Migraine

Migraine is a condition that causes attacks (episodes) of headaches. Other symptoms such as feeling sick (nausea) or being sick (vomiting) are also common. Between migraine attacks, the symptoms go completely.

Migraine is common. About 1 in 4 women and about 1 in 12 men develop migraine at some point in their lives. It most commonly first starts in childhood or as a young adult. Some people have frequent attacks – sometimes several a week. Others have attacks only now and then. In some people, the migraine attacks stop in later adult life.

Types and symptoms of migraine.

There are two main types of migraine attack:

  • Migraine attack without aura – sometimes called common migraine.
  • Migraine attack with aura – sometimes called classic migraine.

Migraine without aura

This is the most common type of migraine. Symptoms include the following:

  • The headacheis usually on one side of the head, typically at the front or side. The pain is moderate or severe and is often described as throbbing or pulsating. Movements of the head may make it worse. Typically, it gradually gets worse and peaks after 2-12 hours, then gradually eases off. However, it can last from 4 to 72 hours.
  • Other migraine symptoms that are common:
    • Feeling sick (nausea).
    • Being sick (vomiting).
    • Not liking bright lights or loud noises, so that a patient may just want to lie in a dark room.

Migraine with aura

About 1 in 4 people with migraine have migraine with aura. The symptoms are the same as those described above (migraine without aura), but also include a warning sign (an aura) before the headache begins.

  • Visual aura is the most common type of aura. Examples include a temporary loss of part of vision, flashes of light, objects may seem to rotate, shake, or boil.
  • Numbness and pins and needles are the second most common type of aura. Numbness usually starts in the hand, travels up the arm, then involves the face, lips, and tongue. The leg is sometimes involved.
  • Problems with speech are the third most common type of aura.
  • Other types of aura include an odd smell, food cravings, a feeling of well-being, other odd sensations.

One of the above auras may develop, or several may occur one after each other. Each aura usually lasts just a few minutes before going, but can last up to 60 minutes. The aura usually goes before the headache begins.The headache usually develops within 60 minutes of the end of the aura.

Phases of a typical migraine attack

A migraine attack can typically be divided into four phases:

  • A warning (premonitory) phase occurs in up to half of people with migraine. One may feel irritable, depressed, tired, have food cravings, or just know that a migraine is going to occur.
  • The aura phase (if it occurs).
  • The headache phase.
  • The resolution phase when the headache gradually fades. During this time one may feel tired, irritable, depressed, and may have difficulty concentrating.

Less common types of migraine

There are various other types of migraine which are uncommon, and some more types which are rare. These include:

Menstrual migraine. The symptoms of each attack are the same as for common migraine or migraine with aura. However, the migraine attacks are associated with periods (menstruation).

Abdominal migraine. This mainly occurs in children. Instead of headaches, the child has attacks of tummy (abdominal) pain which last several hours. Typically, during each attack there is no headache, or only a mild headache. There may be associated with sickness (nausea), being sick (vomiting), or aura symptoms.

Commonly, children who have abdominal migraine switch to develop common migraine in their teenage years.

Ocular migraine. It causes temporary loss of all or part of the vision in one eye. This may be with or without a headache. Each attack usually occurs in the same eye. There are no abnormalities in the eye itself and vision returns to normal. Important note: see a doctor urgently if you get a sudden loss of vision (particularly if it occurs for the first time). There are various causes of this and these need to be ruled out before ocular migraine can be diagnosed.

Diagnosis of migraine

Migraine is usually diagnosed by the typical symptoms. There is no test to confirm migraine. A doctor can usually be confident that one has migraine by typical symptoms and by an examination which does not reveal any abnormality. However, some people with migraine have non-typical headaches. Therefore, sometimes tests are done to rule out other causes of headaches. Also, with some uncommon or rare types of migraine such as ocular migraine, tests are sometimes done to rule out other causes of these symptoms. (For example, temporary blindness can be due to various causes apart from ocular migraine.)

Causes of migraine

The cause is not clear. A theory that used to be popular was that blood vessels in parts of the brain become narrower (go into spasm) which accounted for the aura. The blood vessels were then thought to open wide (dilate) soon afterwards, which accounted for the headache. However, this theory is not the whole story and, indeed, may not even be a main factor. It is now thought that some chemicals in the brain increase in activity and parts of the brain may then send out confusing signals which cause the symptoms. The exact changes in brain chemicals are not known. It is also not clear why people with migraine should develop these changes. However, something may trigger a change in activity of some brain chemicals to set off a migraine attack.

