MIGRAINE
A migraine feels like a very bad headache accompanied by throbbing pain on one side of the head or even both. It is mostly accompanied by nausea, vomiting, and extreme sensitivity to both light and sound. Migraine attacks can last for hours to days, and the pain can be very severe that it interferes with normal daily activities.
In some Individuals, a warning symptom called an aura occurs before or together with the headache. An aura can include visual disturbances, for example flashes of light or blind spots, or other disturbances, like tingling on one side of the face or in an arm or leg .
Migraine headaches have a prophylactic therapy and they can also be treated.
Epidemiology & Prevalence
- In the United Kingdom, More than 6 million people are affected by migraine.
- Migraine with aura affects 20-30% of all migraine patients.
- Migraine without aura affects 70-80%.
Classification
There are 2 most common classes of migraine headaches;
Classic migraine- Migraine with aura and Common migraine- migraine without aura
Migraine with aura;
- Affects up to 30% of all migraine patients
- Specific symptoms/ auras take place shortly before a headache begins or they occur concurrently
- Accompanied by warning signs and symptoms such as seeing zigzag lines, dizziness and inability to speak fluently/ difficulty speaking just before the migraine begins
Migraine without aura;
No warning signs are present
Risk Factors
- Family history- Individuals who come from families where other members suffer migraines are also likely to suffer from the same condition
- Age- they tend to peak in thirties but then become less frequent in the subsequent decades
- Sex- women are 3 times more likely to develop migraine attacks as compared to men
- Hormonal changes- In women with migraines, headaches can start before or shortly after the onset of menstruation
Causes
- Drinks such as wine and too much caffeine
- Stress
- Sensory stimuli- bright lights, strong smells and loud sounds
- Hormonal changes in females due to hormonal medications such as oral contraceptives. These drugs can worsen migraines.
Factors that can trigger migraine attacks include;
- Facing the start of a menstruation
- Anxiety and being depressed
- Drinking a lot of caffeine
- Irregular feeding and skipping meals
- Stress
- Tiredness
Signs & Symptoms
Prodrome– Occurrence of changes 1-2 days before a migraine attack. These include;
- Constipation
- Mood swings
- Neck becomes stiff
- Frequent urination
- Retention of fluid
- Frequent yawning
- Unusual cravings for food
Aura:
Auras refer to reversible symptoms which are related to the nervous system
These symptoms start gradually, develop over time and can last up to 1 hour
Examples of aura are;
- Vision disturbances
- Difficulty speaking
- Numbness on one side of the face
- Loss of vision
- Visual phenomena, where the victim observes various shapes or bright spots
Attack:
An attack can last somewhere between 4 hours to 3 days, if left untreated.
Frequency of the attacks varies from one person to anoyther.
The following might happen during a migraine attack;
- Pain on one or both sides of the head
- Throbbing or pulsating pain
- Sensitivity to light and smell
- Nausea
- Vomiting
Post-drome:
Instances that occur after an attack include ;
- Feeling drained up
- Confusion
- Pain when the head is moved suddenly
- Throbbing head pain, mostly on one side
- Sensitivity to odours, smells and bright light
- Fatigue
- Nausea and vomiting
- Stuffy nose
- Dizziness
Diagnosis
- Presence of symptoms of headache associated with sensitivity to light, a decrease in function and nausea
- Perform a CT scan to help check for bleeding in the brain, brain damage or tumors
- Conduct an MRI scan to check for infections and brain strokes
Treatment & Management
Drugs used for migraine include;
Acute attack;
- Lasmitidan- which is a 5HT1F receptor agonist
- Acetaminophen- as an analgesic
- Aspirin/ acetyl salicylic acid
- Metoclopramide- to hasten the absorption of aspirin or acetaminophen
- Triptans( 5HT1D agonists) – naratriptan, zolmitriptan, sumatriptan, frovatriptan, almotriptan, eletriptan
- Ergotamine- which is an ergot alkaloid
Prophylaxis;
These are drugs meant to prevent an attack from happening.
They include;
- Beta-blockers such as propranolol
- Cyproheptadine
- Amitriptyline
- Pizotifen- a 5HT2 receptor antagonist
Prevention & Control
To prevent migraines, it is a necessary prerequisite to identify and avoid triggers that predispose individuals to migraine attacks
To avoid migraine attacks;
- Manage stress
- Get adequate sleep
- Keep healthy weight
- Hydrate, re-hydrate and minimize caffeine intake
In order to control;
Sleep in a darker room during an attack.