Underlying Causes Of Migraine Attack
A migraine attack is a primary headache disorder and is caused by the brain stimulation to produce the pain-inducing substances around the blood vessels and the neurons. Migraine headache is usually a moderate to intense headache, felt like a throbbing pain inside the head. Pain can persist from hours to days. Neurotransmitters in brains play an essential role in triggering the migraine. The exact cause is not confirmed yet, but environmental factors, stress, anxiety, hormonal change are some factors that may cause migraine and may vary from person to person. The symptoms associated with the migraines include irritability or sensitivity to light and sound, obstruction in vision, nausea, vomiting.
What are the stages of Migraine?
- Prodromal stage or Premonitory stage
- Migraine attack
- Prodromal stage or Premonitory stage:
It is the condition that occurs for a few hours and even lasts for a few days. It is considered an alarming sign for the migraine sufferers for the imminent migraine. The symptoms associated with the prodromal phase are as follows:
- Mood swings
- Increased cravings for food
- Mood changes
- Muscle stiffness
- Lack of concentration
- Feeling sensitivity towards light
- Feeling sensitivity towards sounds
- Increased urination
Aura is the condition when the person with migraine attacks faces multiple psychological events, which are due to electrochemical changes in the brain, but every migraine is not with Aura. It is found among 1/3 people suffering from migraines. Aura is due to the obstruction in veins, which progress from the periphery to the midline. The electrical signal passing over this part of the brain leads to Aura.
In some cases, complete loss of vision occurs. A few of the conditions associated with migraine aura are vision loss, vertigo, visualizing dark spots or zigzag patterns, confusion, involuntary movements, tingling sensation in arms or legs in rare cases, fainting or paralysis. Symptoms occur accordingly, owing to which part is affected.
In the migraine attacks, the headache starts from one side of the brain and gradually spreads to other parts during the whole period of migraine. The person suffering from migraine attacks experience different kinds of pains, which are throbbing, drilling or burning. The entire period lasts for about four hours to 72 hours if left untreated. The symptoms associated with the migraine attacks are as follows:
- Pain above the eye
- Throb badly during exercise
- Smell intolerance
The postdrome stage of the migraine is often called ‘’Hangover Stage’’, it occurs right after the headache. A person may feel exhausted and confused for a whole day. This stage may last for a day or two. Few of the symptoms associated with the Postdrome stage are as follows:
- Inability to comprehend
- Feeling lethargic
- Lack of concentration
What are the types of Migraine?
Migraine without Aura (Common Migraine)
- Menstrual Migraine
Migraine with Aura (Classic Migraine)
- Aura with headache
- Aura without headache
- Hemiplegic Migraine
- Brainstem aura with migraine
What is Aura?
Aura is the condition when the person with migraine attacks faces multiple psychological events, which are due to electrochemical changes in the brain. Aura is considered as the obstruction in veins, which is progressed from the periphery to the midline. In some cases, complete loss of vision occurs. A few of the conditions of migraine aura are vision loss, involuntary movements, tingling sensation in arms or legs.
Migraine without Aura:
Migraine without aura is a headache disorder, and the duration of this attack may lie between 4 hours to 70 hours. The symptoms associated with this type of migraine include the pulsating pain, Unilateral location and, the pain ranges from moderate intensity to high intensity, which further gets worsens with nausea, irritation with light or sound. One of the condition lies within migraine without Aura is ‘’Menstrual Migraine’’.
More than 50% of the female are affected by this kind of migraine. It stays for longer duration; all the women with this kind of migraine suffer from intrusion in regular activities such as physical or social activities.
Migraine with Aura:
Aura is defined as a psychological event that occurs due to the electrochemical changes in the brain. Not everyone suffering from migraine attacks every time needs to suffer from Aura too, a migraine attack can be without aura. It is not fatal but can be very painful. It has complex neurological symptoms, and the symptoms associated with Aura are:
- Loss of Visual senses
- Impaired motor activities
- Difficulty in Language or speech
- Excessive yawning
- GIT disturbances
Migraine with Aura is further classified as:
Migraine with Headache:
In this condition, there is a recurring headache that occurs due to the sensory disturbances called Aura. The troubles associated with this kind of migraine are blurred vision, blindspot, scintilla, etc.
