When we talk about headaches, the word Migraine is not anonymous to most of the people. It is described as a throbbing pain originating in one side of the head. A migraine is not just a headache but a complex series of events in the brain of which a headache is the most identifiable symptom. A headache associated with a migraine can last from a few hours to several days. Apart from a headache, the patient can experience a number of other symptoms such as nausea, vomiting, diarrhoea, extreme sensitivity to lights, sounds and smells. But a question may arise what makes a Migraine different from other headaches? Why is a migraine such a complex kind of a headache associated with so many other things that can almost leave a person unable to carry on with daily life? In fact, migraines can be such a nightmare for some people that they may have to claim it as a disability at their work because it leaves them almost helpless.
A migraine is a disease of the nervous system. It is a neurobiological disorder that involves neurological and vascular changes in the brain during a headache episode. This makes migraine headaches unique in a sense that it is not a single disease but a spectrum of symptoms ranging from mild to debilitating. The exact mechanism of a migraine is yet unknown but there have been many theories in the past that have suggested the possible series of events that might take place behind a headache.
Possible causes of a Migraine:
Initially, scientists thought that migraines were caused by changes in the vascular makeup of the brain. It was believed that an artery located outside of skull swells and enlarges. This enlarged artery releases certain chemicals that cause further inflammation and pain. Along with a severe throbbing headache, the patient also feels other symptoms like nausea and vomiting. This is accompanied by many other disturbances in the body physiology such as delayed emptying of food from the stomach to the small intestine. This can result in bitter vomits that are often associated with migraines. Blood circulation is also affected and a person may experience cold extremities and hands.
A more recent study shows that a migraine is not a vascular problem. No changes in the blood vessels of the brain or surrounding skull occur. It is suggested that it is a neurological disorder and involves the neurons of the brain. A study has shown that there is a genetic predisposition for migraines in some individuals. A migraine is an abnormal self-propagating depolarisation of nerve cells and a condition where a seemingly innocent stimulus can cause neurons to start firing and become hyperexcitable. The nervous system is so sensitive that it reacts to stimuli such as food, sleeping patterns, light, smells and sounds with an exaggerated response.
Since we know that migraines are a disease of neurons. Sometimes accidents fall or fractures etc. can also cause injuries that can compress a specific neuron that can be responsible for causing a migraine. Usually in these kinds of cases upper cervical region and its bones are involved. Usually, the Atlas bone which sits just above C2 (cervical 2) bone moves out of its place putting pressure on the brain stem and certain arteries. This pressure can also be a cause of throbbing headaches, Migraines, tension headaches. Patients should be assessed thoroughly through X-Rays and other diagnostic tools. Consultation should be made with a physiotherapist or a chiropractor.
Factors that cause Migraines:
There is a range of varying factors that are responsible for causing migraines. These factors can be different for different patients. Most of these stimuli are completely harmless and does nothing to a normal individual. But the nervous system of a person with a migraine responds differently to them. This response is usually in form of an exaggerated neuron firing resulting in mild to a severe migraine that can last up to days rendering the person unfit for daily life. Some of these stimuli are;
- An allergic reaction
- Foods: for some people certain types of foods can also cause migraines. Eating some types of cheese, salty foods etc. can also trigger migraines. Fasting for too long or eating to the stomach full can also serve as a stimulus for a migraine. Certain food components like Aspartame, Monosodium glutamate may also trigger the headaches.
- Stress: excessive stress can cause headaches and fatigue. Stress has the most debilitating effects on the body in long term.
- Lack of sleep: change in sleeping patterns can result in headaches. Jet lags etc. can cause headaches. Both a lack of sleep or excessive sleep can cause headaches and migraines.
- Menstrual cycle & Hormone fluctuation: Some women experience headaches near or after their periods. A drop in oestrogen level can be responsible for migraines and headaches.
- Medication: certain types of medications are responsible for causing headaches. Medication that contains Nitrates or their derivatives can cause throbbing headaches like Nitro-glycerine. Certain oral contraceptives are also responsible for causing migraines.
- Change in weather: A change in weather and seasons can also trigger migraines. If pressure difference occurs with body and environment then this can be responsible for headaches.
- Loud noises
- Bright light
- Perfumes, Odours, smells
- Predisposing Factors:
There are certain factors that make an individual more susceptible to having a migraine attack. Some of these factors are;
- Family History: If one or both parents have migraines then the chance of having an attack increases. Genetic factors play an important role in having migraines.
