you take OTC pain meds, because they might also add to a headache. If you use them too much, you can get rebound headaches or become dependent on them. If you take any OTC pain relievers more than 2 days a week, talk to your doctor about prescription drugs that may work better. They may suggest prescription medicines that may work well to end your migraine pain, including triptans, as well as the newer ditans and gepants. Your doctor can tell you if these are right for you.
  • Nausea medicine. Your doctor can prescribe medication if you get nausea with your migraine.
  • Triptans. These drugs balance the chemicals in your brain. You might get a pill to swallow, tablets you dissolve on your tongue, a nasal spray, or a shot.
  • Ergotamine. This also works on the chemicals in your brain.
  • Lasmiditan (Reyvow). This drug eases pain, nausea, and sensitivity to light or sound.
  • CGRP receptor antagonists. Your doctor might give you rimegepant (Nurtec), or ubrogepant (Ubrelvy) if other treatments don’t help.
  • Preventive medicines. If other treatments don’t work, your headaches are severe, or you have four or more migraine days a month, your doctor may suggest these. You take them regularly to make your headaches less severe or frequent. They include seizure medicines, blood pressure medicines (like beta-blockers and calcium channel blockers), some antidepressants, and shots of botulinum toxin type A (Botox). CGRP antagonists such as atogepant (Qulipta), eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) can also prevent migraines.
  • Single-pulse transcranial magnetic stimulation (sTMS). You place this device on the back of your head at the start of a migraine with aura. It sends a pulse of magnetic energy to part of your brain, which may stop or reduce pain.
  • Neuromodulation devices. Other devices can affect the vagus nerve and the trigeminal nerve to give relief from or prevent migraines.

Home remedies

You may ease migraine symptoms by:

  • Resting with your eyes closed in a dark, quiet room
  • Putting a cool compress or ice pack on your forehead
  • Drinking plenty of liquids

Complementary and alternative treatments

Some people get relief with therapies they use in addition to or instead of traditional medical treatment. These are called complementary or alternative treatments. For migraine, they include:

  • Biofeedback. This helps you take note of stressful situations that could trigger symptoms. If the headache begins slowly, biofeedback can stop the attack before it becomes full-blown.
  • Cognitive behavioral therapy (CBT). A specialist can teach you how actions and thoughts affect how you sense pain.
  • Supplements. Research has found that some vitamins, minerals, and herbs can prevent or treat migraines. These include riboflavin, coenzyme Q10, and melatonin. Butterbur may head off migraines, but it can also affect your liver enzymes.
  • Body work. Physical treatments like chiropractic, massage, acupressure, acupuncture, and craniosacral therapy might ease headache symptoms.

Talk to your doctor before trying any complementary or alternative treatments.

Migraine Prevention

Try these steps to prevent symptoms:

  • Identify and avoid triggers. Keep track of your symptom patterns in a diary so you can figure out what’s causing them.
  • Manage stress. Relaxation techniques like meditation, yoga, and mindful breathing can help.
  • Eat on a regular schedule.
  • Drink lots of fluids.
  • Get plenty of rest.
  • Get regular moderate exercise.
  • Ask your doctor about preventive medicines if you get migraines around your period or if lifestyle changes don’t help.

Some new devices can also prevent migraines. Cefaly is a headband-like gadget that sends electrical pulses through the skin of your forehead. It affects your trigeminal nerve, which is linked with migraine headaches. You use Cefaly once a day for 20 minutes. When it’s on, you’ll feel a tingling or massaging sensation. Another stimulator, gammaCore, sends out a mild electrical signal to the fibers of the vagus nerve in your neck to relieve pain and help prevent migraines.

Sources:

https://www.webmd.com/balance/guide/the-health-benefits-of-yoga

https://www.webmd.com/heart-disease/understanding-aneurysm-basics

https://www.webmd.com/eye-health/eyelid-droops-after-botox

https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201#:~:text=A%20migraine%20is%20a%20headache,sensitivity%20to%20light%20and%20sound.

https://www.webmd.com/migraines-headaches/migraines-headaches-migraines

https://www.medicalnewstoday.com/articles/148373

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