Migraine symptoms, causes, risk factor, test, treatment

Table of content

1. Overview of migraine

Migraine means pain discomfort felt partly or wholly in the head. Primary headaches are discomforts lying in the head that are caused directly by overactivity or structural problems in the head. Which are pain-sensitive. These include the blood vessels, muscles, nerves in the head and the neck. They may also result from changes in chemical activity. Although popularly it is called a headache, it is not a pain in the head (or in the brain). The brain sends a message when other parts of the body hurt. Most of the headaches appear in the blood vessels or muscles or nerves covering the head or neck.

To well explain the severity of the headache, sometimes instance is given like-  ‘2 big spikes are being hammered into the brain from both the sides’. Metaphorically, any discomforts/ sufferings afflicting a baby (who has not yet grown enough to speak or complain except crying at the top of the voice) may itself be a severe headache to the loving parents.

Headaches are of many types. And one of them is ‘Migraine’, others being: tension headache/ sinus headache/preeclampsia headache. Migraine is an intense headache triggered by a host of factors. Such as stress/ noise/exertions/ certain foods and medications/ sensitivity to light or sound or even touch. A migraine is a type of headache that results in intense throbbing/sensation in one part of the head. It may arrive with a feeling of nausea or vomiting.

2. Migraine vs. headache

Usually, pain from a common headache (arising out of tension) will be mild to moderate. However, in migraines, the pain will be moderate to severe. Some patients with migraines will experience nausea and vomiting as well as sensitivity to light, sound, and even touch.

3. Migraine complications

• A migraine headache can invite many problems even when efforts are made to control it.
• Abdominal problems: Certain pain relievers (such as Ibuprofen) may result in abdominal pain and bleeding ulcers, especially if taken in large doses and for an extended period.
• Serotonin syndrome:  Although it rarely occurs, it is potentially a life-threatening condition. The risk gets higher, with too many nervous system chemicals called Serotonin. The medication SNRI (Serotonin and Norepinephrine Rupture Inhibitor) may increase the risk of serotonin syndrome.
• Chronic neurological disorder: For many, migraine remains a chronic neurological disorder that worsens the quality of life that interferes with the smooth performance of the daily home and job responsibilities.

4. What is a Migraine aura

Migraine aura (also known as classic migraine or ocular migraine) invites visual disturbance with flashing or shimmering light. Additionally, it may create a blind spot in the field of vision.

4.2) Food that triggers aura

These include:

• Cheese
• Caffeinated drinks
• Red wine
• Smoked meat
• Chocolate.

4.3) Advice

When a migraine with aura arrives, it is well advised to stay in a quiet and darkroom. Compression or pressure may be tried on the painful areas. Counter pain medication (For instance, Aspirin / Acetaminophen / Non- steroidal anti-inflammatory drugs, such as Ibuprofen or Naproxen) may help.

4.4) Aura symptoms

Tingling or numbness that spreads or moves from one part of the body to another part.

• Odd sensations in hand.       
• Discomfort/ pain in the arm
• Pain/discomfort on one side of the head
• Weird (supernatural) feeling in the face.
• A sensation of numbness in the tongue. 
• Food cravings.
• Getting cranky.
• Be fatigued and yawn frequently.
• Feeling stiff, especially in the neck.
• Feeling the need to urinate frequently.
• Having constipation or diarrhea.
• Aphasia (Impaired ability to understand as well as trouble in finding the appropriate word to speak on account of brain damage)

Conclusively, migraine aura often starts about an hour or so before the discomfort in the head arrives.

4.5) Aura causes

According to theory, a wave of nerve cells activity spreads across the brain and excites the trigeminal nerve (It is the 5th  and the largest cranial nerve which is responsible for sensation and function in the face, such as grasping/biting/chewing). The excitation causes the release of a variety of neurotransmitters ( neurotransmitter is an endogenous chemical that enables neurotransmission. It is a type of chemical messenger which transmits signals across a chemical synapse, such as neuromuscular junction from one neuron to another. And synapse is a structure in the nervous system that permits a neuron or nerve cell to pass an electrical or chemical signal to another neuron.) which results in the change in the size of blood vessels releasing more neurotransmitters and ultimately causing an inflammatory process and pain.

Conclusively, medical scientists have not yet confirmed the actual cause of migraine aura (which covers around 25%  of a total migraine attack).

