MIGRAINES

Migraines are characterised by a variety of symptoms that can range in severity and duration. These symptoms can be grouped into two main phases: the prodrome phase (pre-headache) and the headache phase. Here's a breakdown of some common migraine symptoms:

Prodrome Phase (Pre-Headache):

• Aura: Some individuals with migraines experience visual disturbances, such as flashing lights, zigzag lines, blind spots, or temporary vision loss. This is known as a migraine aura and typically occurs before the headache phase.

Headache Phase:

• Headache: Migraine headaches are often described as pulsating or throbbing and typically occur on one side of the head. They can last for several hours to several days.

• Nausea and Vomiting: Many people with migraines experience nausea and may vomit during a migraine attack.

• Sensitivity to Light (Photophobia): Bright lights, sunlight, and even indoor lighting can worsen migraine symptoms. People with migraines often prefer to be in a dark or dimly lit room during an attack.

• Sensitivity to Sounds (Phonophobia): Sounds or noise can exacerbate migraine pain and discomfort, making individuals more sensitive to even normal levels of sound.

• Sensitivity to Smells (Osmophobia): Certain odours or strong smells, like perfumes or cooking odours, can trigger or worsen migraine symptoms in some people.

• Numbness and Tingling: Some individuals may experience sensations of numbness, tingling, or weakness on one side of the body, face, or limbs. This can be part of the aura phase or occur without aura.

• Difficulty Speaking: Migraine attacks can lead to difficulty with speech or language, which is often temporary and reversible.

• Fatigue and Irritability: Migraine attacks can leave individuals feeling fatigued and irritable, even after the headache phase has subsided.

• Neck Pain: Neck pain or stiffness is a symptom that some people with migraines experience either during or after an attack.

The most common types of migraines include:

• Migraine without Aura (formerly known as Common Migraine): This is the most prevalent type of migraine, accounting for about 80-85% of all migraine cases. Individuals with this type of migraine experience moderate to severe headache pain without experiencing any specific warning signs or neurological symptoms before the onset of the headache.

• Migraine with Aura (formerly known as Classic Migraine): Migraine with aura accounts for about 15-20% of all migraines. This type of migraine is characterised by a warning phase known as an "aura," which can occur before or during the headache. 

• Chronic Migraine: Chronic migraine is diagnosed when an individual experiences migraine on 15 or more days per month, with at least 8 of those days being migraines with or without aura, for a minimum of three months. It is a subtype of migraine that can significantly impact daily life and requires specialised management.

• Menstrual Migraine: Menstrual migraines are migraines that occur in association with the menstrual cycle. They typically happen around the time of menstruation and are triggered by hormonal fluctuations.

• Hemiplegic Migraine: Hemiplegic migraine is a rare and severe subtype of migraine with aura. It is characterised by temporary motor weakness or paralysis on one side of the body (hemiparesis) during or after the aura phase.

• Vestibular Migraine: Vestibular migraine, also known as migrainous vertigo, is a type of migraine that primarily affects the balance and vestibular system, leading to symptoms like dizziness, vertigo, and difficulty with balance.

• Retinal Migraine: Retinal migraine is a rare type of migraine with aura that involves temporary vision loss or blindness in one eye. The vision disturbances are usually reversible and typically last less than an hour.

• Ophthalmoplegic Migraine: Ophthalmoplegic migraine is a rare type of migraine with symptoms of ocular nerve palsy, which can cause weakness or paralysis of eye muscles, resulting in double vision and drooping eyelids.

Migraines are a complex neurological condition with various factors contributing to their development. These factors include:

• Genetic Predisposition: Family history plays a significant role in migraines, and having a family member with migraines increases the risk.

• Neurological and Chemical Changes: Migraines involve changes in brain chemicals and nerve pathways, including alterations in serotonin levels and the trigeminal nerve system.

• Hormonal Fluctuations: Hormonal changes, especially in women, can trigger migraines, such as those related to the menstrual cycle, pregnancy, menopause, or hormonal contraceptives.

• Triggers: Certain triggers can set off migraine attacks, including specific foods, alcohol, bright lights, strong odours, weather changes, and more. Triggers vary among individuals.

• Stress: High stress levels and emotional factors can trigger migraines in some individuals, emphasising the importance of stress management.

• Sleep Patterns: Changes in sleep patterns, such as irregular sleep or insufficient sleep, can increase migraine risk.

• Environmental Factors: Environmental factors like extreme heat, bright or flickering lights, and loud noises may trigger migraines in susceptible individuals.

