Migraine is the second most common cause of headache in U.S and around the world. In U.S it affects around 15% of women and 6% of men. Women are likely to affected more from Migraine when compared to men, the affected rate is almost double.
Migraine headache is usually an episodic headache associated with certain features like sensitivity to light, sensitivity to sound or movement. Sometime patients suffers from nausea and vomiting accompanied by the headache.
Migraine Overview
Migraine is referred as neurological condition, in which individual suffers benign(soft) and recurring syndrome of headache associated with other symptoms of neurological dysfunction.
Brain of individual suffering from migraine is particularly sensitive to environmental and sensory stimuli (something that causes activity). Migraine headache can be initiated by various triggers like:-
- Glare
- Bright Lights
- Sounds
- Hunger
- Excess stress
- Physical exertion
- Stormy Weather or Barometric pressure changes.
- Hormonal fluctuations during mensuration cycle.
- Lack of or Excess sleep
- Alcohol and other chemical stimulation
Migraine conditions are often developed due to genetics. Genetics plays and important and vital role in migraine. which means migraine is often inherited in families. 60% of the people affected with migraine are because of their genes.
These genes are often responsible to make people more sensitive to environmental changes, lifestyle factors etc. to trigger migraine attack.
Role of Genes in Migraine
Single gene or mutation is unlikely to affect and cause migraine. The more chances are develop from several different genes and all coming together and increasing your chances to have migraine. However it is not compulsory to have migraine even if you have genes that increase your chances of migraine.
Migraine diagnosis is done by patient clinical history, symptoms reported, genetic, and by ruling out the migraine headache with other types of headache.
Common type of migraine headache are episodic versus chronic, headache with aura and without aura.
What is an Aura or Classical Migraine? How it is related to Migraine?
Aura can be considered as a migraine begin signal, in which individual suffers from group of sensory, motor and speech symptoms. These symptoms act like a warning signal for Migraine.
People often misinterpreted Aura with seizure or strokes. Aura typically begins before the headache starts but sometime in can even appear during the headache episodes or after. Person feels the sensory disturbance during Aura. Symptoms of Aura in individual are as follows:-
- Seeing flashes of lights, sparkling of lights or flashing light dots.
- Blind spots and other vision changes
- Numb or tingling in your hand, face or skin
Symptoms of Migraine
The most common and primary symptom of migraine is headache. The severity of pain can be high, moderate or low. when the severity of pain is high it feels like pounding or throbbing. The intensity of pain can be low in starting but can become worse if untreated.
Migraine headache pain usually starts from one side of head and shift to other side. Migraine headache pain may also affect the front of head, back of your head or it may affect your whole head.
Few individuals feel pain around eye or back side of eye, face or neck.
Basis on the studies, Migraine symptoms which are reported by the patients before migraine headache are listed below. Migraine symptoms can begin from 1 to 7 days before the actual headache starts
Migraine Symptoms:-
- Nausea
- Photophobia
- Lightheadedness
- Scalp tenderness
- Vomiting
- Visual Disturbance
- Photopsia
- Fortification Spectra
- Paresthesias
- Vertigo
- Alteration of consciousness — Syncope, Seizure and Confusional state
- Diarrhea
- Neck stiffness
- Hunger and food cravings
- Depression, Fatigue or low energy.
Prodrome symptoms:-
- Unable to concentrate:- Individuals feels difficulty in concentrating
- Depression
- Facing difficulty in writing or reading.
- Sweating
- Fever
- Feeling of tiredness or lack of energy
- Increase in frequency of urination
- Sensation to light and sound
Types of Migraine
There are different types of migraine experienced by the individuals. Below we have discussed types of migraine:-
- Complicated Migraine (Migraine with Aura):- In U.S around 18% to 22% people experience the Complicated migraine headache. They get warning signs that Aura gives you before the headache strikes.
- Common Migraine (Migraine without Aura):- Migraine headache pain which strikes without aura warning of aura. The migraine headache are the same as of Complicated Migraine but Aura phase doesn’t happens before the headache strikes.
- Acephalgic Migraine (Silent Migraine):- This type of migraine is referred as Migraine without head pain. Individuals experience the aura symptoms but headache do not happen.
