MIGRAINE HEADACHE

Dr. Tariq Jagnarine
Family Medicine, Endocrinology, Diabetes

Migraine is a neurological condition that can cause multiple symptoms. While intense, debilitating headaches frequently characterise it, additional symptoms may include:
• Nausea
• Vomiting
• Difficulty speaking
• Numbness, or tingling sensation
• Sensitivity to light and sound
The condition often runs in families, and can affect people of all ages. People assigned females at birth are more likely to be diagnosed with migraine than those assigned males. The diagnosis of migraine is determined based on clinical history, reported symptoms, and by ruling out other causes. The most common categories of migraine headaches (or attacks) are episodic versus chronic, and then those without aura and those with aura.

WHAT DOES A MIGRAINE FEEL LIKE?
People describe migraine pain as:
• Pulsating
• Throbbing
• Perforating
• Pounding
• Debilitating
It can also feel like a severe, dull, steady ache. The pain may start as mild, but, without treatment, it can become moderate to severe.
Migraine pain most commonly affects the forehead area. It’s usually on one side of the head, but it can occur on either side, or shift.
Most migraine attacks last about 4 hours. If they’re not treated, or don’t respond to treatment, they can last for as long as 72 hours, or even a week. In migraine with aura, pain may overlap with an aura, or may never occur at all.

Migraine symptoms
Migraine symptoms may begin 1 to 2 days before the headache itself. This is known as the prodrome stage. Symptoms during this stage can include:
• Food cravings
• Depression
• Fatigue, or low energy
• Frequent yawning
• Hyperactivity
• Irritability
• Neck stiffness
In migraine with aura, the aura occurs after the prodrome stage. During an aura, persons may have problems with their vision, sensation, movement, and speech. Examples of these problems include:
• Difficulty speaking clearly
• Feeling a prickling or tingling sensation in the face, arms, or legs
• Seeing shapes, light flashes, or bright spots
• Temporarily losing vision
The next phase is known as the attack phase. This is the most acute, or severest, of the phases, when the actual migraine pain occurs. In some people, this can overlap or occur during an aura. Attack phase symptoms can last for any length of time, from hours to days. Symptoms of migraine can vary from person to person.
Some symptoms may include:
• Increased sensitivity to light and sound
• Nausea
• Dizziness, or feeling faint
• Pain on one side of the head, either on the left side, right side, front, or back, or in the temples
• Pulsing and throbbing head pain
• Vomiting
After the attack phase, a person would often experience the postdrome phase. During this phase, there are usually changes in mood and feelings. These can range from feeling euphoric and extremely happy to feeling very fatigued and apathetic. A mild, dull headache may persist.
The length and intensity of these phases can occur to different degrees in different people. Sometimes a phase gets skipped, and a migraine attack may occur without causing a headache.

CAUSES OF MIGRAINE ATTACKS
Researchers haven’t identified a definitive cause of migraine. But they still believe the condition is due to “abnormal” brain activity that affects nerve signalling, and chemicals and blood vessels in the brain.

Many migraine triggers are continually reported, including:

• Bright lights
• Severe heat, or other extremes in weather
• Dehydration
• Changes in barometric pressure
• Hormone changes in people assigned female at birth, like estrogen and progesterone fluctuations during menstruation, pregnancy, or menopause
• Excess stress
• Loud sounds
• Intense physical activity
• Skipping meals
• Changes in sleep patterns
• Use of certain medications, like oral contraceptives or nitroglycerin
• Unusual smells
• Certain foods
• Smoking
• Alcohol use
• Travelling

MIGRAINE DIAGNOSIS
Doctors diagnose migraine by listening to a person’s symptoms, taking a thorough medical and family history, and performing a physical exam to rule out other potential causes.
Imaging scans, like a CT scan or MRI, can rule out other causes, including:
• Tumours
• Abnormal brain structures
• Stroke

MIGRAINE TREATMENT
Migraine can’t be cured, but doctors can help to manage migraine attacks by giving the tools to treat symptoms when they occur, which may lead to fewer attacks in general. Treatment can also help make migraine less severe.

A treatment plan may include a combination of:
• Lifestyle adjustments, including stress management and avoiding migraine triggers
• OTC pain or migraine medications, like nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol)
• Hormone therapy if migraines seem to occur about the menstrual cycle
• Counselling
• Alternative care, which may include meditation, acupressure, or acupuncture
Medication
Medications can be used to either prevent a migraine attack from happening, or treat it once it occurs. The severity of the migraine and any other health condition persons have would determine which treatment is right for them.
Acute medications — taken as soon as you suspect a migraine attack is coming — include:
• NSAIDs: These medications, like ibuprofen or aspirin, are typically used in mild-to-moderate attacks that don’t include nausea or vomiting.
• Triptans: These medications, like sumatriptan, eletriptan, and rizatriptan, are typically the first line of defence for individuals who have nerve pain as a symptom of their migraine attacks.
• Antiemetic: These medications, like metoclopramide, chlorpromazine, and prochlorperazine, are typically used with NSAIDs to help decrease nausea.
• Ergot alkaloids: These medications, like Migranal and Ergomar, aren’t prescribed that often, and are usually reserved for individuals who don’t respond to triptans or analgesics.
Preventative medications — prescribed to people whose migraine attacks can be debilitating, or happen more than four times a month — are taken once a day, or every 3 months via injection. These medications include:
• Antihypertensive: These drugs are prescribed for high blood pressure, and can also help with migraine attacks. Beta-blockers and angiotensin receptor blockers (losartan) are some examples of antihypertensive drugs used for migraine prevention.
• Anticonvulsants: Certain anti-seizure medications may also be able to prevent migraine attacks.
• Antidepressants: Some antidepressants, like amitriptyline and Fluoxetine, may also be able to prevent migraine attacks.
• Botox: Botox injections are administered to the head and neck muscles every 3 months.
• Calcitonin gene-related peptide treatments: These treatments are administered either via injection or through an IV, and work to prevent a migraine attack from developing.
Migraine prevention
Some options that may help to prevent a migraine attack.
• Learn the foods, smells, and situations that trigger migraine attacks, and avoid those things when possible.
• Stay hydrated. Dehydration can lead to both dizziness and headaches.
• Avoid skipping meals when possible.
• Focus on quality sleep. A good night’s sleep is important for overall health.
• Quit smoking.
• Make it a priority to reduce stress
• Invest time and energy in developing relaxation skills.
• Exercise regularly. Exercise has been linked to lowered stress levels.
Talk with a doctor about the best treatment for you and your specific type of migraine.