The following factors are associated with migraine:
- Family history, suggesting a genetic predisposition.
- Hormonal influences can also exacerbate it.
- Medications such as oral contraceptives and vasodilators
- Sensory stimulation
- Foods such as aged cheeses and salty and processed foods
Clinical features
Prodromal symptoms that appear before the attack are:
- Constipation
- Mood changes
- Swift Food cravings
- Neck rigidity
- Increased urination
- Excessive thirst
- Yawning
- Frequent yawning
Symptoms of migraine aura include:
- Visual hallucinations
- Flash Of light in front of eyes
- Temporary loss of vision
- Pin and limb sensation in their limbs.
- Abnormal body moves
- Difficulty in speaking
In around 20% of patients, migraine begins with aura (previously called ‘classical’ migraine). Shimmering, silvery zigzag lines (fortification spectra) start appearing across the visual fields for up to 40 mins, sometimes. This can sometimes cause temporary blindness. Another 80% of patients suffer from migraine without aura.
Following are the characteristics of a migraine attack:
- Severe and throbbing pain
- Photophobia
- Irritation to noise or even voice
- Vomiting
- Pain exacerbated by movement
- Limbs weakness
Diagnosis:
Doctors, particularly expert in headaches (neurologists), can diagnose migraines based on your history, clinical features, and general physical and neurological examination.
Your doctor may advise the following tests to rule out any serious underlying disease:
- MRI. It can help a doctor diagnose any tumour, stroke, bleeding in the brain, infections, and other problems.
- CT scan. A series of X-rays created through a CT scan creates a detailed image of the brain.
Management
Acute attack:
- Simple analgesia with aspirin or paracetamol
- Antiemetic medications to stop the vomiting if there is any
- Triptans such as sumatriptan are used to treat the severe attacks of migraine.
- Dihydroergotamine
- Lasmiditan
- Ubrogepant: This oral calcitonin gene-related peptide receptor antagonist has been recently approved for the treatment of acute migraine with or without aura in adults.
- Opioid medications can be used in individuals who can’t take other drugs due to any reason.
Prevention:
- Avoidance of identified triggers or exacerbating factors.
- If frequent, try calcium channel blockers
- Beta-blockers such as propranolol
- Antidepressants, particularly tricyclic antidepressants (amitriptyline) can prevent migraines.
- Anti-seizure drugs such as Valproate and topiramate
- Botox injections. Injections about every 3 months offer protection against migraine in some adults.
- New drugs such as calcitonin gene-related peptide (CGRP) monoclonal antibodies
Other treatment options:
- Acupuncture.
- Biofeedback.
- Cognitive behavioral therapy.
- Herbs, vitamins and minerals.
- A high dose of riboflavin (vitamin B-2)
It is important to record your migraine experience. For example, what did you eat before the migraine started, what was the weather that day, etc. This will help you learn the warning signals that trigger your migraine.
Most people can feel much better by making lifestyle changes, learning ways to relax and taking pain relievers. A migraine headache can cause intense throbbing or pulsing in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down.
