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Migraine Headache

Articlemigraineheadache
Brain & Nerve
Men's Health
+4
Contributed byKrish Tangella MD, MBAOct 11, 2023

What are the other Names for this Condition? (Also known as/Synonyms)

  • Classic Migraine

What is Migraine Headache? (Definition/Background Information)

  • Migraine Headache is a chronic, neurological disorder and the most common form of headache that is characterized by severe pounding and pain on one side of the head, which can last for several hours
  • Migraine Headaches are often seen along with other symptoms such as nausea, vomiting, and increased to extreme sensitivity to light and sound. Even though there are several subtypes, it is broadly classified into migraine with aura and migraine without aura
  • The exact cause of Migraine Headache is not well-understood, but certain common trigger factors have been established that may include food, stress, and lack of sleep
  • There are multiple medications, non-traditional, and home remedies available for the treatment of Migraine Headaches. The prognosis of the disorder is generally good with appropriate treatment, but it also depends on the type and severity of the migraine

There are several different types of migraines and headaches. Some of these include:

Who gets Migraine Headache? (Age and Sex Distribution)

  • Any individual is likely to be affected by Migraine Headache at any age
  • Adolescents and young adults are affected more commonly than older adults. The onset of migraine is generally rare after the age of 50 years
  • Women are more commonly affected than men
  • Gender: Before puberty, males are affected more than females; following puberty, the incidence changes and females are more affected than males
  • The condition is seen worldwide, and there is no particular preference for any race or ethnicity

What are the Risk Factors for Migraine Headache? (Predisposing Factors)

The risk factors associated with Migraine Headaches can vary depending on the type of migraine. It may include:

  • Family history of the condition: About 90% of individuals with Migraine Headaches are known to have a family history of the disorder
  • Boys and girls in their teens are more likely to be affected
  • Hormonal changes: Women are likely to be affected by Migraine Headaches either before or after the onset of menstruation, pregnancy, and menopause, due to hormonal changes that occur in the body

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Migraine Headache? (Etiology)

The exact cause for Migraine Headache is not well-established. However, some of the possible causes may include:

  • Dilatation of blood vessels in the brain
  • Release of certain chemicals
  • Presence of an excess amount of dopamine and serotonin can cause Migraine Headache
  • Unusual sensitivity of the blood vessels to dopamine and serotonin

The following factors can trigger an attack of Migraine Headache:

  • Certain foods such as chocolate, cheese, nuts, alcohol, and monosodium glutamate (MSG, a food enhancer)
  • Missing out on meals; skipping meals
  • Physical and mental stress
  • Use of birth-control pills
  • Smoking
  • Hormonal changes in women during their menstrual cycle
  • Use of certain medications

What are the Signs and Symptoms of Migraine Headache?

The signs and symptoms of a Migraine Headache differ from one individual to another. Generally, five stages may be identified in the process of development of Migraine Headaches. These include:

 1st stage - Prodrome

The signs and symptoms exhibited during this early stage may include:

  • Changes in mood that may be characterized by
    • Irritability
    • Depression
    • Uncontrollable yawning
    • Food craving
  • Change in sensations 
    • Funny taste
    • Different smell
  • Fatigue
  • Muscle tension

2nd stage - Aura

The signs and symptoms exhibited during this stage may include:

  • Visual symptoms such as seeing various shapes, bright spots, or flashes of light
  • Vision loss
  • Pins and needles sensation in the arms or legs
  • Speech defects

3rd stage - Headache:

  • Pain on one side of the head
  • Experience of throbbing and severe pain
  • Nausea, vomiting
  • Photophobia or increased sensitivity to light
  • Phonophobia or increased sensitivity to sound
  • Pain that may last from 4 hours to 72 hours

4th stage - Headache termination: The pain will subside with proper sleep and rest, even if no treatment is given

5th stage - Postdrome:

The signs and symptoms exhibited during this stage may include:

  • Difficulty in eating
  • Difficulty in concentrating
  • Weakness and lethargy

The signs and symptoms may vary based on the specific type of migraine the individual is affected with.

How is Migraine Headache Diagnosed?

The diagnosis of Migraine Headaches may include:

  • Complete physical examination and assessment of signs and symptoms
  • Thorough analysis of personal and family medical history
  • Neurological examination by a qualified healthcare provider, if necessary
  • Laboratory tests may be performed to rule out other causes of pain
  • Computerized tomography (CT) scan of the head
  • Magnetic resonance imaging (MRI) scan of brain: Apart from detecting various abnormalities of the brain, it can also help in observing the blood vessels that supply the brain

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Migraine Headache?

Migraine Headaches may lead to complications such as:

  • Emotional and mental stress
  • Poor performance at school or at work
  • Recurrence of the condition
  • Reduced quality of life
  • Abdominal signs and symptoms: Pain in the abdomen, bleeding, and ulcers may be caused due to the intake of large dose of pain-relieving medications, such as ibuprofen, for a very long period of time
  • Headaches due to medication overuse: When over-the-counter medicines are chronically taken for a long time period in high dosage, a complication called ‘medication overuse headache’ may occur
  • Serotonin syndrome that may be caused by the intake of:
    • Certain migraine medications such as triptans
    • Anti-depressants called selective serotonin reuptake inhibitors (SSRIs)
    • Anti-depressants called serotonin-norepinephrine reuptake inhibitors (SNRIs)
    • Status migrainosus: Migraine attack that lasts for more than 3 days

The complications that develop also depend on the specific type of migraine the individual has.

