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Migraine - Symptoms, Triggering Factors, Treatment, and Preventive Strategies

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Migraine is a neurological disease with excruciating headaches and associated symptoms. Doctors can help manage and prevent migraine attacks quite effectively.

Written by

Dr. Jayasree S

Medically reviewed by

Dr. Abhishek Juneja

Published At December 15, 2022
Reviewed AtFebruary 27, 2024

Introduction:

Migraine is one of the most prevalent debilitating illnesses in the world. A large part of the global population is affected by migraine, out of which the majority are women. Primarily, a migraine is experienced as a severe, throbbing pain on one side of the head, which lasts for days, coupled with a few other symptoms.

What Are the Classic Signs and Symptoms Associated With Migraine?

A migraine attack comes and goes bringing in a set of different symptoms. There is a beginning stage called the prodrome or pre-headache phase, which progresses to experiencing a certain migraine aura, leading to the actual headache and ending with a postdrome phase. Let us look at the symptoms linked with each stage;

1. Pre-headache Phase: These are the first symptoms to watch for before a migraine attack;

  • Feeling of nausea.

  • Tiredness, sore muscles, stiffness in the neck, sleep issues, and frequent yawning.

  • Increased thirst and urination.

  • Tend to eat more or lose appetite altogether.

  • Depression, anxiety, and irritability.

  • The individual may find it difficult to concentrate on the task at hand and hard to focus on reading and speech.

  • Find loud noises and bright lights unbearable.

  • Get cranky and moody.

2. The ‘Aura’ Stage: Aura is a set of symptoms specific to migraine attacks. A migraine attack may start with or without an aura stage. The usual symptoms are;

  • Blurry eyesight.

  • Flashing of light in front of the eyes, bright spots, and rings in the line of vision.

  • Numbness or tingling in the face, legs, or arms like tiny pinpricks.

  • Changes in the way things smell and taste.

  • A feeling of constant ringing in the ear

3. The Actual Migraine Headache: Headache is the most intense neurological symptom associated with migraine attacks. It can be;

  • A nagging type of head-pounding that can be moderate to severe.

  • A dull ache at the start gradually turned into a severe throbbing type of pain.

  • It is mainly affecting one side of the head.

  • It may last for four to 72 hours, depending on the individual.

  • Rarely migraine attacks can affect both sides of the head, front and back.

  • Some have reported experiencing pain even on the face, jaws, eyes, and neck.

Along with headaches at their peak, people also suffer from;

  • Inability to tolerate certain smells, sounds, touches, and lights.

  • Stuffy nose.

  • Get nauseated and vomit a lot.

  • Inability to eat or sleep properly.

  • Indigestion, tummy aches, and diarrhea.

  • Fatigue, chills, and occasional sweats.

  • Mental anxiety and blues.

  • Migraine (associated with vertigo and dizziness).

4. The Hangover Phase: This postdrome stage follows a migraine attack that may last for a day or two. One might feel:

  • Physically weak and drained.

  • Mental confusion and euphoria.

  • Giddiness.

  • Prefer to stay away from lights and noisy surroundings.

What Are the Major Migraine Symptoms Found in Children?

Children suffer migraine attacks too, and the symptoms are mostly related to the digestive system. One might experience;

  • Regular and forceful vomiting.

  • Involuntary eye movements.

  • Behavioral changes.

What Are the Causes and Triggers of a Migraine Attack?

Migraines result from unusual neurological activity between the nerves and blood vessels in an individual’s brain. It keeps recurring in most people. Sometimes they are passed on from one generation to the next in a family. If both parents suffer from migraine attacks, there is a chance that the children will get them too. Women are at a greater risk for migraine. Also, individuals ailing from neurological disorders, mental anxiety, and depression are at risk of migraine. Studies have found a few conditions that act as a trigger in developing migraine. They are:

  • Long-term emotional stress and anxiety.

  • Lack of sleep.

  • Staying hungry or dehydrated for a long time.

  • Excessive consumption of caffeine.

  • Hormonal changes in women, especially during menstruation.

  • Exposure to bright lights and extreme heat for a long time.

  • Smoking and alcohol abuse.

  • Long traveling.

  • High-intensity physical activities.

  • Exposure to certain smells and food ingredients.

  • Presence of loud and unpleasant noises in the surroundings.

  • Consuming certain medicines like oral contraceptives.

How Is Migraine Medically Diagnosed?