Migraine without Headache/ Sans Migraine:
It is also called as silent migraine, which is not followed by any headache. This type of migraine is complicated to diagnose as there is no headache or presence of Aura.
Hemiplegic Migraine/ Migraine Variant:
It is a rare type of migraine; the signs of this type of migraine include one-sided body pain or headache, confusion, nausea, loss of coordination and control, tingling sensation, sensitivity or irritability to light and sound. It resembles stroke or seizures as it also causes muscular weakening resulting in short term paralysis. It is further categorized as:
- Sporadic Hemiplegic Migraine:
It occurs in one person of a family with probable cause of genetic mutation. It is a condition in which migraine causes intense throbbing pain on one side of the body. This pain is reported to affect upper limbs with a period of 8 hours to a day. The person with this kind of pain may experience one-sided body pain, visual disturbances, and other related symptoms.
- Familial Hemiplegic Migraine:
It is a type of hemiplegic migraine occurring in more than one person of a family. It may last for hours to days. Genetic mutation and irregular levels of neurotransmitters have shown to be a cause of Familial hemiplegic migraine, though researchers are still working to find out the exact reason.
Brainstem Aura with Migraine:
Brainstem Aura with Migraine is also termed as Basilar Migraine, a condition that arises with the strain on the backside of the head. It occurs on the lower side of the brain, i.e brainstem affecting both hemispheres. It can be a result of hyperventilation, anxiety, or depression.
Rare Forms of Migraines are:
Migraine, in terms of a layman language, is considered to be a headache. These types of rare migraine and headaches are categorized based on symptoms, which are:
It is a neurological syndrome rendering damage to one or more nerve typically 3rd cranial nerve with the symptoms of repeated migrainous or non-migrainous headache and ophthalmoplegia. According to a survey, about 0.7 per million people suffer from ophthalmoplegic migraine around the globe. It can persist for weeks to months.
Retinal/ Ocular Migraine:
It is repetitive attacks of visual turbulences with signs like scintillations, temporary blindness, scotoma and inability to move that eye. These symptoms are one-eyed and are often confused with migraines, including visual symptoms. A migraine attack is suspected to happen within 60 minutes of these symptoms.
It is usually found in children with symptoms like stomach pain, nausea, vomiting. It can be mild to intense, lasting for hours and can be a result of a family history of migraines. A child with abdominal migraine is a suspect to migraine attacks at adulthood.
It is a long term result of migraines with headaches. These headaches would persist for at least 15 days a month. The number of periodic headaches may increase with time, which can be controlled by medicines if diagnosed on time.
Migraine is prevalent in children and might affect children’s life quality. It may show symptoms like headache, dizziness, mood swings, abdominal pain, nausea, sensitivity to light, touch or odour. It can be as harsh as affecting about 10% of school-going and 28% of children between the age of 15-19 years.
Some headaches mimic migraines. The doctor for the treatment should appropriately diagnose these. These include:
They are also called “Chronic Headache.” It is among the most painful type of headache with cyclic patterns which can attack without any warning even at nights after you sleep. Its symptoms include a pale face, a one-sided headache, runny nose.
It mimics migraine so considered under the umbrella of headache migraine. It causes pain in the region of neck arising either from bones, muscles or nerves in that area.
Ice pick Headaches:
It is also known as “Stabbing Headache” or “Jabs and Jolts” or “needle-in-the-eye syndrome”. It leads to severe sudden pain like that in Chronic migraine, but it differs by the symptoms like droopy eyelids, watery red eyes, face flushing.
What are the symptoms of Migraine?
- Moderate to intense pain.
- Throbbing and pulsing pain.
- Increased thirst
- Fluid retention
- Neck stiffness
- Pain in stomach
- Feeling of irritation during exercise
- Difficulty in eye movement
- Lack of concentration.
- Incompetence to perform regular activities.
How can we diagnose Migraine?
Diagnosis of Migraine is challenging as there is no specific test present for the determination of migraine attacks. If a person has a medical history of migraine, then there are higher chances of migraine attacks. The neurologist diagnoses the migraine attacks after determining the complete medical history and neurological examinations. Some criteria may help the doctor to predict the reason behind the migraine attacks.
