Migraine : Symptoms, Causes, Diagnosis, Management and Prevention

Migraine : Symptoms, Causes, Diagnosis, Management and Prevention

Migraine is a  neurological disorder often described as intense pulsing or throbbing pain in one area of the head. Typically the headache is unilateral (affecting one half of the head) and pulsating in nature, lasting from 2 to 72 hours.

Migraines are believed to be due to a mixture of environmental and genetic factors . Migraines typically present with self-limited, recurrent severe headache associated with autonomic symptoms.

Symptoms:

Symptoms of migraine can be divided into stages. There are five distinct stages of migraine, though not everyone goes through all the stages:

‘Prodromal’ (pre-headache) stage: Some people experience changes in mood, energy levels, behaviour and appetite, and sometimes aches and pains several hours or days before an attack.
Aura: Some people experience a sensation, or aura, just before their migraine starts. Symptoms of aura include flashes of light or blind spots, difficulty focusing, and seeing things as if they are looking through a broken mirror. This stage normally lasts around 15 minutes to an hour.
Headache stage: This is usually a pulsating or throbbing pain on one side of the head. It is associated with nausea or vomiting, and extreme sensitivity to bright light and loud sounds, with a strong desire to lie down in a darkened room. This stage lasts for four to 72 hours.
Resolution stage: Most attacks gradually fade away. Some people find the headache stops suddenly after they have been sick. Sleep often relieves the symptoms.
‘Postdromal’ or recovery phase: There may be a stage of exhaustion and weakness afterwards. Other symptoms can also occur during a migraine. These include:

Poor concentration
Sweating
Feeling very hot or very cold
Abdominal pain
A frequent need to urinate

Causes:

Exact cause of migraine is still not known. Though various trigger factors are associated with physiological factors, such as:

Stress
Hunger
Fatigue

Other hormonal influences, such as menarche (First menstrual cycle), oral contraceptive use, pregnancy, peri menopause and menopause, also play an important role. These hormonal influences seem to play a greater role in migraine without aura.

Dietary triggers include:

Eating less food (dieting)
Delayed or irregular meals
Dehydration
Alcohol
Food containing high content of tyramine (for instance: dairy,meat,poultry and fish products)
Caffeine products, such as tea and coffee
Specific foods such as chocolate, citrus fruit or cheese

Environmental factors include:

Bright light
Smoke
Crowded atmosphere
Loud noise
Changes in climate, such as changes in humidity or very cold temperature
Flickering screen on television or computer screen

Diagnosis:

The diagnosis of migraine is based on signs and symptoms.
Imaging tests are occasionally performed to exclude other causes of headaches.

Management:

There is currently no cure for migraines. Pain killers like paracetamol and aspirin are very effective to combat migraine.Triptans such as sumatriptan (imitrex), rizatriptan (maxalt) are also effective in relieving the pain and other symptoms that are associated with migraines.

Prevention:

Avoid triggers such as dietary as well as environmental triggers.
Exercise regularly as it helps in managing stress and thus can help prevent migraines.
If woman has migraine and estrogen seems to trigger or make headache worse, then medication containing estrogen should be avoided.

References:

www.who.int
www.nhs.uk
www.nlm.nih.gov
www.ninds.nih.gov

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