Initially, one has to go through the medical and family history of the individual to determine the triggers. The doctor will then learn the nature of symptoms occurring every time a migraine attack happens. A physical examination follows this to rule out any other significant causes of headaches. Patients are often advised to keep a migraine journal to keep track of the intensity and onset of every migraine attack. Sometimes, the doctor will order imaging scans such as computed tomography (CT) or magnetic resonance imaging (MRI) to rule out brain tumors, structural abnormalities in the brain, and bleeding inside the brain.

How to Treat Migraines Effectively?

Migraine attacks cannot be cured completely. However, treatments can help manage them so that they appear less often and with less intensity. There are several treatment strategies and combinations available for migraine. With the help of a doctor, one may figure out what treatments suit them best. Migraine pills prescriptions can be taken online through a telemedicine portal or at an in-office doctors portal.

A. Medical Management: The first step is to prevent migraine attacks from happening. The treatment plan may depend on the age, type of migraine a person is suffering from, how often they occur, severity level, how long the symptoms persist, and other health conditions. One or more of the following can be combined to treat migraine;

  1. The doctor may prescribe migraine medications to be taken on a daily basis. These medicines prevent the attacks from setting in. They belong to the category of- beta-blockers (Atenolol, Propranolol), anticonvulsants (Sodium valproate, Topiramate), calcium channel blockers (Flunarizine), angiotensin inhibitors (Candesartan), along with necessary vitamin supplements.

  2. They may also prescribe medications to consume at the onset of a headache to keep it from becoming severe. Most of them belong to the category ‘Triptans’ such as Sumatriptan, Almotriptan, Zolmitriptan, and Rizatriptan.

  3. Over-the-counter stress-relieving medications such as Aspirin, Ibuprofen, Paracetamol, and Naproxen can also be used to relieve the symptoms during an attack.

  4. Medications to help with nausea and vomiting, such as Domperidone.

  5. Stress-relieving drugs such as tricyclics (Amitriptyline, Nortriptyline)

B. Other Treatment Modalities: Some other useful remedies may help relieve the symptoms and prevent migraine attacks, such as:

  1. Lifestyle modifications on sleep, eating habits, and regular physical activity.

  2. Identifying the individual triggers and eliminating them.

  3. Psychological counseling to manage stress and anxiety.

  4. Hormone therapy for menstrual cycle-related migraine attacks, where the reduced level of estrogen hormone in the blood is compensated in women during the menstrual cycle to prevent the onset of migraine.

  5. Therapy biofeedback techniques help reduce triggers, where one monitors the body temperature and channels the blood from the head to the extremities to relax the head.

  6. Procedures like trans-cranial magnetic stimulations and vagal nerve stimulations are effective, where one monitors the tension building in the muscles using electrodes attached to the head. This pressure is relieved by practicing mental relaxation exercises to lower blood pressure.

  7. Yoga and meditation.

  8. Cold packs placed on the forehead and back of the neck may give relief during the attack.

  9. Head and neck massages.

Conclusion:

Preventing and controlling migraine attacks requires active participation from the affected individual as well the healthcare professionals. From the part of the affected, they can do their best to maintain a healthy lifestyle with regular exercise and timely meal plans. Staying hydrated is important too. And the doctor can help by providing preventive medications and symptomatic relief. Chronic migraine can be a cause of disability, as they can affect a person’s ability to perform typical everyday tasks. Though it does not have a comprehensive cure, a qualified medical professional can help avoid the triggers, minimize the symptoms and prevent migraine attacks to a large extent.

Frequently Asked Questions

1.

Is It Possible to Stop a Migraine?

Certain behavioral measures, medications, and lifestyle changes can help stop a migraine episode. These include;
- Turning off the lights and relaxing in a dark and quiet room.
- Applying hot or cold compresses to the head and neck or massaging or taking warm showers can help relax the muscles and reduce the pain.
- Consuming caffeine in small amounts can be beneficial, as excess caffeine can interfere with sleep.
- Taking over-the-counter (OTC) medications such as Acetaminophen, Ibuprofen, etc can ease the pain

2.

What Are the Symptoms of a Migraine?

The symptoms of migraine include;
-An intense throbbing headache is present only on one side of the head, but sometimes, it can occur on both sides and affect daily activities.
- Increased sensitivity to sound and light.
- Stiffness of the neck.
- Nausea and vomiting.
- Constipation.
- Mood changes.

3.

Is Migraine a Serious Condition?