- Hemiplegic Migraine:- In this type of migraine, patient suffers from neurological or sensory changes on one side of the body. The patient suffers from temporary paralysis (hemiplegia). Headache is associated with numbness, patients feels weakness on one side of body, tingling sensation and loss of sensation, blur vision, vision changes. Sometimes individual experience head pain and sometime it doesn’t.
- Ocular Migraine (Retinal Migraine):- Patient experience temporary or permanent loss of vision at one side of body. Individuals often experience dull ache behind the eyes but later spread to rest of the head. Patient should immediately seek the medical help because delaying the process lead to serous issue.
- Chronic Migraine:– This type of Migraine is experienced by the individuals occurs at least 15days per month. The severity of the headache pain and symptoms changes very frequently. Chronic Migraine patients use pain medicines regularly. Due to pain medications individuals may develop other type of headache as well.
- Brainstem aura with Migraine:- In this migraine condition, individuals suffered from vertigo, slurred speech, vision changes, loss of balance . These symptoms are experienced before the headache starts. Individual experience headache pain back of your head.
Migraine Stages or Phases? What are the stages of Migraine and timeline of Migraine phases?
There are four stages of migraine in chronological order experienced by the individuals:- Prodrome, Aura, Headache and Postdrome. Before the actual headache strikes, 30% to 40% of people experience the symptoms.
The four phases of Migraine are:-
- Prodrome:- This stage is known as “preheadache” or “premonitory” phase. The prodrome phase lasts a few hour or it can lasts up to several days. It is not necessary that individual experience the prodrome stage every time. Individual may or may not experience it, as it not happen every time.
- Aura:- The aura stage can be as little as 5 minutes or it can last up to 1 hour. Some people experience aura and headache as same time while some individuals do not experience an aura and migraine headache begins without any aura warning sign.
- Headache:- In this phase, patient actual suffers from migraine headache. The average duration of headache is about 4 hours but it can lasts up to 3 days. The severity of pain is mild to high. The high severity pain is often described by patients as drilling, throbbing or you may feel sensation of hammering in head. The pain starts at one side of head and later get spread out to other side or whole head.
- Postdrome:- Nearly 80 % of U.S citizens who are affected from Migraine experience the Postdtome migraine phase. Postdrome phase goes on for one or two days. This stage is often referred as migraine “Hangover” phase.
Individuals nearly takes around 8 hours to 72 hours to pass through all the four stages.
Are Migraine headaches common?
Studies have shown that, nearly half of the world population experience headache. In U.S nearly 12% to 15% of people get migraine headaches. Also, Women are affected twice as compared to men with migraine.
It is not easy to predict who will get affected with migraine or who will not but several risk factors adds the risk to make individual more vulnerable to develop migraine. The risk factors are but not limited to below:-
a. Genetics:- More than 50% of people who experience migraine headache already have relatives affected with disease. They have first-degree of relatives affected with migraine and transfers the same to others genetically.
b. Gender:- Gender plays an important role in migraine. Women are like to get affected more than twice as compared to men with migraine due to hormones influence.
c. Stress:- Stress is one of the factor to trigger the migraine. If you have high stress of any kind like work stress, family stress, relationship stress etc. There are high chances you will get migraine more often compared to other individuals.
d. Smoking & Alcohol abuse:- Smoking increases the chances to develop migraine headache in individuals. People in high stress often smoke more to get relived from it and in return expose themselves to migraine headache.
Causes of migraine attacks?
Research and studies have not find any definite cause for migraine headache. The sensory sensitivity that is characteristic of migraine is probably due to dsyfunction of monoaaminergic sensory control system located in the brainstem and thalamus.
Abnormal brain activity affects nerve signaling, blood vessels and chemicals in the brain. Genetics and environmental factor changes plays an important role in developing migraine.
What are the migraine triggers?
Migraine can be prevented by identifying triggers and treating them accordingly. Below is the list of migraine triggers which can cause migraine:-
- Hormonal changes:- Hormonal changes specially in women is one of the major trigger for migraine. Estrogen level fluctuation during the menstrual cycle causes weight gains, fatigue and fibroids in female. Which seems to be the key factor in triggering headache in many women.
