Migraines: A real pain in the head

A migraine is a severe, painful headache that can be preceded or accompanied by sensory warning signs such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting, and increased sensitivity to light and sound.

The excruciating pain that migraines bring can last for hours or even days. Migraine attacks can cause significant pain for hours to days and can be so severe that the pain is disabling.

Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, may help.

Migraines are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

Several factors make you more prone to having migraines, including family history. Women are three times more likely to get them.

Symptoms

Migraines can start in childhood, adolescence or early adulthood. They usually progress through four stages: prodrome, aura, headache and post-drome, though you may not experience all stages.

• Prodrome: One or two days before a migraine, you may notice signs that warn of an upcoming migraine. These include constipation, mood changes, from depression to euphoria, craving certain foods – usually sugars – neck stiffness, increased thirst and urination, frequent yawning.

• Aura: Auras are symptoms of the nervous system. They are visual disturbances, such as flashes of light or wavy, zigzag vision. Sometimes auras can also be touching sensations (sensory), movement (motor) or speech (verbal) disturbances. Your muscles may get weak, or you may feel as though someone is touching you.

Each of these symptoms usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes. Examples of migraine aura include seeing various shapes, bright spots or flashes of light, loss of vision, pins and needles sensations in an arm or leg, weakness or numbness in the face or one side of the body.

• Attack: The headache usually lasts from four to 72 hours if untreated. Migraines may be rare, or strike several times a month. During a migraine, you may experience pain on one side or both sides of your head, pain that feels throbbing or pulsing, sensitivity to light, sounds, and sometimes smells and touch, nausea and vomiting, blurred vision, lightheadedness, sometimes followed by fainting.

• Post-drome: The final phase, known as post-drome, occurs after a migraine attack. You may feel drained and washed out, while some people feel elated.

Picture: iStock

Causes

Imbalances in brain chemicals, including serotonin, which helps regulate pain in your nervous system, are said to be involved. Researchers are still studying the role of serotonin in migraines. Serotonin levels drop during migraine attacks.

Migraine triggers

• Hormonal changes in women. Fluctuations in oestrogen seem to trigger headaches in many women. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in oestrogen.

Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications, such as oral contraceptives and hormone replacement therapy, may also worsen migraines. Some women, however, find their migraines occur less often when taking these medications.

• Foods. Aged cheeses, salty foods and processed foods may trigger migraines. Skipping meals or fasting also can trigger attacks.

• Food additives. The sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods, may trigger migraines.

• Drinks. Alcohol, especially wine, and highly caffeinated beverages may trigger migraines.

• Stress. Stress at work or home can cause migraines.

• Sensory stimuli. Bright lights, loud sounds and sun glare can induce migraines. Strong smells – including perfume, paint thinner and second-hand smoke and others – can trigger migraines.

• Changes in wake-sleep pattern. Missing sleep or getting too much sleep may trigger migraines, as can jet lag.

• Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.

• Changes in the environment. A change of weather or barometric pressure.

• Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.

Diagnosis

If you have migraines or a family history of migraines, or symptoms suggestive of a migraine see your doctor who will be able to diagnose you based on your medical history, symptoms, and a physical and neurological examination.

Your doctor may also recommend more tests to rule out other possible causes for your pain if your condition is unusual, complex or suddenly becomes severe.

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Treatment

Migraine treatments can help stop symptoms and prevent future attacks. Some drugs often used to treat other conditions also may help relieve or prevent migraines.

Your treatment strategy depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and other medical conditions. Medications used to combat migraines fall into two categories:

• Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms.

Take pain-relieving drugs as soon as you experience signs or symptoms of a migraine for the best results. It may help if you rest or sleep in a dark room after taking them. Examples are aspirin, ibuprofen and painamol.

Some combination drugs are marketed specifically for migraines, such as the combination of acetaminophen, aspirin and caffeine (excedrin migraine) and may also ease moderate migraine pain. They aren’t effective alone for severe migraines.

Take them as directed by your doctor because if taken too often or for long periods of time, these medications can lead to ulcers, gastrointestinal bleeding and medication-overuse headaches.

The prescription pain reliever indomethacin may help treat a migraine and is available in suppository form, which may be helpful if you’re nauseated.

If no relief is received do go back to your doctor to get more treatment options like triptans, glucorticoids, etc.

Picture: iStock

• Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.

You may be a candidate for preventive therapy if you have four or more debilitating attacks a month, if attacks last more than 12 hours, if pain-relieving medications aren’t helping or if your migraine signs and symptoms include a prolonged aura or numbness and weakness.

Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks. It may take several weeks to see improvements in your symptoms.

Your doctor may recommend daily preventive medications, or only when a predictable trigger, such as menstruation, is approaching.

Preventive medications don’t always stop headaches completely, and some drugs cause serious side effects.

If you have had good results from preventive medicine and your migraines are well-controlled, your doctor may recommend tapering off the medication to see if your migraines return without it.

The most common medications for migraine prevention include cardiovascular drugs like beta blockers, ACE inhibitors and calcium channel blockers.

Antidepressants – especially tricyclic antidepressants – may be effective in preventing migraines, even in people without depression. These medications can, however, cause sleepiness, dry mouth, constipation, weight gain and other side effects.

Some anti-seizure drugs seem to reduce the frequency of migraines. In high doses, however, these anti-seizure drugs may cause side effects.

Taking nonsteroidal anti-inflammatory drugs, especially naproxen (Naprosyn), may help prevent migraines and reduce symptoms.

Alternative medicine

Nontraditional therapies may be helpful.

• Acupuncture. Clinical trials have found that acupuncture may be helpful for headache pain.

• Biofeedback. This is a relaxation technique that uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.

• Massage therapy. Researchers continue to study the effectiveness of massage therapy in preventing migraines.

•  Herbs, vitamins and minerals. Some herbs may prevent migraines or reduce their severity.

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