Migraine Symptoms, Causes And Treatment
It was formerly believed that migraine headache was simply caused by vasodilatation (enlargement of blood vessels) that caused the release of chemicals from nerve fibers that coil around the large arteries of the brain. While these blood vessels do indeed enlarge, advanced imaging studies of blood flow in the brain have shown that changes in blood flow cannot be solely responsible for all features of migraine. Instead, complex processes within the nervous system are believed to initiate the development of migraine headache. For example, it is known that certain neurological pathways become sensitized and are stimulated more easily during a migraine headache, and chemicals that promote inflammation are secreted by nerves around the blood vessels.
A migraine headache causes the sympathetic nervous system to respond with feelings of nausea, diarrhea, and vomiting. This response also delays the emptying of the stomach into the small intestine (affecting food absorption), decreases blood circulation (leading to cold hands and feet), and increases sensitivity to light and sound.
Migraine is three times more common in women than in men. Some people can tell when they are about to have a migraine because they see flashing lights or zigzag lines or they temporarily lose their vision. Migraine headaches often begin in childhood, adolescence or early adulthood and may progress through five stages prodrome, aura, attack, Headache and postdrome.
Stages of migraine
1. 'Prodromal' (pre-headache) stage: Some people experience changes in mood, energy levels, behaviour and appetite, and sometimes aches and pains several hours or days before an attack.
2. Aura: Some people experience a sensation, or aura, just before their migraine starts. Symptoms of aura include flashes of light or blind spots, difficulty focusing, and seeing things as if you are looking through a broken mirror. This stage normally lasts around 15 minutes to an hour.
3. Headache stage: This is usually a pulsating or throbbing pain on one side of the head. You usually have nausea or vomiting, and extreme sensitivity to bright light and loud sounds, with a strong desire to lie down in a darkened room. This stage lasts for four to 72 hours.
4. Resolution stage: Most attacks gradually fade away. Some people find the headache stops suddenly after they have been sick. Sleep often relieves the symptoms.
5. 'Postdromal' or recovery phase: There may be a stage of exhaustion and weakness afterwards.
The frequency of migraine attacks depends on the person. Some people experience constant headaches on a daily basis, while most only have attacks once or twice a month. Migraine triggers also depend heavily on the individual, although common causes can include stress, foods, or other environmental factors.
How long do migraines last?
Many people experience migraines lasting for at least four hours or may last for days. The range of time someone is affected by an attack is actually longer than the migraine itself, as there is a pre-monitory, or build-up phase, and a post-drome that can last one to two days.
Some people who suffer from migraines can clearly identify triggers or factors that cause the headaches, but many cannot. Potential migraine triggers include:
• Allergies and allergic reactions
• Bright lights, loud noises, and certain odors or perfumes
• Physical or emotional stress
• Changes in sleep patterns or irregular sleep
• Smoking or exposure to smoke
• Skipping meals or fasting
• Menstrual cycle fluctuations, birth control pills, hormone fluctuations during menopause onset
• Tension headaches
• Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
• Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods.
Symptoms of migraine can occur a while before the headache, immediately before the headache, during the headache, and after the headache. Although not all migraines are the same, typical symptoms include:
• Moderate to severe pain, usually confined to one side of the head, but switching in successive migraines
• Pulsing and throbbing head pain
• Increasing pain during physical activity
• Inability to perform regular activities due to pain
• Increased sensitivity to light and sound
Some lifestyle alterations might help reduce migraine frequency such as getting enough sleep, reducing stress, drinking plenty of water, avoiding certain foods, and regular physical exercise.
Migraine treatment (abortive therapies) and prevention (prophylactic therapies) focus on avoiding triggers, controlling symptoms, and taking medicines. Over-the-counter medications such as naproxen, ibuprofen, acetaminophen (paracetamol), and other analgesics like Excedrin (aspirin with caffeine) are often the first abortive therapies to eliminate the headache or substantially reduce pain. Anti-emetics may also be employed to control symptoms such as nausea and vomiting.
Serotonin such as sumatriptan may also be prescribed for severe migraines or for migraines that are not responding to the over-the-counter medications. Similarly, some selective serotonin re-uptake inhibitors (SSRIs) - antidepressants such as tricyclics - are prescribed to reduce migraine symptoms although they are not approved in all countries for this purpose.
Migraine is often under-diagnosed and under-treated. There is no cure for migraine. Nevertheless, there are numerous measures that may help improve the life of migraine sufferers. The choice of these measures should take into account the individual aspects of each migraine sufferer. Triggering factors, nerve inflammation, blood vessel changes, and pain are each addressed aggressively. Individualizing treatment is essential for optimal outcome.
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