Migraine can be a serious problem for some people, while just a headache for a few individuals. Thus, the condition affects each person differently and varies in severity. Some people can frequent migraine attacks, while it may be infrequent for others. If not managed appropriately, migraine can become serious and lead to chronic headaches.

4.

What Is the Duration of a Migraine Episode?

 
A migraine episode usually lasts 4 to 72 hours and may respond to treatment. However, in some individuals, if the pain does not reduce or respond to medications, a healthcare professional must be consulted as soon as possible for additional treatment.

5.

What Foods Can Help to Cure Migraine?

Some of the food that helps stop migraine include;
- Green leafy vegetables such as kale, spinach, mustard greens, collard greens, turnip greens, etc.
- Nuts and seeds include Brazil nuts, cashews, almonds, flax seeds, pumpkin seeds, etc.
- Fatty fish or fish oil supplements.
- Dark chocolate.

6.

How Can Migraine Be Managed?

Migraine is managed by stopping the symptoms and preventing future attacks. Some treatment options include;
- Pain-relieving medicines include Acetaminophen, Ibuprofen, Sumatriptan, Rizatriptan, Lasmiditan, Ubrogepant, and anti-nausea drugs.
- Nasal sprays and injections taken shortly after symptoms start can be effective.
- Migraine attacks can be prevented by avoiding dehydration, alcoholic beverages, smoking, and foods that trigger migraine.
- Getting adequate rest or sleep.
- Regular physical and breathing exercises.

7.

What Foods Trigger Migraine?

Some foods that trigger migraine include  :
- Cheese varieties such as Cheddar, parmesan, Swiss, Provolone, etc.
- Cured meats.
- Citrus fruits such as lemon, orange, etc
- Excess of fermented foods such as pickles, probiotics, etc.
- Food preservatives, artificial sweeteners, yeast extracts, etc can also trigger migraines.

8.

Can Stress Lead To Migraine?

Stress is a common trigger of headaches and migraines, frequently seen in children and youngsters. Emotional stress triggers migraines, affects sleep, and causes other diseases. According to research, stress is the common triggering factor in around 70 percent of individuals suffering from migraines.

9.

What Are the Types of Migraines?

There are different types of migraines, including :
- A type of migraine in which there is a warning sign (an aura) that a migraine attack can happen.
- The most common type of migraine lasts for around four hours to three days and is called a common migraine or a migraine without an aura.
- Retinal migraine is associated with temporary, partial, or complete vision loss. It is a dull ache occurring behind the eye and may spread to the other areas of the head.
- Hemiplegic migraine is associated with temporary paralysis, numbness, or extreme weakness on one side of the body.
- Silent migraine is associated with an aura but not the following headache.
- Chronic migraine is a migraine attack that occurs at least 15 days per month, and the severity and symptoms may frequently change.

10.

At What Age Do migraines occur?

Migraines can occur at any age. However, the first episode begins during adolescence. Migraines usually peak around the age of 30 years and may gradually decrease in severity and become less frequent over decades. Women are more affected by migraines than men.

11.

Does Lack of Sleep Cause Migraine?

A decrease in melatonin, a hormone responsible for producing sleep, has been associated with migraines and cluster headaches. Lack of sleep disrupts rapid eye movement (REM) or other stages of sleep, lowers an individual’s threshold to withstand headaches, and triggers a migraine.

12.

What Are the Stages of a Migraine?

The stages of migraine include;
- Prodrome is a stage around one or two days before a migraine when an individual experiences mood changes, constipation, increased thirst, frequent yawning, etc., which warn of an upcoming migraine.
- Aura is a reversible stage during which each symptom begins gradually and builds over several minutes. It is usually associated with visual changes, difficulty in speaking, uncontrollable jerking, weakness in the face, etc.
- The attack is associated with an intense headache on one or both sides, nausea and vomiting, and sensitivity to light, smell, sound, touch, etc.
- Post-drome is after a migraine episode, the individual experiences confusion and feels completely drained or washed out for up to a day.

13.

What Does Silent Migraine Mean?

A silent migraine is a migraine without an aura or any headache. It is also called acephalgic migraine, associated with dizziness, nausea, visual disturbances, and sensitivity to sound and light. Though it does not cause pain, it can significantly affect an individual and can be managed by treating the symptoms and lifestyle changes.
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Dr. Abhishek Juneja
Dr. Abhishek Juneja

Neurology

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migraine headaches
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