Migraine typically is severe throbbing or pulsating headache usually on one side of head often accompanied by severe sensitivity to light and sound.
Migraines usually pass through 4 phases
Prodrome – Phase 1
1 or 2 days before migraine attack one may experience subtle changes that warn the upcoming attack of Migraine like:
- Mood changes ranging from depression to euphoria
- Neck stiffness
- Frequent yawning
- Increased thirst, urination etc.
Aura – Phase 2
Most of individuals may not experience Aura. Usually appear just before or during migraine attack. The symptoms gradually build up and lasts for 20 to 60 minutes. They are the symptoms of nervous system like:
- Visual: seeing various shapes, flashes of light or bright spots. There may also be vision loss
- Auditory: Hearing noises or music
- Verbal: Difficulty in speaking
- Sensory: Pins and needle sensation in arm or leg
- Motor: Jerking movements, weakness in limb, face or one side of body.
Migraine attack – Phase 3
If untreated lasts for 4 hours to 72 hours. Symptoms during attack are:
- Severe throbbing or pulsating pain usually on one-half of head and/or both sides of head.
- Nausea and vomiting. Vomiting relieves the symptoms/headache
- Blurred vision
- Sensitivity to light, sound, smell and sometimes even to touch
- Light-headedness, sometimes fainting
Postdrome – Phase 4
Final phase of Migraine and occurs after attack. May last for 24 hours with symptoms like:
Weakness, dizziness, confusion and sometimes with sensitivity to light and sound.
The exact cause for migraine is yet to be understood. It may be due to genetic and environmental factors. Changes in brainstem and its interaction with trigeminal nerve may play a role. Imbalance in neurochemicals like serotonin may also a play a role in causing migraine attack.
Triggers for migraine attack
- Changes in sleep pattern (sleeping too much or too less)
- Changes in food intake pattern (fasting or having feast) and food additives
- Stress, alcohol intake or caffeinated drinks
- Exposure to intense odour. Intense physical activity or sexual activity
- Hormonal changes in women (migraine in women triggered just before and after menstruation) and medications that include vasodilators
- Change of weather and barometric pressure
Diagnosis made by exclusion of other similar symptoms producing diseases like tumor, infection in brain. So one has to get MRI, CT-scan or spinal fluid analysis based on advice of doctor
Treatment of attack:
- Pain relieving medications like Ibuprofen, Naproxen etc. during attacks to relieve pain.
- Triptans like sumatriptan, zolmitriptan constrict blood vessels and block pain pathways. Combination of both Naproxen and sumatriptan used.
- Other symptomatic medications to treat nausea and seizure used.
- Opioid medications and glucocorticoids.
- Used if there are four or more attacks per month
- Attacks lasting for more than 12 hours
Preventive migraine medications include
- Calcium channel blockers, Beta blockers, or ACE inhibitors
- Antidepressants and others
- Get enough sleep and don’t over sleep
- Have regular and optimal food and do not over eat
- Practice relaxation techniques
- Regular exercise