A migraine is a headache that often affects one side of the head and may be very painful, throbbing, or pulsating. It often comes with high sensitivity to light and sound as well as nausea and vomiting. The pain from a migraine episode may be so intense that it interferes with your regular activities and can persist for hours or even days.

A warning sign known as an “aura” may appear before or concurrently with the headache in some people. Auras may include speech difficulties, tingling on one side of the face or in an arm or leg, as well as vision problems like light flashes or blind patches.

Some migraines may be prevented and made less painful with medication. The correct medications, together with self-help techniques and lifestyle modifications, may be helpful.

Symptoms

Children and teens may also have migraines, which can develop through four stages: prodrome, aura, attack, and post-drome. Not every migraine sufferer experiences each stage.

Post-drome

You may detect little alterations one or two days before to a migraine that indicate an impending migraine, such as:

  • Constipation
  • mood swings between joy and despair
  • Hunger pangs
  • Neck discomfort
  • more frequent urination
  • Retention of fluid
  • often yawning

Aura

Auras may happen before or during migraines for certain individuals. Auras are temporary nervous system symptoms. The majority of them are visual, but they may also include other disruptions. Each symptom often starts off mildly, intensifies over a few minutes, and lasts for up to 60 minutes.

Auras associated with migraines include:

  • Visual phenomena include the perception of different forms, bright spots, or light bursts
  • Loss of vision.
  • Feelings of pins and needles in the arm or leg
  • Weakness or numbness on one side of the body, the face, or both.
  • Speaking is challenging.

Attack

If left untreated, a migraine often lasts 4 to 72 hours. Each person experiences migraines differently. Migraines might hit seldom or often each month.

Symptoms of a migraine include:

Pain often on both sides of your head but typically on one side.

A throbbing or pulsing pain

sensitivity to scent, touch, and sometimes light and sound

nausea and diarrhoea

Post-drome

You can have post-migraine drowsiness, confusion, and fatigue for up to a day. Some individuals claim to feel happy. A sudden head movement might momentarily reactivate the discomfort.

When to consult a doctor

Frequently, migraines go unidentified and untreated. If you often have migraine symptoms, maintain a log of your attacks and the medications you used to manage them. Then schedule a consultation with your doctor to talk about your headaches.

If your headache pattern changes or they start to feel different all of a sudden, even if you have a history of headaches, consult your doctor.

If you have any of the following indications of a more severe medical condition, see your doctor right away or visit the emergency room:

  • a sharp, sudden headache that feels like a thunderclap
  • Symptoms of a stroke include a headache accompanied by fever, stiff neck, disorientation, convulsions, double vision, numbness or paralysis in any area of the body, and seizures.
  • after a head injury, headache
  • a persistent headache that becomes worse when you cough, work out, strain, or make an abrupt movement
  • Around the age of 50, a new headache

Causes

Although the exact causes of migraines are still not known, genetics and environmental factors seem to be involved.

A significant pain route, the trigeminal nerve, and its interactions with the brainstem may play a role. The same may be said for chemical imbalances in the brain, such as serotonin, which helps your nervous system control pain.

There are several factors that might cause migraines, such as:

Hormonal changes in women: Many women tend to have headaches when their estrogen levels fluctuate, such as before or during menstrual periods, during pregnancy, or throughout menopause.

Oral contraceptives are one example of a hormonal medicine that might make migraines worse. However, some women find that using these drugs reduces the frequency of their migraine attacks.

Drinks. A lot of alcohol, particularly wine, and coffee, which is high in caffeine, are examples of these.

Stress. Migraines may be triggered by stress at work or home.

Sensory arousal. Loud noises and bright or flashing lights may also cause migraines. Some individuals have migraines when they are exposed to strong scents like perfume, paint thinner, secondhand smoke, and others.

Foods. Migraines may be brought on by aged cheeses, salty meals, and processed foods. As well as missing meals.

additions in food. These include the food preservative monosodium glutamate (MSG) and the artificial sweetener aspartame.

Sleep modifies. For certain individuals, sleep deprivation or excessive sleep may cause migraines.

Physical elements. Migraines may be brought on by vigorous physical activity, including sexual activity.

The weather shifts. A migraine may be brought on by a change in the weather or barometric pressure.

Medications. Vasodilators like nitroglycerin and oral contraceptives may make migraines worse

Risk factors

You are more likely to get migraines due to a number of reasons, including:

Family background. If you have a family member who does, you have a high likelihood of getting migraines.

Age. Although they may start at any age, adolescents are often the first to experience migraines. The frequency and severity of migraines tend to peak in your 30s and progressively decline over the next decades.

Sex. Migraines are three times more common in women than in men.

Hormonal adjustments. Migraine sufferers may have headaches that start either before or soon after the start of their period. Additionally, they could change with menopause or pregnancy. Following menopause, migraines usually get better.

Complications

Overusing painkillers might result in severe headaches from pharmaceutical misuse. Combinations of aspirin, acetaminophen, and caffeine seem to carry the greatest risk. If you use aspirin or ibuprofen (Advil, Motrin IB, etc.) for more than 14 days in a month or triptans, such as sumatriptan (Imitrex, Tosymra), rizatriptan (Maxalt, Maxalt-MLT), for more than nine days in a month, headaches may also result from overuse.

When drugs cease reducing pain and start to induce headaches, medication-overuse headaches result. Following that, you take additional painkillers, which keeps the cycle going.

A headache specialist (neurologist) will likely make the diagnosis of migraines if you have migraines or a family history of migraines based on your medical history, your symptoms, and a physical and neurological examination.

