Migraine affects around 37 million people nationwide and is the seventh leading cause of disability in the world. It occurs most commonly between the ages of 15 to 55 and has a strong relation to family history.
What is Migraine:
Migraine is an abnormal activation of the trigeminovascular system. So it is a vascular headache which can be triggered by many factors. The trigeminal nerve is triggered by exciting brain cells. The nerve releases chemicals that irritate and cause swelling of blood vessels on the surface of the brain. These swollen blood vessels send pain signals to the brain stem. The earlier assumption of migraine being a result of ischemia or necrosis to the brain cells is not true anymore. There are many things about the migraine that needs to be understood but it is suggested that migraine is much more than just a “bad headache”.
Migraine can be with or without the aura.
Symptoms of migraine without Aura are:
- At least 5 headache attacks, lasting 4 – 72 hours
- One-side, pulsating pain of moderate to severe intensity
- Aggravated by or causing avoidance of routine physical activity
- Accompanied by at least one of the following:
- Nausea and or vomiting
20 to 30% of migraines follow aura. Aura usually precedes headache but not all the time. It lasts for less than 60 minutes, usually 20 minutes. This is a warning sign of a migraine attack.
It is best described as focal neurological disturbances or sensory disturbances that precede migraine headaches. The types of aura include Visual, sensory, and language aura. Out of these, a visual aura is the most common type that is seen in people with migraine.
This is described as seeing spots, flashes, zig-zag pattern, stars, or a blind spot in the vision.
With sensory aura, people complain of tingling, pins- and needle sensation in one arm or leg, paresthesias in arm or leg, or feel numb in the face, hand, body, etc.
This is the inability to produce the right words, slurred speech or mumbling words.
Research indicates that aura is not due to the lack of blood flow or constriction of the brain’s blood vessels. Rather, it is due to hyper-excited nerves in the brain that are activated prior to migraine pain. When the excited nerves are activated in the visual processing areas of the brain, the patient experiences visual symptoms. When the other areas of the brain are excited, paresthesias may occur.
It is possible for a person to experience one or more aura. People can also experience different symptoms with a different migraine attack. Although, people with migraine, can identify the pattern of symptoms prior to the attack. It is also possible to see people changing their aura as well as classic migraine symptoms completely.
PRODORMES in Migraine:
Some people report experiencing generalized changes like elation, increase in energy or hunger, personality changes, etc.. this is not the same as Aura. These are referred to as prodrome of migraine and it can precede a headache by hours to days.
Before or During the Attack:
- Feeling of well-being
- Increased appetite
During the Attack:
- Nausea, vomiting, diarrhea
- Sweating or cold hands
- Sensitivity to light or sounds
- Scalp tenderness or pressure
- Pale facial color
- Pulsing pain
Migraine triggers can vary from person to person. Additionally, the same person can have different triggers and different types of attacks. It is crucial to know your triggers and try to avoid it. The exposure to the triggers to a certain threshold will only cause the migraine. Therefore, it is important to know how much (a general idea) your body can handle being exposed to certain triggers before you absolutely have to remove yourself from that area.
Disturbed sleep, and avoiding meals are the two most common migraine triggers.
Examples of migraine triggers are environmental triggers, weather-related triggers, food triggers, a certain type of sound triggers, etc. Certain medical factors, as well as psychological factors like mood and anxiety, can also play a part in migraine attacks as well.
While knowing about the triggers, it is important to know the trigger threshold. This information about threshold is helpful in a situation where you can not avoid certain triggers completely
Knowing the triggers and preventing the triggers is the first and foremost important remedy in preventing attacks. Medications are available as treatment options but no medicines can prevent the attack yet. Lifestyle changes are crucial in preventing migraine attack and so avoiding the triggers.
Research has found that calcitonin gene-related peptide (CGRP) and its receptor play a key role in migraine as well as cluster headache. Currently, there are three medicines that are approved by the FDA for the attacks. They are erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality).
These medicines are found to be highly effective, due to their high cost, they are not readily available for patients. Also, since they are newer in the market, there are few unknown areas. Also, research is high in the direction of not only treating it but also prevent it.
FDA has also approved some over the counter medicines to treat migraine. they are Aspirin, Acetaminophen (Tylenol), Ibuprofen, Naproxen or combinations of these. These medicines are good to treat the symptoms.
A regulated structured environment is helpful for people to prevent the onset of the attack.
Sufficient and qualitative sleep is crucial in the prevention of the onset of the attack. Having a regular sleep schedule and sticking to it, is helpful to prevent the attacks.
A healthy diet with fruits, vegetables, protein, and dairy is linked with fewer migraine attacks. Staying hydrated and avoiding caffeine are also helpful factors.
This is big and crucial for people who get frequent attacks. About 90% of people with migraine will admit having more frequent attacks under stress. Managing stress with proper breathing exercises, relaxation techniques as well as with lifestyle changes help not only to prevent attacks but also to manage other symptoms.
Managing anxiety also helps to prevent the onset of the attack. Moreover, anxiety management helps to deal with the situation in a more positive way.
National Headache Foundation www.headaches.org
American Migraine Foundation: https://americanmigrainefoundation.org/patient-guides/