Migraine – Causes, Symptoms, Treatment

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Overview

Migraine is defined as an intense headache (cephalalgia), lasting between 4 to 72 hours and has recurrent character (it repeats). A person who has migraines, can not perform normal daily activities (routine). Although migraines are uncomfortable and interfere with the normal life, they do not produce long-term damage. Migraines can be considered a disease that must be treated as such. The specialist consultation is important, because the doctor may recommend different medications that can alleviate the intense cephalalgia associated with headaches.

Article Contents:

Overview

Causes

Symptoms

Evolution

Risk Factors

Specialist Consultation

Watchful waiting

Recommended specialists

Treatment – Overview

Initial treatment

Treatment if the disease worsens

Outpatient Treatment

Surgical treatment

Other treatments


Causes

- family aggregation (genetic transmission), was shown in the case of migraines. However, no one knows exactly why some people are more prone to headaches than others

- Expansion or narrowing of cerebral vessels (aneurysms, vascular stenosis respectively), which can cause intense headache secondary to the various chemical modifications at this level (the chemical changes can cause inflammation, swelling and pain)


Symptoms

The symptoms of migraine can vary from case to case, often being preceded by some warning signs (aura). The characteristic symptoms of aura appear usually about 30 minutes before the migraine attack itself and they are characterized by headache that increases in intensity and visual disturbances (patient sees blackheads or perceives intense light flashes). Some persons signal a numbness or tingling in the arms, hands or face during the aura. However, most people do not have an aura before a migraine.

The most common symptoms of migraine include:

- Throbbing headache on one side of the skull (hemicrania continua)

- Moderately severe headache

- Increased headache when doing routine physical activity

- Nausea, vomiting

- Sensitivity to light (photophobia) or noise, sometimes even to certain scents.

There are several types of headaches, each one with its unique features. For example, some women get migraines before menstruation (PMS). It is quite difficult to distinguish migraines from other types of headaches. Sinus headache is similar to that of migraine. Migraines are different from other types of headaches because they occur on one side of the head (hemicrania continua), namely on the right or on the left side, but it can vary from one episode to another. Migraines are often accompanied by photophobia and sensitivity to noise. Migraines can also occur in the context of other diseases such as asthma or depression. Other more serious diseases such as tumors or cerebral infections can have symptoms similar to that of migraines. Headaches that are caused by other serious health problems are relatively rare.


Evolution

Symptoms that occur before migraine (prodrome)

A day or two before the appearance of migraine, the person may report different symptoms such as, marked fatigue, drowsiness, selective appetite for certain aliments (e.g. chocolate), irritability and psychomotor agitation.

Aura

30% percent of those who suffer from migraine, show before the migraine headache some warning signs, called medically aura. the characteristic symptoms of aura are developed in between 5 and 20 minutes and are characterized by the appearance of visual disorders such as intense light flashes, dark, black spots, a feeling of distorted images. Sensory disturbances (numbness, tingling) in the hands, arms or face may also occur.

In rare cases the patient can not describe in words the sensations experienced, sometimes a sudden weakness on one side of the body being formed. If new symptoms appear along with the migraine, which were not reported by the patient before, it’s important that he should seek emergency specialist medical help in order to rule out other (serious) diseases that can have similar symptoms (ischemic transient stroke or ischemic or hemorrhagic stroke, itself).

Migraine attack

Usually after a period of 30 minutes after the onset of the aura, the migraine itself appears. Without treatment, it can last between 4 and 72 hours. The headache appears on one side of the head (hemicrania continua),very often behind the orbit, although pain can change location and move to the other side of the head or to generalize on both sides. Pain can vary in intensity from mild to severe, sometimes can be agonizing, debilitating.

Other symptoms that may accompany the headache, are:

- Increased sensitivity to light (photophobia) or other stimuli (auditory or olfactory)

- Nausea, vomiting

- Accentuated symptoms while performing normal daily activities.

Quite rarely, speech problems (dysarthria), tingling of the face, hands, shoulders or weakness installed on one side of the body (hemiplegia) were reported.

Symptoms appeared after the migraine attack (postdrome)

With the reduction and disappearance of secondary symptoms of migraine, there may appear some symptoms such as pain or cramps, fatigue (tiredness) or sometimes short periods of revelation. These symptoms can last up to 24 hours after the migraine headache finished.


Risk Factors

People with these characteristics are more likely to develop migraines:

- Family history of migraines;

- Women. Women are at a risk of developing migraines 3 times higher than men;

- Teenagers and young adults, migraine occurring most often in these age categories;

- Diseases such as depression, anxious depressive syndrome, asthma or epilepsy.


Consult a specialist

The following directions are recommended to people who suspect that they might have a migraine.