First is the unilateral location, which shows the pain occurring in one direction of the brain. The second criteria are the pulsating type of pain in which the pain starts from the front or back of the brain, the other is the throbbing pain to avoid activities. These types of discomfort may help the doctor predict the reason for the migraine attacks. So the doctor might suggest some therapies concerning it. In the case of severe Migraine, a neurologist performs two tests to identify the exact causes of the pain.
MRI (Magnetic Resonance Imaging)
That uses the magnetic field and radioactive waves for showing the images of the brain and blood vessels to determine the disturbances leading to migraine attacks.
CT (Computed Tomography)
Uses x-rays to view the cross-sectional images of the brain.
- Some blood and urine tests may also help find out the reason behind migraines as they tell about any change of chemical balance in the body fluid. Changes in hormones, the infectious disease could also be a reason for the migrainous attack.
Lumbar Puncture or Spinal Tap
It is also an option to measure the pressure of CSF between the brain and spinal cord. CSF is also analyzed for any infections or related problems.
Seizure analysis by using techniques like Electroencephalogram (EEG) as a seizure might also be a cause of migraines.
Make a Diary of Symptoms
Make a diary to note down all the symptoms that result in migraine attacks so that diagnosis becomes easy.
What is the treatment of Migraine?
It involves the procedure with the help of drug therapies.
There are many medicines available for migraines. Some of the drugs available for the migraines provides its best effect when taken as the migraine attacks begin. It rapidly controls the migraine attack, thus lowering the pain, this drug therapy is called as Abortive therapy. Other medicines that are available for the migraines work on reducing the frequency of the migraine. These medications need to be taken regularly so that the rate of the migraine can be controlled gradually, the therapy is called as prophylactic therapy.
Drugs to be taken for Abortive therapy includes:
- Pain relievers like Paracetamol, acetaminophen, Naproxen sodium, Ibuprofen.
- Dihydroergotamines (DHE)
- CGRP (calcitonin gene-related peptide) inhibitors like Ubrogepant, Remanezumab.
- NSAID like Diclofenac.
- Triptans like Somatriptan, Almotriptan, Zolmitriptan, Frovatriptan.
- Antiemetic drugs like chlorpromazine, metoclopramide and prochlorperazine.
Other than OTC drugs, all drugs are to be taken with the permission of your doctor.
It involves treatment without the use of medications. Non-pharmacological techniques for treating migraines are as follows:
Changes in the lifestyle:
Lifestyle has a significant impact on the cruelty of the migraines. The following measures need to be practiced to control the frequency of the migraines.
Sleeping pattern is essential for a person’s health. One should monitor the regular sleeping patterns; how much sleep you need and do not extend or reduce the sleeping hours. Extra sleep or not getting enough sleep, both factors influence in triggering the migraine attack.
Physical Activity is necessary for reducing the stress, which in turn reduces the chances of a migraine attack. 30-40 minutes exercise is mandatory for balancing the internal physiology. But some exercises may also trigger a migraine, so make sure to check and adjust your physical activities.
Maintain a consistent eating schedule, don’t skip meals and try to eat a healthy diet.
The Body Posture:
The posture plays a vital role in triggering the migraine attack. One should know at what position or posture the neck and shoulders should be while sitting in front of computers, televisions or using cellphones.
Cognitive Behavioral Therapy:
Cognitive Behavioral therapy or treatment identifies the negative thought of individuals. It helps migraines by improving the coping skills for managing the pain. Secondly, it helps by boosting the capability of solving problems among the individual.
Biofeedback plays an essential role in controlling the migraine attack as it helps the individual to manage and understand the involuntary body function such as Blood pressure, Heart rate etc.
Meditation for Mindfulness:
Meditation is necessary for being aware of the present moment. Mindfulness can be achieved by focusing without being affected by your current situation. You must be mindful of the fact, how to control and regulate your emotions.
Muscle relaxation is necessary for reducing the Migraine, as the muscle tension is removed, it lowers down the triggering of migraine attacks.
The complementary treatment for lowering the migraine attacks are as follows:
The process involves applying mechanical pressure to the body with the help of the needle to bring the body back to its steady-state.
Spinal Manipulative procedures:
Spinal Manipulative procedure tends to relax the compressed nerves, which results in improvising blood circulation. Relaxing the compressed nerves result in improving kinesthetic pressure, thus reduces the chances of migraine attacks.
Many dietary supplements support by lowering the migraine attacks such as magnesium oxide, melatonin supplements, Riboflavin or vitamin B complex.