• Dehydration: Dehydration can lead to blood vessel dilation in the brain, potentially triggering migraines. Adequate hydration is essential.

• Physical Exertion: Strenuous physical exercise or activities can sometimes trigger migraines, particularly if a person is not adequately conditioned or hydrated.

• Food and Drink: Certain foods and beverages can act as migraine triggers for some individuals. Keeping a food diary can help identify specific triggers.

• Medication Overuse: Overusing certain medications, especially pain relievers like opioids and some headache medications, can lead to medication-overuse headaches, resembling migraines.

Medical treatment for migraines can involve both preventive measures and medications for pain relief. Here are some common medications used for migraine treatment:

• Pain Relievers (Analgesics): These are typically over-the-counter (OTC) medications used to relieve mild to moderate migraine pain. Examples include ibuprofen and aspirin. Prescription-strength versions may also be recommended by a healthcare provider.

• Triptans: Triptans are a class of prescription medications specifically designed to target migraines. They work by narrowing blood vessels and reducing inflammation in the brain. Examples include sumatriptan and rizatriptan.

• Lasmiditan: Lasmiditan is a newer medication approved for the acute treatment of migraines in adults. It works differently from triptans and doesn't constrict blood vessels. It can be used when triptans are not suitable or effective.

• Preventive Medications: These medications are prescribed to reduce the frequency and severity of migraine attacks, especially for individuals who have frequent or chronic migraines. Options include beta-blockers, antiepileptic drugs, tricyclic antidepressants, and others. The choice of preventive medication depends on the patient's specific situation and medical history.

• CGRP Monoclonal Antibodies: Calcitonin gene-related peptide (CGRP) monoclonal antibodies are a relatively new class of medications developed specifically for migraine prevention. They target CGRP, a neurotransmitter involved in migraine attacks. Examples include erenumab, fremanezumab, and galcanezumab.

• Nausea and Vomiting Medications: In cases where migraines are accompanied by severe nausea and vomiting, medications like metoclopramide or prochlorperazine may be prescribed to relieve these symptoms.

• Corticosteroids: In certain situations, such as when migraines are prolonged or severe, corticosteroids like prednisone may be prescribed as a short-term treatment to reduce inflammation and pain.

Natural approaches and lifestyle changes can be effective in managing migraines and reducing their frequency and severity. Here are some natural treatments and strategies to consider:

• Identify and Avoid Triggers: Keep a migraine diary to track potential triggers, such as certain foods, beverages, environmental factors, or stressors. Once identified, try to avoid or minimise exposure to these triggers.

• Hydration: Staying well-hydrated is essential. Dehydration can be a migraine trigger for some individuals. Drink plenty of water throughout the day.

• Regular Sleep: Maintain a consistent sleep schedule and ensure you get enough quality sleep each night. Sleep disturbances can contribute to migraine attacks.

• Stress Management: Practise relaxation techniques such as deep breathing, progressive muscle relaxation, mindfulness meditation, or yoga. Stress reduction can help prevent migraines.

• Regular Exercise: Engage in regular physical activity, such as aerobic exercises, walking, swimming, or yoga. Exercise can help reduce the frequency and intensity of migraines.

• Dietary Changes: Be mindful of your diet and consider avoiding common migraine trigger foods, which can include aged cheeses, chocolate, caffeine, artificial sweeteners, and processed foods. Maintaining stable blood sugar levels by eating regular meals and snacks can also be helpful.

• Acupuncture: Some people find relief from migraines through acupuncture, a traditional Chinese medicine practice that involves inserting thin needles into specific points on the body.

• Aromatherapy: Certain essential oils, such as lavender, peppermint, and eucalyptus, may provide migraine relief when used in aromatherapy or applied topically. Be sure to dilute essential oils properly before using them on the skin.

• Massage: Regular massages, especially targeting neck and shoulder muscles, can help relieve tension and reduce the likelihood of migraines.

• Biofeedback: Biofeedback is a technique that teaches individuals how to control physiological functions like heart rate, muscle tension, and skin temperature. It can be helpful in managing migraine triggers related to stress and tension.

• Herbal Remedies: Some herbal supplements like butterbur and feverfew have been studied for their potential in migraine prevention. Always consult with a healthcare provider before trying herbal remedies, as they can interact with medications or have side effects.

• Tai Chi: Tai chi is a mind-body practice that combines gentle movements and deep breathing. It can help reduce stress and improve overall well-being.

• Mindfulness-Based Stress Reduction (MBSR): MBSR programs teach mindfulness meditation and stress reduction techniques, which can be beneficial for migraine management.