4.6) Aura treatment

Drugs that are proved effective in migraine aura include Valpolic acid / Lamotrigine. Among non-medications, essential procedures are: Biofeedback (It is a technique that is used to control the body functions, such as heart rate) / Cognitive Behavior Therapy (It is a form of psychotherapy that treats the problems affecting happiness ) 

5. Migraine during pregnancy

Many women are found to complain of headaches during pregnancy. Reportedly, (among women) 15% of migraine sufferers get their 1st migraine headache during the pregnancy period. While the exact cause of migraine remains unknown. It is believed that the increased flow of blood in the brain contributes to the onset and creation of the headache.

Migraine usually appears during the   1st trimester (Pregnancy period is divided into three trimesters—the 1st trimester:  duration from the 1st week to the 12th week, 2nd trimester: length from the 13th week to the 26th week and the 3rd trimester: measure from the 27th till the end of the pregnancy period). But it can also occur during the 2nd trimester pregnancy period and onwards. This type of migraine can cause moderate to severe throbbing, typically on one side of the head. The headache can last up to 72 hours, which tends to be triggered by physical activity. During the pregnancy period, migraine headaches may invite nausea and vomiting.

Again some complain that migraine headache arrives to stay throughout the pregnancy period with equal severity.

Conclusively, the AHS (American Head Society) reveals the fact that 8% of the total American population having age 12 years and above suffer from migraine headaches. And among those migraine sufferers, 75% are female.

6. Migraine symptoms

Since migraine headache in general also includes ‘’Migraine Aura’, so symptoms in both cases appear mostly the same. Migraine aura symptoms include:

• Pain in one or both the sides of the head.
• Pain feeling with throbbing as well as pulsing.
• Sensitivity to light and sound and sometimes to smell and even touch.
• Nausea: Nausea is a feeling of sickness with an inclination to vomit at the sight or smell of detestable food or non-food item or on account of headache.
• Blurred vision: It is a loss of sharpness of eyesight, making the targeted object appear hazy and out of focus. The primary cause of blurred vision is a refractive error or nearsightedness or farsightedness. Blurred vision can affect one or both eyes.
• Lightheadedness: It is a familiar and typically unpleasant sensation that can be short-lived, prolonged, or rarely recurring. Often it is felt as if the head is weightless.

7. Migraine Diagnosis

For an effective and successful treatment procedure, the doctor will initially record family and personal history, ask about symptoms experienced by the patient and then conduct various physical and neurological examinations.

7.1) Blood test for migraine

Blood tests can be an important step for researchers at Johns Hopkins University to determine the appropriate treatment for migraines.

7.2) MRI (Magnetic Resonance Imaging)

The doctor may advise the test for ascertaining the problems in the blood vessel, detecting infection in the spinal cord or brain and toxins in the system.

7.3) CT (Computerized Tomography) scan

The procedure uses a series of X- rays to create a detailed cross-sectional image of the brain. This helps the doctor diagnose tumors  (It is abnormal; growth of cells that serves no purpose. When a benign tumor deteriorates to fatality, it is called cancer). Infection  (It is the invasion and multiplication of microorganisms, such as bacteria/virus/ parasites that are typically not present in the body. An infection may or may not cause any symptom),  brain damage  (The severity of brain damage can vary with the type of brain injury.

A mild brain injury may be temporary when it causes headache/confusion/ nausea and memory problem. In moderate brain injury, symptoms can last longer and be more pronounced), bleeding in the brain (In general, bleeding anywhere in the skull is called intracranial hemorrhage. When the bleeding occurs within the brain itself, it is known as intracerebral hemorrhage. Bleeding can also occur between the covering of the brain and the brain tissue itself referred to as subarachnoid hemorrhage — ) and other possible medical problems that may be causing a migraine headache.

7.4) Spinal tap (lumber or puncture)

The doctor may carry a test if the infection is suspected. In the procedure, a thin needle is inserted between 2 vertebrae  (in the lower back) to remove a sample of cerebrospinal fluid  (It is a clear colorless fluid found in the brain and the spinal cord. It is produced by the individual ependymal cells in the choroid plexuses of the ventricles of the brain and is absorbed in the arachnoids granulations) for analysis in the laboratory.

8. Migraine causes and risk factors

Objectives are the agents directly responsible for the occurrence of the disease. On the other hand, a risk factor is not necessarily a cause. A risk factor may be anything that increases the likelihood to develop the disease (For instance, aging is a risk factor to invite most of the conditions including migraine headache. But it is not a cause).

8.1) What are the main causes of migraines?