- Food & Drinks:- Processed meat and food due to addition of preservatives can trigger the migraine. Drinks like alcohol, beer, red wine and high caffeine (coffee) develops migraine.
- High Stress:- Increase in stress level of any kind such as work stress, home stress, family stress can be a key factor in developing migraine.
- Sensory Stimuli:- High contrast bright lights or flashing lights or loud sounds can induce migraine. Passive smoking, strong smells of perfume, oil, paint thinner, polish can trigger migraine in some people.
- Irregular Sleeping Patterns:- Getting too much sleep or getting too little sleep can trigger migraine headache in some individuals.
- Environmental or Weather changes:- Sudden change in weather or biometric pressure can trigger migraine attacks.
- Medications:- Overuse of medications, Contraceptive medicines or vasodilators can trigger migraine.
Migraine Diagnosis and Clinical Features of Migraine
Simplified Diagnostic Criteria for Migraine:-
Repeated attacks of headache lasting 4 hours to 72 hours in patients with a normal physical examination, no other reasonable cause for the headache and have at least two of the following features:-
a. Unilateral Pain
b. Throbbing Pain
c. Aggravation by movement
d. Moderate or severe intensity of pain
Apart from above listed feature, patient should have at least 1 of the following features:-
a. Nauses/Vomitting
b. Photophobia and Phonophobia
Note:- Source of above mentioned Diagnostic Criteria for Migraine is adapted from the International Headache Society Classification (Headache Classification Committee of the International Headache Society, 2004).
A high index of suspicion is required to diagnose migraine.
Clinical Feature of Migraine
a. Migraine Aura:- Migraine aura consist of visual disturbances with flashing lights o zigzag lines moving across the visual field or of other neurological symptoms. In U.S Migraine aura is reported in only 20% to 25% patients.
b. Chronic Migraine:- A headache diary can often be helpful in making the diagnosis. Headache diary is also helpful in assessing disability and frequency of treatment for acute headache attacks.
Patients with episodes of migraine that occur daily or near daily are considered to have chronic migraine.
c. Acephalgic Migraine:- Patients with acephalgic migraine experience recurrent neurologic symptoms, often with nausea or vomiting but with little or no headache.
Migraine Treatment:- How to treat Migraine?
Once the diagnosis of migraine has been established. It is important to assess the extent of a patient’s disease and disability. As we know migraine headaches are chronic. Migraine can’t be cured but treating migraine helps in analyzing and stopping symptoms to prevent future migraine attacks.
What is MIDAS (Migraine Disability Assessment Score). How MIDAS tool is used to treat headache.?
The Migraine Disability Assessment Score (MIDAS) is a well-validated, easy to use tool to treat migraine. Below is the MIDAS questionnaire which your healthcare advisor may ask you t fill.
- On how many days in the last 3 months did you miss work or school because of your headaches?
- How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches (do not include days you counted in question 1 where you missed work or school)?
- On how many days in the last 3 months did you not do household work because of your headaches?
- How many days in the last 3 months was your productivity in household work reduced by half or more because of your headaches (do not include days you counted in question 3 where you did not do household work)?
- On how many days in the last 3 months did you miss family, social, or leisure activities because of your headaches?
A. On how many days in the last 3 months did you have a headache? (If a headache lasted more than one day, count each day.)
B. On a scale of 0-10, on average how painful were these headaches? (Where 0=no pain at all, and 10 = pain as bad as it can be)
Migraine Treatment Measures
a. Non-Pharmacologic Management (non-medication treatments):- Migraine can often be managed to some degree by a variety of non-pharmacologic approaches.
Most patients benefit by the identification and avoidance of specific headache triggers. Healthy and regulated lifestyle, including a healthful diet, regular exercise, regular sleep pattern, avoidance of excess caffeine and alcohol, and avoidance of acute changes in stress level. All these factors are helpful in avoiding headache triggers.
b. Acute Attack Therapies For Migraine:-The mainstay of pharmacologic therapy is the judicious use of one or more of the many drugs are effective in migraine. Mild migraine attacks can usually be managed by oral agents; the average efficacy rate is 50% to 70%. Severe migraine attacks may require parenteral therapy.
Must Read:- Difference between Cluster Headache and Migraine