Call the emergency services (ambulance or hospital emergency reception units), if you experience:

- Intense, atrocious, often paroxysmal (sudden onset) headache, different from other previous episodes or one which seems inconsistent;

- Numbness, paralysis or weakness appeared on the face, limbs, especially on one side of the body (hemiplegia);

- Sudden dizziness, inability to walk normally or maintain upright (vertical position of the body);

- Sudden visual disturbances;

- Speech problems (dysarthria) or mental confusion (obnubilation)

- Difficulties in walking or maintaining your balance and ortostatism.

Consult your doctor for specialist medical advice or call the hospital emergency service, if the following occurs:

- Fever and neck stiffness (neck muscles are stiffened);

- Nausea and vomiting with inability to ingest liquids;

- Headache that does not diminish in 24 hours.

Carefully monitor the symptoms and perform a medical specialist consultation if the following occurs:

- Headache that does diminish 1-2 days after the onset or wakes the patient up at night (nocturnal headache);

- Headache worsens or recurs (repetitive) more and more frequently in small intervals of time;

- Appearance of new symptoms;

- Problems related to medication are suspected;

- Headache relapsed , at an age of more than 50 years;

- Headache appeared after physical activity (even after sexual activity), after coughing or sneezing;

- Symptoms are powerful enough to disrupt routine physical activity (e.g. absence from school or work).

Watchful waiting

Watchful waiting is the time when the doctor notices the evolution of the symptoms or of the disease  without giving any treatment. This approach is recommended to newly diagnosed patients who are using a range of drugs in order to reduce the intensity and frequency of the attacks.


Recommended specialists

Specialists who can diagnose and treat migraine are:

- GP

- Generalist doctor

- Doctor of internal medicine

- Neurologist.

It is recommended to consult a specialist in treating migraine, especially if the headache does not diminish and disappear while treating it. In the case of children complaining of headaches, it is very important to call a pediatrician with experience in treating such diseases (most common pediatric neurologist). It is also important to know that medical studies for using antimigraine medication to children are quite limited.

If there is a suspicion that migraine is in relationship with a mental illness such as depression or anxiety, a psychiatric or psychological expert is recommended in order to prescribe of a proper treatment.


Treatment – Overview

There is no cure for migraines, but various treatments can be performed in order to reduce intensity and frequency of migraine attacks. There are several types of drugs that are used to prevent and treat migraine recurrence. There is evidence that chronic administration of aspirin and an antiemetic drug ( which reduce nausea and vomiting), such as metoclopramide (Reglan), can reduce symptoms associated with migraine.

Another way to reduce the number of migraine attacks is avoiding the risk factors that can trigger migraine attacks, such as the consumption of red wine or excessive or, on the contrary, insufficient sleep.

 


Initial treatment

To relieve the symptoms associated with migraines, common drugs that can be purchased by the patient without the need for a medical prescription, such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory (aspirin, ibuprofen, naproxen) can be used initially. Most experts recommend using NSAIDs, initially, before using other medicines that may have more side effects.

The initial treatment of migraine depends on the severity and frequency of the symptoms and the frequency of the migraine attacks. As a result, drugs that reduce symptoms and medication to prevent recurrent attacks are used.

The drugs that are most commonly used in order to treat migraine are:

- the agonists of serotonin receptor (triptans) are drugs that are used when trying rapid reduction of headache

- Ergotamine derivatives, such as Cafergot, are also used to treat migraines but they are not as effective as triptans

- Midrin is a combination drug of isometheptene, acetaminophen and dichlorphenol

- Nonsteroidal anti-inflammatories (NSAID) like aspirin, can be bought without prescription.

The most common medicines used to prevent migraine attacks are:

- Beta-blockers which cause the relaxation of the vascular muscles

- Calcium channel blockers that reduce vasoconstriction (narrowing of blood vessels)

- Antidepressant medications, like tricyclic antidepressants or amitriptyline are also useful in preventing migraine attacks

- Anticonvulsants, such as topiramate which was recently approved by the pharmaceutical associations as antimigraine medication.

Some medical studies have shown that the inhibitors of the angiotensin converting enzyme (ACE) and angiotensin receptors blockers, reduce frequency of migraine attacks. However, many clinical studies are needed in order to prove this.

The antiemetic medication (which reduces nausea and vomiting), like Compazine or Reglan, is often prescribed with other drugs that can effectively control these symptoms.

Some drugs based on triptans are used by women with premenstrual migraines. A recent medical study showed that women with premenstrual migraines take frovatriptan (Frova) for 6 days (beginning two days before menstruation). Frovatriptan is a drug used to treat intense, persistent headache. Another medical study showed that naratriptan can prevent migraine attacks that occur before menstruation.