- Gender: In childhood, it is more likely that boys will be affected than the girls. But after puberty and in adulthood women are more likely to develop a migraine than men. The hormonal changes in women can put them at an increased risk of developing the disease. Some women may develop migraines during pregnancy, or for others, their migraine may improve during pregnancy. Some women may also develop a migraine postpartum.
- Age: Migraines can begin at any age. But generally, it is believed that they happen most during the 30s and gradually become less frequent and severe in later years.
Symptoms of a Migraine:
Following are a few usual symptoms reported by the patients;
- Throbbing headaches usually on one side of the head affecting the eye of that side too and the patient may experience a dropping eye
- Neck pain or pain originating from the back of the head
- Headaches become worst due to physical activity
- Nausea, vomiting. In some patients, headache is relieved after episodes of vomiting
- Feeling depressed
- Extreme sensitivity to light and sounds
- It may or may not be accompanied by aura
Types of Migraines:
There are two major and common types of migraines that are experienced by a wide range of patients. They are;
Migraines with aura:
This is also called a classical migraine. It usually occurs in 20% – 30% of patients. It is accompanied by some neurological changes in the brain that manifest itself as changes in vision or sensory changes in general. It usually starts 30-60 minutes before a migraine headache and is an indication for the patient. The sensory changes that take place include;
- Visual changes such as blurred vision, geometric patterns in vision field, zigzag patterns, flashing lights, blind spots.
- Tingling feeling in hands and arms rising all the way to the face
- Muscular weakness
- Loss of coordination
- Slurry speech
- Usually, a severe headache follows after these symptoms. It may last up to 3 days along with sensitivity to lights, sounds smell and nausea vomiting.
Migraines without aura:
This is the most common type of migraine and is experienced by most of the people. It is a headache without any signs and symptoms. It starts all of a sudden and like a migraine headache may last up to 3 days or more and is accompanied by sensitivity to lights, sounds and smells, a stiffness of neck and shoulders, nausea and vomiting.
Uncommon types of Migraines:
There are some more types of migraines but they are not experienced by a lot of people. Some of these types are rare. These types are;
Aura without a migraine:
This type is most rare and happens in around 1%-2% of the patients. It represents all the symptoms of aura but it is not followed by any headaches. The symptoms of aura are;
- Zigzag patterns in vision field
- Blind spots
- Flashing lights
- Tingling in arms and hands reaching all the way to the face
- Loss of coordination
- Slurry speech
This happens due to hormonal changes in women. It usually happens in women around the time of their periods. It happens due to a fall in Estrogen levels in the body just before periods. Around 20% of women may experience it. It mostly is without aura. It starts 2 days before a period, may last up to four days and resolves on its own. This type of migraine is also called a Menstrual Related Migraine.
This type of migraine is most rare and difficult to diagnose as its symptoms are similar to a stroke. Its diagnosis is usually confused with stroke. During this condition, the migraine progresses slowly and affects one side of the face or body. It causes one side of the face to droop, limbs difficult to move, slurred speech, blurred vision and even hearing problems. It is very important that whenever these symptoms are experienced, the patient should be taken to hospital in an emergency because it might be stroke as well.
This is yet another rare type of migraine that is not widely found. It is also called a retinal migraine and may or may not involve a headache most of the time. It involves one and same eye of the patient and the migraine attack include loss of vision completely or partly. The vision may return to normal after every attack. It is important to note here that like a hemiplegic migraine, loss of vision in an ocular migraine can have a variety of other reasons and it should be thoroughly checked before being diagnosed with ocular migraines.
This type of migraine usually occurs in children and it is similar to a severe colic except for the fact that abdominal migraines also involves headaches apart from pain in the abdomen, and feeling sick and aura symptoms as well. Commonly kids who have abdominal migraines grow up to develop the common form of migraine in their adulthood.
Vestibular migraines may involve symptoms of vertigo that is feeling dizzy especially upon standing up. The severe dizziness might be mixed up with aura but it is not aura. Headaches typical of migraines may also accompany it. The symptoms of vestibular migraines might last from 1 to 3 days.