The following tests to rule out alternative reasons of your pain might be performed if your condition is rare, complicated, or suddenly becomes severe:

imaging with magnetic resonance (MRI). A strong magnetic field and radio waves are used in an MRI scan to provide precise pictures of the brain and blood arteries. MRI scans assist physicians in the diagnosis of cancers, strokes, brain hemorrhages, infections, and other neurological diseases affecting the brain and nervous system.

A CT scan (computerized tomography). A CT scan uses a sequence of X-rays to produce an extensive cross-sectional picture of the brain. This aids medical professionals in identifying tumors, infections, brain injury, brain hemorrhage, and other conditions that might be causing headaches.

Diagnosing Migraine

A neurologist would likely diagnose migraines based on your medical history, symptoms, and physical and neurological testing.

Tests to rule out alternative causes of pain may include:

M.R.I. (Magnetic resonance imaging). A strong magnetic field and radio waves provide comprehensive pictures of the brain and blood arteries. MRIs assist identify cancers, strokes, brain hemorrhage, infections, and other neurological diseases.

CT scanning. CT scans employ X-rays to produce cross-sectional brain pictures. This helps physicians detect tumors, infections, brain injury, and brain hemorrhage as headache causes.


Treatment 

Migraine medication stops symptoms and prevents future episodes.

Migraine drugs abound. Two types of migraine medications exist:

Painkillers. These medicines are given during migraine episodes to stop symptoms

Your treatment options depend on the frequency, intensity, nausea, disability, and other medical problems of your headaches.

Painkillers


Migraine mand edications function best when given as soon as symptoms appear. Treatments include:NSAIDs. Pain treatments include aspirin or ibuprofen (Advil, Motrin IB, others). Overuse may produce medication-overuse headaches, ulcers, and GI bleeding.Combination migraine drugs (Excedrin Migraine) may assist with mild migraine discomfort.Triptans. Sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) inhibit brain pain pathways to treat migraines. They may alleviate migraine symptoms as tablets, injections, or nasal sprays. They may be unsafe for stroke or heart attack patients.DHE (D.H.E. 45, Migranal)LASMIDTAN (Reyvow). Ubrogepant. (Ubrelvy). Anti-CGRP. Ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) are oral CGRP antagonists licensed for treating acute migraine in adults. Antiemetics.

These drugs aren’t safe during pregnancy. If you’re pregnant or trying to conceive, see your doctor before using any of these drugs.

Preventive medications

  • Antihypertensives. These include propranolol (Inderal, InnoPran XL) and metoprolol tartrate (Lopressor). Verapamil (Verelan) helps prevent migraines with an aura.
  • Antidepressants. Amitriptyline prevents migraines. Other antidepressants may be recommended because of amitriptyline’s drowsiness.
  • Anticonvulsants. Valproate and topiramate (Topamax, Qudexy XR) may help with less frequent headaches but might cause dizziness, weight changes, nausea, and more. These drugs aren’t safe for pregnant or trying-to-conceive women.
  • Botox. Botox prevent migraines in some individuals.
  • Anti-CGRP monoclonals. Erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy), galcanezumab-gnlm (Emgality), and eptinezumab-jjmr (Vyepti) are novel migraine medicines. Injections are monthly or quarterly. Injection site reactions are frequent.

Consult your doctor about these drugs. These drugs aren’t safe during pregnancy. If you’re pregnant or trying to conceive, see your doctor before using any of these drugs.

Lifestyle and home remedies

When symptoms of migraine start, try heading to a quiet, darkened room. Close your eyes and rest or take a nap. Place a cool cloth or ice pack wrapped in a towel or cloth on your forehead and drink lots of water.

These practices might also soothe migraine pain:

Try relaxation techniques. Biofeedback and other forms of relaxation training teach you ways to deal with stressful situations, which might help reduce the number of migraines you have.

Develop a sleeping and eating routine. Avoid getting too little or too much sleep. Establish and stick to a daily schedule for your sleep and wake times. Try to eat meals at the same time every day.

Drink plenty of fluids. Staying hydrated, particularly with water, might help.

Keeping a headache diary. You can find out more about what causes your migraines and the best treatments by keeping a headache diary where you can record your symptoms. Additionally, it will help your doctor make a diagnosis and monitor your progress in between visits.

Regular exercise Regular aerobic exercise reduces tension and can help prevent a migraine. Choose an aerobic activity you enjoy, such as walking, swimming, or cycling, if your doctor approves. Warm up slowly, however, because sudden, intense exercise can cause headaches.

Regular exercise can also help you lose weight or maintain healthy body weight, and obesity is thought to be a factor in migraines.

Chronic migraine pain might benefit from non-traditional therapies.

Acupuncture. Clinical trials have found that acupuncture may be helpful for headache pain. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points.

Biofeedback. Biofeedback appears to be effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.

Cognitive behavioral therapy. Cognitive behavioral therapy may benefit some people with migraines. You will learn how your actions and thoughts impact how you experience pain through this type of psychotherapy.

Yoga and meditation. Stress, a known migraine trigger, might be reduced through meditation. Regular yoga practice may lessen the frequency and length of migraine attacks.

vitamins, minerals, and herbs. There is some evidence that the herbs feverfew and butterbur might prevent migraines or reduce their severity, though study results are mixed. Butterbur isn’t recommended because of safety concerns.

A high dose of riboflavin (vitamin B-2) may reduce the frequency and severity of headaches. Supplements containing coenzyme Q10 may reduce migraine frequency, but larger studies are required.

Magnesium supplements have been used to treat migraines, but with mixed results.

Ask your doctor if these treatments are right for you. If you’re pregnant, don’t use any of these treatments without first talking with your doctor.

References:

https://www.healthline.com/health/migraine/er-for-a-migraine#takeaway

https://www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/drc-20360207