Migraine is much more than just a headache. It is a complex neurological disorder that affects millions of people around the world. It is characterized by a throbbing pain, usually on one side of the head, which can vary in intensity from moderate to severe.
Migraine is a type of primary headache, meaning it is not caused by another medical condition. It is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. These distinctive symptoms help differentiate it from other types of headaches, such as tension headaches, which are usually a pressing pain on both sides of the head.
Migraine significantly affects the patient’s quality of life, limiting their daily activities, work capacity, and overall well-being.
Migraine symptoms
Migraine symptoms can vary greatly and affect each person differently. Some individuals experience symptoms prior to a headache, known as prodromes, which may include mood changes, food cravings, excessive yawning, and neck stiffness. The most common symptoms are described below:
Throbbing headache:
usually on one side of the head.
Nausea and vomiting.
Sensitivity to light and sound:
(photophobia and phonophobia).
Aura (in some cases):
approximately one third of people with migraine experience aura, which are visual disturbances, such as flashes of light, blind spots, or zigzag lines, or other neurological symptoms, such as numbness or tingling, that precede or accompany the headache.
Causes of migraine
Although the exact cause of migraine is not fully understood, it is believed to result from a combination of genetic and environmental factors. Changes in levels of serotonin, a brain chemical, may also be involved.
Various factors can influence the predisposition to suffer from migraine, increasing the likelihood of experiencing these headache episodes. Some of these factors are modifiable, while others are not. Risk factors for migraine include:
Family history of migraine.
Female sex.
Hormonal changes in women.
Stress.
Lack of sleep or changes in sleep patterns.
Exposure to bright lights, strong smells, or loud noises.
Changes in the weather or air pressure.
Consumption of certain foods or beverages.
Skipping meals.
Smoking.
Complications of migraine
While migraine itself is not a life-threatening condition, it can significantly affect quality of life and, in some cases, may be associated with other complications. It is essential to seek medical attention if migraines interfere with your daily life.
Chronic migraine: people who experience headaches for 15 days or more per month may have chronic migraine.
Migrainous infarction: in rare cases, migraine can cause a migrainous infarcion, a type of stroke that can cause permanent brain damage.
Status migrainosus: status migrainosus is a severe migraine that lasts more than 72 hours and often requires hospitalization.
It’s important to seek medical advice if you suspect you may be suffering from migraines, especially if they are frequent, severe, or interfere with your daily life.
Migraine diagnosis
The diagnosis of migraine is based primarily on the patient’s medical history, including the description of symptoms, the frequency and duration of headaches, and family history. A complete physical and neurological examination is also essential to rule out other possible causes of headache.
Detailed medical history: the doctor will ask you detailed questions about your symptoms, including the location, intensity, and quality of the pain (throbbing, pressing, stabbing), triggers, associated symptoms (nausea, vomiting, sensitivity to light and sound), and the duration and frequency of headaches. They will also ask about your personal and family medical history.
Physical and neurological examination: the doctor will perform a complete physical examination and a neurological examination to assess your brain function, including cranial nerve function, muscle strength, coordination, reflexes, and sensation.
Headache diary: keeping a headache diary helps identify patterns, triggers, and the effectiveness of treatment. The goal is to record information about your headaches, including the date and time of onset, duration, intensity, location, associated symptoms, possible triggers, and response to treatment.
Imaging tests: in some cases, imaging tests such as a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan of the head may be performed to rule out other conditions. The decision to perform imaging tests is based on the medical history, physical examination, and the presence of warning signs.
Other tests: in rare cases, other tests, such as an electroencephalogram (EEG) or a lumbar puncture, may be performed to rule out other conditions.
Treatments for migraine
Migraine treatment focuses on two main goals: relieving pain and discomfort during an acute attack and preventing the occurrence of future migraines. The specific treatment plan is tailored to each individual, taking into account the frequency, intensity, and impact of migraines on their daily life.
Treatment for the relief of a migraine attack:
among the options for relieving a migraine attack are over-the-counter pain relievers. These can be effective for mild migraines, but it is important to follow the dosage instructions and not exceed the recommended dose. NSAIDs (nonsteroidal anti-inflammatory drugs) are similar to over-the-counter pain relievers and also help reduce inflammation that can contribute to migraine pain. Triptans are medications specifically designed to treat migraines. They act on serotonin receptors in the brain and can be very effective in relieving pain and other symptoms such as nausea and sensitivity to light and sound. They are available in different formats, including tablets, pills, nasal sprays, and injections. Another option for people who cannot take triptans or for whom triptans are ineffective are ergot alkaloids. However, these can have more side effects. Antiemetics can help control nausea and vomiting, common symptoms of migraine, and make migraine more tolerable. In cases of severe migraines that do not respond to other treatments, opioids or corticosteroids can be used. However, these medications are reserved for specific situations due to their potential for side effects and risk of dependence. Recently, some gepants have been introduced as a treatment for acute migraine attacks.
Treatment to prevent future migraines:
it is crucial to identify and avoid migraine triggers. These triggers can include certain foods (such as chocolate, aged cheese, and red wine), caffeinated beverages, stress, lack of sleep, hormonal changes, bright lights, and strong odors. Keeping a migraine diary can help identify specific patterns and triggers. Stress is a common trigger for migraines, so learning relaxation techniques such as meditation, yoga, deep breathing, and progressive muscle relaxation can help reduce stress and the frequency of migraines. Physiotherapy, especially focused on the neck and back, can help relieve muscle tension and improve posture, which in turn can reduce the frequency and intensity of migraines. There are medications such as beta-blockers, antidepressants and anticonvulsants that, although originally designed for other conditions, may be prescribed to prevent migraines. CGRP antagonists (gepants) and selective serotonin receptor agonists (ditans) are newer medications specifically developed to prevent migraines. Injections of botulinum toxin, commonly known as Botox, may be an option for people with chronic migraines (15 or more days a month with headache). In addition to the treatments mentioned above, a new class of medications has emerged in the field of migraine treatment: monoclonal antibodies. These medications, also known as anti-CGRP monoclonal therapies, are designed to prevent migraines before they start.
Migraine treatment often involves a multidisciplinary approach, with the involvement of neurologists, physiotherapists, psychologists, and other healthcare professionals.
Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect you have migraine, consult a specialist to obtain an accurate diagnosis and an appropriate treatment plan tailored to your needs.
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