Genetic/Environmental factors: Although, migraine causes are mysterious. Still, generic/environmental factors are considered to play a pivotal role.  Also, changes in the brainstorm and its interactions with the trigeminal nerve—a dominant pair, causes the migraine headache.

Imbalances in brain chemicals: Serotonin is one of the brain chemicals that helps to regulate the nervous system. Too much or too few amounts of this brain chemical can trigger migraine headaches. Usually, the level of serotonin drops during a migraine attack. This may cause the trigeminal nerve to release the substance called neuropeptides (These are small protein-like molecules used by neurons to communicate with each other. These are neuronal signaling molecules that influence the activity of the brain and the body in specific ways) which travel to meninges (Brain’s outer covering). The ultimate result is migraine pain. Other neurotransmitters play a role in migraine attacks.

8.2) Migraine risk factor

Several risk factors may trigger the arrival of the migraine attack.

Hormonal changes (in case of women):

Fluctuation in estrogen (It is a primary female sex hormone that is responsible for the development and regulation of the female reproductive system and secondary sex characteristics.) seems to trigger a migraine attack in many women. Women having a previous history often report migraine headaches immediately before or during their period when they face a significant drop in estrogen. Besides tendency of migraine attacks rises during pregnancy or menopause (This is the time in most women’s lives when the menstrual period stops permanently. And they are no longer able to bear children. It occurs mostly during the age 49- 52 years)

Hormonal medications:

Oral contraceptives and hormone replacement may also invite a migraine attack.

Foods:

Aged cheese / salty and processed foods / skipping meals/ fasting may also trigger a migraine attack. 

Drinks:

Alcohol and highly caffeinated beverages may increase the likelihood of migraine attacks.

Stress:

It is a significant risk factor for most diseases, including migraine headaches. Stress, if paired with shock/grief/anxiety/ trauma/overwork/irregular and unhealthy diets, can trigger the symptoms to arrive in full swing.

Sensory stimuli:

Bright light and sun glare (in addition to loud sound and strong smell) can also trigger the arrival of migraine symptoms in the case of some people.

Inadequate sleep or insomnia and even may increase the likelihood of the occurrence of a migraine attack.

Physical factors:

Intensive physical exertion, such as excessive physical activity may provoke migraine attacks.

Weather:

Changes in weather conditions and atmospheric pressure can prompt migraine attacks.

Family history:

If there is a family member, particularly among the parents or brothers or sisters, then the risk of migraine attack becomes higher.

Age:

Migraine can arrive at any age. But still, the fact remains that as one ages, the risk of falling prey to migraine attacks becomes higher.

Gender:

As compared to males, females are more likely to develop migraine attack

9. Migraine prevention (without medication)

9.1) Research study reveals the fact that TSNS (Transcutaneous Supra-orbital Nerve Stimulation) is an effective preventive therapy, similar to the headband with attached electrodes against migraine attack.

9.2) Further, it is recommended to develop a consistent lifestyle (It includes meticulously following regular food and sleep patterns at the right time and of the right amount without any stress. Additionally, regular aerobic exercise can reduce tension and help to cope with migraine attacks).

10. Migraine treatment

Effective migraine treatment can stop symptoms and prevent the attack. Many medications are designed to treat and reduce migraine symptoms, while some other drugs are often used to manage the conditions causing migraines. Medications used to fight migraine attacks mainly fall into two categories, as stated below.

10.1) Pain-relieving medications

It is also known as acute treatment. These types of drugs are taken during a migraine attack and are designed to stop the symptoms. The doctor shall recommend what medicine will suit which patient.

Advice: As soon as the migraine attack is experienced, it is advised to sleep or rest in a dark room after taking the following me

Aspirin or Ibuprofen may help to relieve migraine pain. In some cases, Acetaminophen or Tylenol may also help dications.

Specific drugs (such as, a combination of acetaminophen/aspirin/caffeine) may also help ease moderate migraine pain, particularly while feeling nausea. However, if taken alone, they will not be adequate to treat severe migraines. The drug is also available in suppository form.

Caution: If the drug is taken too often or for a long time, then it may invite ulcer (ulcer is a break or discontinuity in a body membrane, and the membrane is a part of an organ. The break impedes the organ in performing normal function) and gastrointestinal bleeding (It is also known as gastrointestinal hemorrhage. It includes all types of bleeding in the gastro-intestine)

10.1.3) Trip-tans

The drug makes the blood vessels constrict to prevent pain (from traveling to the brain). As such, the drug is quite sufficient to reduce the symptoms associated with migraines. The drug is available in the form of pill / nasal spray/injection.