Top Migraine Triggers:
The actual reason for migraines is still unknown, but certain factors that trigger migraines are environmental triggers, food triggers, hormonal changes, emotional triggers, and psychological triggers.
- Bright light
- Various odors
- Changes in temperature
- Weather changes
Two types of food trigger a migraine, which are:
1 – By-products of food:
This food includes fermented products such as wine, processed cheese, the yeast used in fresh bread and sugar; they may lead to migraines.
2 – Food having the chemical similar to the neurotransmitters:
This type of food includes the product having caffeine, preservatives, MSG and nitrates, which is used in many packaged foods, leads to trigger Migraines.
Hormonal changes occur during menstruation, and women may experience migraines during the menstruation period.
The main psychological factor for triggering migraine is stress. Most of the symptoms appear in the patient when the person feels lethargic and fatigued.
Remedies for Immediate Relief from Migraine:
- Using sufficient liquids: Having plenty of fluids in your diet prevents yourself from dehydration, which in turn reduces the chance of migraine attacks.
- Massage: Relaxing the muscles of the neck, shoulder and back helps relief from the migraine pains.
- Reducing Sensory Inputs: This includes avoiding direct exposure to light and preventing from going to noisy places. Relax in the dark and quiet room for some time.
- Use a cold pack: Place a cold pack at the pain area and leave it for twenty minutes, it might help in relieving the pain.
Prevention of Migraine:
- Maintain a proper sleep routine with 7 to 9 hours of sleep every night.
- Avoid skipping meals and try to eat healthily.
- Caffeine has shown varying effects among individuals. High intake may be a migraine stimulator, but some may get relieved with low caffeine content. Note your body’s response to continuing caffeine.
- Note down the symptoms that stimulate migraine in you. Reasons for migraines may differ from person to person.
- Make an appropriate diet chart for migraines taking into consideration the food items that might trigger it.
- Avoid dehydration by having plenty of water.
- Involve yourself in activities like yoga, meditation, and muscle relaxation techniques to avoid stress.
- Be careful while taking dry fruits, baked items, oily products, alcoholic products.
- Take the proper medication prescribed by the doctor.
- Take a note of the weather that might disturb you. Avoid going outside during such weather.
- Consult your doctor about the hormonal imbalance if the migraine occurs during menstruation.
- Practice daily exercise to maintain a healthy weight
- Avoid noisy places or places with stimulant lighting.
As per the Migraine Research Foundation:
Migraine is the 3rd most prevalent disease in the world, and 12% of the population inclusive of children suffer from migraines. It occurs between the ages of 22 and 55, and migraine is most common among women as compared to men.
- Migraine triggered seizures
- Serotonin syndrome
- Persistent Aura without infarction
- Migrainous infarction
- Blood pressure problems
- Severe depression
- GIT upset
- Bipolar disorder
- Anxiety disorder
- Night terrors
- Status migrainosus
What is a migraine?
Answer: Migraine is a neurological disorder that occurs with periodic headaches.
Who is more likely to suffer from migraines?
Answer: Migraine is common among women.
What is the duration of Migraine?
Answer: It may vary from person to person and types of migraine, but it can last from hours to days.
Is stress a factor of Migraine?
Answer: Yes, stress triggers Migraine.
What is the difference between Cervicogenic headache and Migraine?
Answer: The core difference is, Cervicogenic headache arises from the cervical (spine), whereas the Migraine arises from the areas of the brain.
How to treat Migraines in children?
Answer: A healthy lifestyle with enough sleep, a proper diet, physical activities are good enough to treat migraines in children. But in need, pain killers, Triptans are better choices.
Is there any cure for Migraine Headaches?
Answer: There is no cure for migraines except for preventing it from attacking you.
What is the medication strategy of migraine for pregnant women?
Answer: Avoid medication during pregnancy as much as possible, try to figure out the underlying triggers for migraines, and avoid them. In case of need, anti-inflammatory or Triptans may be given under the prescription of your doctor.
What causes migraines in females?
Answer: About three out of four people if they are migraine patients, then they are women. Migraines are common in women between the ages of 22 and 55. Women tend to report more painful and longer-lasting headaches and more symptoms, such as nausea and vomiting. These factors make it hard for a woman to fulfill her roles at work and at home when a migraine strikes.