Migraine is not classed as an inherited condition. However, it often occurs in several members of the same family. So, there is probably some genetic factor involved.

Triggers of migraine attacks

Most migraine attacks occur for no apparent reason. However, something may trigger migraine attacks in some people. Triggers can be all sorts of things. For example:

  • Diet. Dieting too fast, irregular meals, cheese, chocolate, citrus fruits, and foods containing a food additive called tyramine.
  • Environmental. Smoking and smoky rooms, glaring light, VDU screens or flickering TV sets, loud noises, strong smells.
  • Psychological. Depression, anxiety, anger, tiredness, stress, etc. Many people with migraine cope well with stress but have attacks when they relax.
  • Medicines. For example, hormone replacement therapy (HRT), some sleeping tablets, and the contraceptive pill.
  • Other. Periods (menstruation), shift work, different sleep patterns, the menopause.

It may help to keep a migraine diary. Noting down when and where each migraine attack started, what one was doing, and what one had eaten that day. A pattern may emerge, and it may be possible to avoid one or more things that may trigger migraine attacks.

Treatment options for migraine.

A brief summary is given here.

Painkillers

Paracetamol or aspirin works well for many migraine attacks. (Note: children aged under 16 should not take aspirin for any condition.) The dose should be taken as early as possible after symptoms begin. If taken enough, painkillers often reduce the severity of the headache, or stop it completely. A lot of people do not take a painkiller until a headache becomes really bad. This is often too late for the painkiller to work well.

Dealing with nausea and sickness

Migraine attacks may cause a feeling of sickness (nausea) which can cause poor absorption of tablets into the body. If painkillers are taken, they may remain in the stomach and not work well if one is feeling sick. The tablets may even be vomited.  Tips that may help include:

  • Use dissolvable painkillers. These are absorbed more quickly from the stomach and are likely to work better.
  • Anti-sickness medicine can be taken with painkillers. A doctor may prescribe one. Like painkillers, they work best if you take them as soon as possible after symptoms begin.

Preventing migraine attacks

A medicine to prevent migraine attacks is an option if one has frequent or severe attacks. It may not stop all attacks, but their number and severity are often reduced. Medicines to prevent migraine are taken every day. They are not painkillers, and are different to those used to treat each migraine attack. A doctor can advise on the various medicines available.

Migraine and children

Some points to note about migraine in children include the following:

  • Migraine is common in children. It affects about 1 in 10 school-age children.
  • Symptoms can be similar to those experienced by adults. However, sometimes symptoms are not typical. For example, compared with adults, attacks are often shorter, pain may be on both sides of the head. Also, associated symptoms such as feeling sick (nausea) and being sick (vomiting) may not occur.
  • Abdominal migraine (described earlier) mainly affects children.
  • Common triggers in children include missing meals, lack of fluid in the body (dehydration) and irregular routines. So, if a child is troubled with migraine attacks, it is important to try to have regular routines, with set meals and bedtimes. Also, encourage children to have plenty to drink.
  • Many of the medicines used by adults are not licensed for children:
    • Paracetamol or ibuprofen are suitable and are commonly used. Do not use aspirin.

Migraine when pregnant or breast-feeding

The good news is that about 2 in 3 women with migraine have an improvement whilst pregnant or breast-feeding. However, some women find that their migraine gets worse whilst pregnant.  Many of the medicines used to treat migraine should not be taken by pregnant or breast-feeding women.

  • For relief of a migraine headache:
    • Paracetamol is the medicine most commonly used, as it is known to be safe during pregnancy.
    • Ibuprofen is sometimes used but should not be taken in the last third of the pregnancy (the third trimester).
  • Aspirin – should be avoided if one is trying to conceive, early in pregnancy, in the third trimester and whilst breast-feeding.
  • For feeling sick (nausea) and being sick (vomiting) – no medicines are licensed in pregnancy. However, occasionally a doctor will prescribe one off licence.
  • Medicines used for the prevention of migraine are not recommended for pregnant or breast-feeding women.

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