Basilar type migraine:
This is also one of the rare types of migraines. This type of migraine is thought to originate due to an artery at the back of the head known as the basilar artery. A headache in this type of migraine is usually at the back of the head and not on one side of the head which is the most common symptom of migraine. This may lead to a stroke as well. So a doctor must be seen at the earliest if severe pain at the back of the head is experienced along with other symptoms like loss of vision, tinnitus, ringing in the ears, slurred speech. It is important to note that any kind of headache that also involves difficulty in speech, motor incoordination, falls, droopy eyelids or any other type of changes in the face or arms must be immediately presented to the doctor in an emergency as this can be a sign of stroke or haemorrhage.
Treatment for migraines:
There are several treatment options for migraines. Some of them are used to prevent migraine attacks while others are used to treat the pain.
Drugs for the prevention of migraines:
Some Anti-depressants and Anticonvulsants are used to prevent migraine attacks. These drugs are used for a long time as a part of a treatment of migraine but are usually not taken during the attack as they have no effect on the pain of the migraine but are used prophylactically. A doctor may recommend a preventive drug for migraines if you have more than four attacks of migraine in a month, if the pain lasts for more than 15 hours if the migraine is accompanied by symptoms of aura or numbness of any part of body. These prophylactic drugs are good for increasing the efficacy of pain relievers during the attack and they also reduce the length and severity of the migraine attacks in patients with severe pain history.
Some of the drugs used for preventing the pain of migraines are;
Some drugs that are used for treating various heart conditions and other coronary artery diseases are effective as a prophylactic treatment for migraine attacks. These include Beta blockers, Calcium channel blockers, Angiotensin converting enzyme inhibitors. The exact mechanism of their action is unknown but Propranolol (beta blocker) is known to have a profound effect on the migraine attack when used for a prolonged time. These drugs shouldn’t be taken during the attack as they have no effect on the pain itself. It may take several weeks to see any effect of these drugs altogether.
If the patient’s age is above 60 years, they may be prescribed calcium channel blockers like verapamil. Calcium channel blockers are used to treat migraines with aura. These drugs have shown their efficacy in reducing the length and severity of the migraine attacks.
Some of the anti-depressants may be used to prevent a migraine attack from occurring. The most effective anti-depressant used for preventing the migraine pain is Amitriptyline. This is a Tri-cyclic anti-depressant. Other classes of anti-depressants are not as effective as Amitriptyline. Anti-depressants usually work in preventing the headache by increasing the serotonin levels in brain. This hormone acts as a calming agent in the brain and as a result of its release the high activity zones in brain responsible for triggering the migraine attack slow down. Anti-depressants like cardiovascular drugs shouldn’t be taken during the attack as they have no effect on the pain. These drugs have side effects too like constipation, memory problems, weight gain, dry mouth etc.
Anti-seizure drugs or anticonvulsants like Topiramate or Valproate are widely used in the prevention of a migraine attack. These drugs also act by slowing the high firing neurons and as a result, slowing down and calming the brain. Anti-seizure drugs should never be used by pregnant women as they can cause severe deformities in the foetus. These drugs have side effects like weight gain, dizziness, tremors, abnormal foetal deformities.
Non-steroidal anti-inflammatory drugs (NSAIDs):
This is a huge class of drugs that includes pain relievers. Naproxen is the only known effective NSAID used for a migraine attack and it can be used during the attack as well but its effectiveness will not be great.
Botox toxin is obtained from Clostridium botulinum. It has types A and B. Type A is usually used for preventive treatment of a migraine. It is administered every 12 weeks in the doctor’s office. Botox works by temporarily paralysing the active muscle and relieving a muscle spasm also. When the over-active muscle of head is numbed temporarily it helps in relieving the pain.
Drugs for the treatment of migraines
These drugs are used during an acute attack of a migraine and act on the pain and other symptoms directly and help relieve the pain. These drugs include:
Over the counter drugs like Aspirin, Paracetamol is extremely effective in relieving the migraine pain. They also come in certain combinations like Aspirin + paracetamol + caffeine. These are extremely effective and most of the patients feel alright after using them.
These drugs relieve pain by constricting the blood vessel in the brain and their by blocking the pain pathways.
Triptans include drugs like Somatriptan, zomitriptan, frovatriptan.
Sumatriptan also comes as a single combination drug with naproxen and this is shown to be an extremely effective combination.
This class of drug is effective for pain management in headaches that last more than two days. These also act by blocking the pain pathways in the brain but they are known to be less effective than Triptans. Some of the drugs in the ergot class are available in combination with caffeine.
Mens Pharmacy is not liable for the currency or accuracy of the information contained in this blog post. For specific information about your personal medical condition, please contact our doctors or pharmacists for advice on [email protected].