Trip-tan medicines include:

• Sumatriptan (Imitrex)
• Rizatriptan  (Maxalt)
• Almotriptan (Axert)
• Naratriptan  (Amerge)
• Zolmitriptan (Zomig)
• Frovartriptan (Frova)
• Eleptriptan (Relpex).

Caution:  Trip-tans are not recommended for patients at risk of stroke and heart attack Side effects include

• Reaction at the injection site
• Nausea
• Dizziness
• Drowsiness
• Muscle weakness.

Ergots: The drug is highly effective in the case of those patients where the migraine pain lasts for more than 48 hours.

Anti-nausea medications: Medication usually involves the combination of several drugs to treat the symptom of nausea. Frequently prescribed medicines include: Chlorpromazine /Metoclopramide (Region) /Prochlorperazine (Compro).

Opioid medications: The drug (containing narcotics, particularly  Codeine)  is sometimes used to treat migraine pain for patients who can take neither Trip-tans nor Ergots. Opiates are the only option if no other drug proves useful.

Glucocorticoids: The drug may be used with other medications to provide pain relief.

Caution: The drug should not be used frequently to avoid side effects.

10.2) Preventive medications

It is the doctor who will recommend preventive medicine to be taken regularly (For instance, when a predictable symptom triggers, such as impending menstruation). Preventive medications include:

10.2.1) Cardio-vascular drugs: The drugs include

Beta-Blockers (It is commonly used to prevent severe migraine headaches. It is also used to treat high blood pressure as well as coronary artery disease).

Another cardiovascular medication (Calcium Channel Blocker) is used to prevent migraine attacks in addition to treating high blood pressure.

Additionally, Angiotensin-Converting Enzyme Inhibitor Lisinopril (Zestril) may be used in reducing the length and severity of migraine attacks.

10.2.2) Anti-depressants

Anti-depressants are drugs used for the treatment of major depressive disorder and other conditions, such as chronic pain conditions.

Common side effects include dry mouth, weight gain, sexual disability, etc.

Conclusively, these type of medications is taken often daily to minimize the severity or frequency of migraine attack. However, the choice and the effectiveness of the preventive medicines to a large extent, depend on the severity as well as the frequency of the migraine headache/extent of disability caused by the migraine headache and other medical conditions.

11. Key global information

• Migraine is the 6th most disabling illness worldwide
• Migraine aura accounts for 25% of all migraines.
• Also, Migraine is a traumatically prevalent neurological disorder affecting I  billion population worldwide and 30 million people in the USA.
• During the migraine  attack, more than 90% of sufferers are unable to do regular work.,
• In the USA in every 10 seconds, someone goes to the emergency room with a complaint of migraine and other head pains.

12. Concluding remark

Insomnia or sleeplessness is considered a significant risk factor for a migraine attack. But excess of anything is wrong. Also, oversleep (sleeping for a long time) can become a significant risk factor to trigger migraine headaches. Just as under-dose or overdose will not cure a disease.

Regular physical exercise is always recommended to reduce the symptoms of most of the conditions, including migraine headaches. But sudden intense exercise can trigger migraine headaches. Because health rule suggests to warm up slowly and speed up body movement gradually during physical workout.

13. TIPS

• M= MIGRAINE (is one type of headache)
• I= IMBALANCE (in brain chemical is a major cause of migraine)
• G= GENETIC (factor often plays a pivotal role in migraine)
• R= REGULAR (aerobic exercise can prevent and cope with migraine)
• A= AURA (is an ocular migraine that  involves visual disturbance)
• I = INSOMNIA (can trigger migraine in some cases)
• N= NAUSEA (is one of the migraine symptoms)
• E= EXCESSIVE ( physical exertion may trigger migraine headache)
• H= HEADACHE (mostly springs from the blood vessels/muscles/ nerves)
• E= EFFECTIVE (treatment depends on age, gender, and severity or frequency of migraine)
• A= AGING (is a high-risk factor for all diseases including migraine headache)  
• D= DURING (migraine attack 90% of sufferers are unable to do normal work)
• A= ABDOMINAL(pain is one of the complications arising from migraine attack)
• C= CONSISTENT(lifestyle, healthy foods, drinks, and physical activity can tackle migraine)
• H= H0RMONAL(change in women can be a significant risk factor for migraine)
• E=   EXERCISE( is indispensable to reduce the symptom of a migraine attack)