Overview
A migraine is an intense headache that causes a throbbing or pulsing pain, typically on one side of the head. This neurological condition is often accompanied by symptoms like nausea, vomiting, and heightened sensitivity to light and sound. The severity of migraine attacks can disrupt daily activities, sometimes confining individuals to bed for days.
Associated Anatomy
The brain is primarily involved in migraine episodes.
Causes of Migraine
The exact cause of migraines is not fully understood, but they are believed to be linked to genetics and brain function. Migraines may run in families, suggesting a genetic component.
Current research indicates that migraines begin when the trigeminal nerve is triggered by signals from overactive nerve cells. This activation leads to sensations in the face and head and triggers the release of certain chemicals, such as calcitonin gene-related peptide (CGRP) and serotonin. CGRP causes blood vessels in the brain's lining to swell, leading to pain and inflammation.
Symptoms of Migraine
Migraine symptoms can last from a few hours to several days. Since migraines often occur in stages, the symptoms may vary at each stage.
Common Symptoms:
- Sensitivity to light, sound, and smells
- Nausea and vomiting
- Loss of appetite
- Fatigue
- Blurred vision
- Scalp tenderness
- Fever (rare)
- Diarrhea (rare)
Prodrome Symptoms (before the migraine):
- Irritability
- Depression
- Difficulty concentrating
- Fatigue
- Muscle stiffness
- Sensitivity to light and sound
- Food cravings
- Increased urination
Aura Symptoms:
- Visual disturbances (blurry spots, lines, or sparkles)
- Speech changes
- Numbness or tingling
- Weakness on one side of the body
Headache Symptoms:
- Throbbing pain that worsens with physical activity
- Neck stiffness or pain
- Dizziness
- Anxiety
- Insomnia
- Sensitivity to smells, light, and sound
Postdrome Symptoms (after the migraine):
- Fatigue
- Confusion
- Mood swings
- Inability to concentrate
Stages of Migraine
Migraines often progress through four stages, though not everyone experiences all of them:
- Prodrome: Subtle changes like mood swings or food cravings may occur a day or two before a migraine.
- Aura: Some people experience visual or sensory disturbances before or during the migraine.
- Attack: The migraine begins as a mild ache and can develop into severe, throbbing pain.
- Postdrome: After the headache subsides, feelings of confusion or exhaustion may linger.
Diagnosis of Migraine
Migraines are diagnosed based on a combination of family history, medical history, symptoms, and a neurological examination. If your doctor detects any unusual patterns, additional tests like MRI or CT scans may be recommended to rule out other conditions such as tumors, strokes, or infections.
Treatment of Migraine
While migraines cannot be completely cured, treatment focuses on preventing future attacks and managing symptoms. Treatment options include:
- Pain Relievers: Over-the-counter or prescription painkillers, such as ibuprofen or aspirin, may be effective for mild migraines.
- Triptans: Drugs like rizatriptan and sumatriptan block pain pathways in the brain and are commonly used in migraine treatment.
- Dihydroergotamine: This medication, administered as an injection or nasal spray, is effective if taken when symptoms first appear.
- Lasmiditan: An oral medication that can relieve headaches but may cause dizziness.
- CGRP Antagonists: These drugs target specific migraine symptoms like pain, nausea, and sensitivity to light and sound.
- Opioid Medications: These are used as a last resort due to their addictive nature.
- Anti-Nausea Drugs: Medications like metoclopramide can help with nausea and vomiting associated with migraines.
- Alternative Treatments: Techniques such as meditation, acupuncture, yoga, or cognitive behavioral therapy may help manage migraine symptoms.
- Neuromodulation Devices: These devices target the trigeminal and vagus nerves to provide relief.
Risk Factors for Migraine
Several factors can increase the likelihood of developing migraines:
- Family History: A family history of migraines increases the risk.
- Age: Migraines can occur at any age but often begin in adolescence and peak in the 30s.
- Gender: Women are three times more likely to experience migraines than men.
- Hormonal Changes: Women may experience migraines in relation to their menstrual cycle, pregnancy, or menopause.
Prevention of Migraine
Although primary prevention is challenging due to the unknown cause, secondary preventive measures can reduce the frequency and severity of migraines. These include:
- Blood pressure-lowering medications
- Antidepressants
- Anti-seizure drugs
- Botox injections
- CGRP monoclonal antibodies
Complications of Migraine
Overuse of medication is a significant complication for those with migraines. Medications like acetaminophen, aspirin, and caffeine-containing drugs carry a high risk of overuse.
Epidemiology of Migraine
Migraines affect people of all ages, with the highest prevalence observed in individuals in their 30s. Women are three times more likely than men to suffer from migraines.
Prognosis of Migraine
Migraine management varies from person to person. Following medical advice, managing symptoms, avoiding triggers, and practicing preventive measures can help achieve the best outcomes.
Natural Progression of Migraine
If left untreated, migraines can lead to complications such as depression, anxiety, panic disorders, and even cardiovascular diseases like stroke and hypertension.
Pathophysiology of Migraine
Migraines are primarily neurovascular headaches caused by disturbances in sensory processing. During a migraine attack, blood vessels in the brain dilate, leading to increased nerve activation and pain.