Complementary therapy may be associated with the initial treatment in order to reduce the number and intensity of migraine attacks. It is important that your doctor should be informed about the use of such therapies.

Acupuncture is a method that involves using fine needles which are inserted in the skin and which are designed to focus and direct the energy flow to vital organs. This can also relax muscles and reduce the headache.

Biofeedback is a relaxation method, during which the patient learns to control his body functions as well as the muscle tension.

The relaxation techniques, reduce stress and tension. Feverfew (chrysantemum parthenium) is an herb that can prevent migraine attacks. But more studies are needed to prove its effectiveness. Burdock (petasites officinalis) is also used to treat and prevent migraine attacks.

Treatment if the disease worsens

If symptoms of the migraine persist despite the treatment, it is recommended a medical reevaluation in order to establish a new medical treatment. If you have tried several regimens and symptoms remain persistent, additional investigations are needed, such as MRI or CT, so as to rule out other possible diseases that can cause similar symptoms.
 
It is possible that in some cases, the diagnosis of migraine might be a wrong one and confused with other causes of headache, which require another treatment.
 
To be retained!

Migraine attacks can be repeated even under appropriate medical treatment. The goal of the treatment is to reduce the number of migraine attacks and also to reduce their intensity by using effective drugs with fewer side effects. In the case of mild migraine headaches, medicines less powerful that can be bought without medical prescription  are used in the beginning. If symptoms persist or intensify, treatment strategy will be changed, and stronger medications will be used.
 
Finding the appropriate treatment for each person takes time and patience. Excessive use of analgesics or drugs which control headaches, can relapse (rebound). The headaches that relapse are different from the initial  ones and occur at the same time with the disappearance of the effect of the medication that was used, and requires a new administration. Over time, the headache will recur whenever the person in question will interrupt the treatment. Antimigraine medication should always be recommended by your doctor. If the recurrence of migraine attacks is associated with the presence of depression or anxiety, it is important that the doctors who treats you should be informed about it.


Outpatient Treatment

There are several ways by which you can control the symptoms associated with recurrent migraines. Remember the following methods that you can perform at home:
 
- Avoid stress and adequate psychological control

- Practise relaxation techniques that reduce stress and accentuated tension

- Administration of drugs used mainly in the prophylaxis of migraine attacks

- Identify the elements responsible for triggering migraines and avoid them as much as possible

- Call for expert medical help if some mental disorders like depression or anxiety (anxious depressive syndrome) are suspected.

Children headache is often related to the performance of certain daily activities (exams, physical exercises, stress) but it can also be associated with lack of sleep. The parents and the pediatrician should follow together the evolution of migraine in children and also closely monitor the drug therapy performed.


Medication options

The drugs that are most commonly used to treat migraine are:

- The agonists of serotonin receptors (triptans) are drugs that are used when trying rapid reduction of headache

- Ergotamine derivatives, such as Cafergot are also used to treat migraines but they are not as effective as triptans

- Midrin is a combination drug of isometheptene, acetaminophen and dichlorphenol

- Nonsteroidal anti-inflammatory (NSAID) like aspirin, can be bought without prescription.
 
The most common medicines used to prevent migraine attacks are:

- Beta-blockers which cause the relaxation of the vascular muscles

- Calcium channel blockers that reduce vasoconstriction (narrowing of blood vessels)

- Antidepressant medications, like tricyclic antidepressants or amitriptyline are also useful in preventing migraine attacks

- Anticonvulsants, such as topiramate which was recently approved by the pharmaceutical associations as antimigraine medication.

Some medical studies have shown that the inhibitors of the angiotensin converting enzyme (ACE) and angiotensin receptors blockers, reduce frequency of migraine attacks. However, many clinical studies are needed in order to prove this.
 
The antiemetic medication (which reduces nausea and vomiting), like Compazine or Reglan, is often prescribed with other drugs that can effectively control these symptoms.


Surgical treatment

There is no surgical treatment that can cure or alleviate migraine symptoms.


Other treatments

Complementary therapy may be associated with the initial treatment in order to reduce the number and intensity of migraine attacks. It is important that your doctor should be informed about the use of such therapies.

Acupuncture is a method that involves using fine needles which are inserted in the skin and which are designed to focus and direct the energy flow to vital organs. This can also relax muscles and reduce the headache.

Biofeedback is a relaxation method, during which the patient learns to control his body functions as well as the muscle tension.

The relaxation techniques, reduce stress and tension.

Feverfew (chrysantemum parthenium) is an herb that can prevent migraine attacks. But more studies are needed to prove its effectiveness.

Burdock (petasites officinalis) is also used to treat and prevent migraine attacks.

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