Overview Of Migraine Headache
A migraine headache is a type of headache that tends to recur and causes moderate to severe pain. The pain is often described as throbbing or pulsing and usually begins on one side of the head. Migraine headaches are worsened by physical activity, light, sound or physical movement. The pain typically lasts from 4 hours up to 3 days. You may be sensitive to light, sound, and even smell. And you may also experience nausea and/or vomiting.
Migraines may happen only once or twice a year, or as often as daily. Women are more likely to have migraines than men.
There are different types of migraine headaches. The most common types of migraines are classic migraines and common migraines.
Classic migraines (also called complicated migraines) start with a warning sign called an aura. These types of migraines are sometimes also called “migraines with aura.” The aura often involves changes in the way you see. You may see flashing lights, colors, a pattern of lines, or shadows. You may temporarily lose some of vision, such as the side vision.
You may also feel a strange prickly or burning sensation, or have muscle weakness on one side of the body. You may have trouble communicating. You may also feel depressed, irritable, and restless.
Auras last about 15 to 30 minutes. Auras may occur before or after the head pain. Sometimes the pain and aura overlap or the pain never occurs. The head pain of classic migraines may occur on one side of the head or on both sides.
Common migraines don’t start with an aura. For this reason, these types of migraines are also called “migraines without aura.” Common migraines may start more slowly than classic migraines, last longer, and interfere more with daily activities. The pain of common migraines may be on only one side of the head. Most people who have migraines have common migraines (they don’t have an aura).
Migraines without head pain, sometimes called “silent migraines,” may cause you to feel other migraine symptoms, but not pain. At least not the usual migraine pain around the eyes and temples. This type of migraine may even include an aura phase. You may also feel the same sensitivity to light and sound as with a typical migraine.
Hemiplegic migraines cause one side of the body to become weak, similar to having a stroke. These symptoms are only temporary. They are a part of the migraine attack. Areas of the body affected by the weakness may include the face, arm, or leg. The weakness may last from an hour to even days. It most often goes away within 24 hours. For this type of migraine, the head pain can come before or after the weakness. This type of migraine is rare.
Retinal migraines (also called ocular migraines) cause changes in vision that are not related to aura vision changes. For retinal migraines, symptoms involve diminished vision or even blindness in one eye. These symptoms do not last long. They can occur before or after head pain. If you experience this type of migraine, it is important to contact the doctor.
Icepick headaches are not migraine headaches. They produce a stabbing pain around the eyes and temples. These stabbing pains may occur repeatedly in the same place or jump around to different areas each time. This type of headache can occur at any time and without warning. If you are a person who has migraine headaches, you are more likely to than others to get icepick headaches, too.
Cluster headaches are not migraine headaches. They are rare headaches that occur in patterns, known as cluster periods. These periods can mean having a headache at the same time every day for a week or even a month. Cluster headaches can be extremely painful. They usually cause pain on one side of the head. This pain can be so severe that it makes the eyelid droop and the nose to get stuffy.
Cervicogenic headaches are not migraine headaches. They are headaches caused by another illness or physical condition, usually a problem in the neck. Many times, this type of headache can be brought on by a sudden movement of the neck. You might also get a cervicogenic headache after keeping the neck in the same position for too long. The pain can last for hours or days. It may be limited to one side of the head or face.
Causes Of Migraine Headache
The specific cause of migraines is not known, but there may be fluctuations in certain neurotransmitters, chemicals that send messages between brain cells. These changes may predispose some people to develop migraine headaches. There are also a number of factors that can trigger a migraine.
These factors vary from person to person, and they include:
- Stress
- Anxiety
- Hormonal changes in women
- Bright or flashing lights
- Loud noises
- Strong smells
- Medicines
- Too much or not enough sleep
- Sudden changes in weather or environment
- Overexertion (too much physical activity)
- Tobacco
- Caffeine or caffeine withdrawal
- Skipped meals
- Medication overuse (taking medicine for migraines too often)
- Some people have found that certain foods or ingredients can trigger headaches, especially when they are combined with other triggers.
These foods and ingredients include:
- Alcohol
- Chocolate
- Aged cheeses
- Monosodium glutamate (MSG)
- Some fruits and nuts
- Fermented or pickled goods
- Yeast
- Cured or processed meats
Symptoms
There are two main types of migraines:
- Migraine with aura (classic migraine)
- Migraine without aura (common migraine)
An aura is a group of nervous system (neurologic) symptoms. These symptoms are considered a warning sign that a migraine is coming.
Most often, the vision is affected and can include any or all of the following:
- Temporary blind spots or colored spots
- Blurred vision
- Eye pain
- Seeing stars, zigzag lines, or flashing lights
- Tunnel vision (only able to see objects close to the center of the field of view)
Other nervous system symptoms include yawning, difficulty concentrating, nausea, trouble finding the right words, dizziness, weakness, numbness, and tingling. Some of these symptoms are much less common with migraine headaches. If you have any of these symptoms, your provider will likely order tests to find the cause.
An aura often occurs 10 to 15 minutes before the headache, but can occur just a few minutes to 24 hours before. A headache does not always follow an aura.
The headaches usually:
- Start as a dull ache and get worse within minutes to hours
- Are throbbing, pounding, or pulsating
- Are worse on one side of the head with pain behind the eye or in the back of the head and neck
- Last 4 to 72 hours
Other symptoms that may occur with the headache include:
- Chills
- Increased urination
- Fatigue
- Loss of appetite
- Nausea and vomiting
- Sensitivity to light or sound
- Sweating
Symptoms may linger, even after the migraine goes away. This is called a migraine hangover.
Symptoms can include:
- Feeling mentally dull, like your thinking is not clear or sharp
- Needing more sleep
- Neck pain
Exams & Tests
Your provider can diagnose migraine headaches by asking about your symptoms and family history of migraines. A complete physical exam will be done to determine if your headaches are due to muscle tension, sinus problems, or a brain disorder.
There is no specific test to prove that your headache is actually a migraine. In most cases, no special tests are needed. Your provider may order a brain CT or MRI scan if you have never had one before. The test may also be ordered if you have unusual symptoms with your migraine, including weakness, memory problems, or loss of alertness.
An EEG may be needed to rule out seizures. A lumbar puncture (spinal tap) might be done.
Treatment Of Migraine Headache
There are numerous migraine treatment options available from conventional medicines to supplements, herbs, and other options.
Medication
There is a huge range of medications available to treat migraine. It is useful to have some background information to help you make informed choices about which drug may be best for you.
There is no standard treatment for migraine, so the choice of medication should always be made on an individual basis.
Whilst drugs may be necessary to treat the attack, an important factor in the overall management of migraine is finding out what may be causing it and other ways you can manage it.
Acute medicines
The goal of acute migraine treatment is consistent, fast, and complete relief of symptoms with reduced disability and without headache recurrence. This makes it important to match the treatment to the level of disability to gain the best possible relief and prompt return to function. To achieve this the doctor will first establish the diagnosis of migraine, the level of disability and the presence of other conditions that will affect the choice of treatment.
Preventive medicines
In the past few years, the use of prophylactic ( preventive) drug treatments has fallen. This could be because some prophylactics have side effects such as weight gain and can take time before they start to show a beneficial effect. Also, acute medication has improved for migraines. However, if you are having at least four migraine attacks per month you may wish to discuss prophylactic medication with the GP.
There are also other things you can do to feel better:
- Resting with the eyes closed in a quiet, darkened room
- Placing a cool cloth or ice pack on the forehead
- Drinking fluids
There is no cure for migraines. However, medications can treat the symptoms when they arise, and people can take steps to reduce the frequency and severity of episodes.
