What you need to know about migraines

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.

Symptoms

Migraines can start in childhood, adolescence or early adulthood. They usually progress through four stages: prodrome, aura, headache and post-drome.

• Prodrome: One or two days before a migraine, you may notice warning signs like constipation, mood changes from depression to euphoria, craving certain foods (usually sugars), neck stiffness, increased thirst and urination, frequent yawning.

• Aura: 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 include seeing shapes, bright spots or flashes of light, loss of vision, pins and needles in an arm or leg, weakness or numbness in the face or one side of the body, difficulty speaking, hearing noises or music, uncontrollable jerking or other movements.

• Attack: The headache usually lasts from four to 72 hours if untreated. Their frequency varies from person to person. During a migraine, you may experience: pain on one 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 occurs after an attack. You may feel drained and washed out, while some people feel elated. For about 24 hours, you may also experience confusion, moodiness, dizziness, weakness, sensitivity to light and sound.

Picture: iStock

Causes

Imbalances in brain chemicals, including serotonin, which helps regulate pain in your nervous system, are said to be involved.

Migraine triggers

• Hormonal changes in women – fluctuations in oestrogen. Oral contraceptives and hormone replacement therapy may worsen migraines – or taking those medications may help.
• Foods. Aged cheeses, salty and processed foods and skipping meals or fasting
• Food additives, like sweetener aspartame and preservative monosodium glutamate (MSG).
• Avoid alcohol, especially wine, and highly caffeinated beverages.
• Stress.
• Bright lights, loud sounds and sun glare.
• Changes in wake-sleep patterns.
• Intense physical exertion, including sexual activity.
• A change of weather or barometric pressure.
• Oral contraceptives and vasodilators, such as nitroglycerin.

Diagnosis

Your doctor will be able to diagnose you based on your medical history, symptoms and a physical and neurological examination. More tests may be recommended 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. Many medications have been designed to treat migraines. 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 they cause and your other medical conditions.

Medications used to combat migraines fall into two broad categories:

• Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during 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. If no relief is received, go to your doctor to get more treatment options.

Picture: iStock

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

You may qualify 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 attacks. It may take several weeks to see improvements.

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.

• Alternative medicine, or nontraditional therapies, like acupuncture, biofeedback, massage therapy, cognitive behavioural therapy and herbs, vitamins and minerals. Ask your doctor if these treatments are right for you.

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