How is Migraine Headache Treated?

The treatment of migraine depends on the diagnosed migraine type. An individualized treatment plan may be necessary, which may vary from one individual to another.

Medications used in the treatment of Migraine Headaches may be classified into two broad categories namely:

  • Pain-relieving medicines
  • Preventive medications

Pain-relieving medicines may include:

  • Mild attacks of Migraine can be cured with the help of pain-relievers such as:
    • Ibuprofen
    • Acetaminophen
    • A combination of acetaminophen, aspirin, and caffeine are used in the cure of mild and moderate Migraines, though it is not effective in case of severe attacks
  • Class of medications called triptans
  • Class of medications called ergots:
    • A combination of ergotamine and caffeine are to an extent useful in controlling the symptoms of Migraine Headaches
    • These are most effective in individuals who have pain lasting for more than 48 hours
    • Dihydroergotamine derivative is more effective and has fewer side effects than ergotamine. It is available in both injection form and also as a nasal spray
  • Anti-nausea medications
  • Opiates: Medicines that contain narcotics, such as codeine, are used as a last resort for treating Migraine Headaches
  • Dexamethasone is a corticosteroid that is combined with other medicines to improve the symptoms

Preventive medications:

These medications are prescribed when:

  • An individual has two or more episodes of Migraine Headaches in a month
  • If the pain-relieving medications are not effective
  • When the symptoms show continued numbness and weakness

The preventive medicines will help in:

  • Reducing recurrence of the disorder
  • Reducing the severity and duration of the disorder
  • Increasing the effectiveness of the other medicines used in controlling the disorder

Some of the common preventive medicines generally prescribed by the physicians include:

  • Cardiovascular drugs:
    • Beta blockers used in the treatment of high blood pressure and coronary artery disease are used to control the disorder (e.g. propranolol)
    • Calcium channel blockers also help in the prevention of Migraine Headaches and reduce the symptoms of aura
    • Antihypertensive medicines are used to reduce the duration and severity of the condition
  • Class of antidepressants:
    • Tricyclic antidepressants
    • Serotonin norepinephrine reuptake inhibitors (SNRIs) have been used in controlling Migraine Headaches to a certain extent
  • Anti-seizure drugs that are used to reduce the frequency of the condition
  • Botulinum toxin type A (Botox): Under this method, the medicine is injected in the muscles of the forehead and neck to prevent the condition

Non-traditional therapies may also be used in treating Migraines. These include:

  • Acupuncture: Many thin, disposable needles are inserted into the skin at certain defined points, particularly to provide relief from pain
  • Biofeedback: It is a relaxation technique in which certain special devices are used to teach ways to monitor and control physical responses in relation to stress
  • Manual therapy: This therapy helps to reduce the frequency of Migraines and increase the quality of the sleep, which will aid in their prevention. This includes:
    • Massage
    • Chiropractic treatments
  • Herbs, vitamins, and minerals:
    • Herbs, such as feverfew and butterbur, help in reducing the frequency and severity of the condition. This method is not advised for women who are pregnant
    • Riboflavin (vitamin B2) when injected in very high dosages can aid in the prevention of Migraines
    • Coenzyme Q10 supplements are also used in the treatment of Migraines
    • Magnesium supplements are given to individuals with low magnesium levels

Certain home care treatments may include:

  • Muscle relaxation exercises: Relaxation activities, such as gardening, meditation, yoga, listening to music, reading, and taking a hot bath, can help relax the muscles and give a feeling of comfort
  • Getting adequate sleep: An average of 6-8 hours sleep is needed for a human body. Practicing routine bed timing for both sleeping and waking up will help in the prevention of Migraine Headaches
  • While sleeping, resting and relaxing in a dark and quiet room may be beneficial
  • Applying ice packs on the back of the neck
  • Applying pressure (massaging) on the areas where pain is felt
  • Maintaining an headache diary with details regarding how often they occur, the duration of the headaches, their severity, etc. can assist the physician in assessing the condition more accurately

How can Migraine Headache be Prevented?

The prevention of Migraine Headache will largely depend on the specific migraine type (the individual has) and by bringing about some lifestyle changes that may include:

  • Avoidance of triggers:
    • If certain food items activate a Migraine, then avoiding them will be helpful
    • Use of certain type of scents, sprays, and body fresheners may set off a Migraine. Reducing their usage may help in its prevention
    • Reducing the effects of estrogen: Medications that contain estrogen, such as those taken for birth control and hormone replacement therapy, should be avoided because estrogen seems to trigger Migraine
  • A stress-free routine with regular sleeping habits may be pursued
  • Regular exercise: Aerobic exercises done regularly can reduce the occurrence of Migraine Headaches and decrease tension and obesity that are some of the main reasons for the condition. The most common aerobic exercise can include walking, swimming, and cycling

What is the Prognosis of Migraine Headache? (Outcomes/Resolutions)

  • The long term outlook of Migraine Headaches varies from one individual to another. It is generally good in a majority of individuals with adequate treatment
  • The acute attack of a Migraine Headache is very discomforting but with appropriate treatment most of the symptoms are manageable. Individuals are able to carry on with their lives with minimal adverse effects

Additional and Relevant Useful Information for Migraine Headache:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/neurological-institute/

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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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