Migraine is a headache which is common in teens and young people, and it looks scary to many. Let’s learn about it in this post.
Migraine: Quick overview
What is Migraine?
A migraine is a type of headache characterized by head pain that is often severe, pulsatile (throbbing), and usually unilateral (on one side of the head). It is commonly associated with various symptoms such as nausea, phonophobia (sensitivity to sound), and photophobia (sensitivity to light).
How common are migraines and who is most affected?
Migraine is common, affecting 10% to 15% of the general population. Peak prevalence occurs in North America, and the onset typically begins in puberty, increasing until age 40.
What are the Symptoms of a Migraine Attack?
The main headache phase is characterized by pulsatile, throbbing pain that is moderate to severe and typically unilateral. This pain usually lasts between 4 and 72 hours if left untreated. The pain is worsened by physical activity and environmental factors like bright lights. Rest and dark environments often provide improvement. Associated symptoms include nausea, vomiting, photophobia, and phonophobia.
Do migraines happen in stages?
Yes, although not all patients experience every stage, migraines usually progress through four phases:
1. Prodromal Phase: Affects about 75% of patients. Symptoms can include yawning, mood changes, excessive thirst, food cravings, lethargy, cold sensitivity, photophobia, and phonophobia.
2. Aura Phase: Experienced by about 25% of patients. This phase is gradual in onset and lasts less than 60 minutes.
3. Headache Phase: The main phase characterized by the severe, throbbing pain.
4. Postdrome Phase: Lasts up to 24 hours after the headache resolves. Patients often report dizziness, exhaustion, irritability, and poor concentration.
What is a migraine "aura"?
A: An aura refers to sensory, visual, speech, language, motor, brain stem, or retinal symptoms that occur shortly before or during the headache phase. Visual aura is the most common form, which might involve flickering, shining visual field defects, known as scintillating scotoma. Aura symptoms can include positive effects, like bright areas or tinnitus (ringing in the ears), or negative effects, such as vision or hearing loss.
What causes the physical changes that lead to a migraine?
The underlying physical process (pathophysiology) involves the release of vasoactive neuropeptides like substance P, neurokin A, and CGRP. This release leads to abnormal vasodilation (widening of blood vessels), trigeminal nerve activation, neuronal impairment, and potential sterile inflammation. These processes are largely mediated by five-hydroxy-tryptamine one (5-HT1) receptor activity.
What are the risk factors or triggers for migraines?
Risk factors include genetic predisposition—if a person has a first-degree relative with migraine, they are more likely to develop it. Specific triggers vary by person but often include dietary factors like alcohol, MSG, and chocolate. Environmental triggers like bright lights and weather changes are also common.
How are migraines diagnosed?
Diagnosis relies on criteria established by the International Classification of Headache Disorders. Doctors look for patterns and specific characteristics, determining if the patient meets criteria for migraine without aura, migraine with aura, or chronic migraine. For example, diagnosing migraine without aura requires at least five attacks meeting specific criteria, including a headache lasting 4 to 72 hours, having moderate to severe intensity, and being aggravated by physical activity.
Are there any dangerous headache symptoms that require immediate medical attention?
Yes. Symptoms or signs considered “red flags” that necessitate neuroimaging (tests like MRI or CT scan) include a sudden onset of a new headache, especially in older patients, or the presence of focal neurological deficits.
How are migraines generally treated?
Treatment involves both abortive (acute) and preventive strategies, often alongside crucial lifestyle modifications. Lifestyle changes include stress reduction, regular physical activity (outside of attacks), and identifying and avoiding specific triggers.
What is "abortive" therapy, and what medicines are used for acute attacks?
Abortive therapies are used to treat acute attacks when they occur:
• NSAIDs (Nonsteroidal Anti-inflammatory Drugs) such as naproxen, ibuprofen, or diclofenac, are used for mild migraines that are not accompanied by nausea or vomiting.
• Triptans (5-HT1 agonists like sumatriptan or rizatriptan) are used for more severe attacks.
• Ergots (such as dihydroergotamine) are also used.
• Antiemetics can be used to manage nausea and vomiting.
Are there contraindications for using Triptans?
Yes, Triptans are contraindicated (should not be used) if the patient has cardiovascular disease, is pregnant, or has poorly controlled hypertension. Furthermore, they should not be used more than 10 days a month.
What is "preventive" therapy, and when is it used?
Preventive therapies are used regularly to reduce the severity and frequency of future migraine attacks. They are considered when a patient experiences long-lasting or frequent headaches, has specific types of migraine (like menstrual or hemiplegic migraine), or when there are contraindications to using abortive therapies. Preventive options include anti-convulsants, beta-blockers, anti-depressants, and calcium channel blockers.