Migraine

Migraine is a neurological condition characterized by recurrent, moderate to severe headaches that are often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. Migraines affect approximately 12% of the population and are three times more common in women than men.

Migraines are more than just bad headaches - they're a complex neurological disorder that can significantly impact quality of life. While there's no cure, effective treatments are available to reduce frequency, severity, and duration of attacks.

Migraine Phases:

1. Prodrome (1-2 days before):

   • Mood changes
   • Food cravings
   • Neck stiffness
   • Increased thirst and urination
   • Frequent yawning

2. Aura (before or during, in some people):

   • Visual disturbances (flashing lights, zigzag lines)
   • Vision loss
   • Pins and needles in arm or leg
   • Weakness or numbness
   • Difficulty speaking

3. Attack (4-72 hours if untreated):

   • Throbbing or pulsing pain
   • Usually one side of head
   • Sensitivity to light, sound, sometimes smell
   • Nausea and vomiting
   • Blurred vision
   • Lightheadedness, sometimes fainting

4. Postdrome (after attack):

   • Feeling drained or washed out
   • Confusion
   • Mood changes
   • May last up to a day

During a Migraine Attack:

1. Rest in a Dark, Quiet Room:

   • Minimize sensory stimulation
   • Close curtains
   • Turn off lights and sounds

2. Apply Cold or Warm Compress:

   • Cold compress on forehead or neck
   • Some prefer warmth
   • Try both to see what helps

3. Stay Hydrated:

   • Sip water slowly
   • Avoid dehydration
   • Consider electrolyte drinks if vomiting

4. Over-the-Counter Medications (if appropriate):

   • Ibuprofen or naproxen
   • Acetaminophen
   • Caffeine (small amount, may help)
   • Take early in attack for best effect

5. Avoid Triggers During Attack:

   • Strong smells
   • Bright lights
   • Loud noises

Preventive Strategies:

1. Identify and Avoid Triggers:

   • Keep a migraine diary
   • Common triggers:
     • Stress
     • Hormonal changes
     • Certain foods
     • Sleep changes
     • Weather changes
     • Strong stimuli (lights, smells)

2. Lifestyle Modifications:

   • Regular sleep schedule
   • Regular meals
   • Stay hydrated
   • Regular exercise
   • Stress management

• Sudden, severe headache ("thunderclap")
• Headache with fever, stiff neck, confusion
• Headache after head injury
• Headache with vision loss, weakness, difficulty speaking
• First severe headache ever
• Headache different from usual migraines

• Frequent migraines (more than 4 per month)
• Migraines interfering with daily life
• Need for preventive treatment
• Current treatment not working
• Overusing pain medications
• New or changing symptoms

• Occasional migraines responding to treatment
• Well-controlled with current plan
• Following preventive strategies

Diagnosis is typically clinical:

1. Medical History:

   • Detailed description of headaches
   • Frequency, duration, triggers
   • Associated symptoms
   • Family history

2. Physical and Neurological Exam:

   • Rule out other causes
   • Check for neurological abnormalities

3. Imaging (if indicated):

   • MRI or CT scan
   • Usually not needed for typical migraines
   • May be ordered if:
     • Atypical features
     • Abnormal neurological exam
     • Sudden onset
     • Headaches have changed

Diagnostic Criteria:

• At least 5 attacks
• Lasting 4-72 hours
• With 2+ of: one-sided, pulsating, moderate-severe, worsened by activity
• With 1+ of: nausea/vomiting, light/sound sensitivity

Acute Treatment (during attack):

1. Over-the-Counter:

   • NSAIDs (ibuprofen, naproxen)
   • Acetaminophen
   • Caffeine combinations

2. Prescription Medications:

   • Triptans: Sumatriptan, rizatriptan, etc.
   • Ergots: Dihydroergotamine
   • Anti-nausea: Metoclopramide, prochlorperazine
   • CGRP antagonists: Newer class of medications

Preventive Treatment (if frequent/severe):

1. Medications:

   • Beta-blockers
   • Antidepressants
   • Anticonvulsants
   • Calcium channel blockers
   • CGRP monoclonal antibodies

2. Lifestyle:

   • Regular sleep
   • Regular meals
   • Stress management
   • Regular exercise

3. Alternative/Complementary:

   • Biofeedback
   • Acupuncture
   • Magnesium supplements
   • Riboflavin (B2)
   • Coenzyme Q10

Identify Triggers:

• Keep detailed migraine diary
• Track: foods, sleep, stress, weather, hormones
• Look for patterns

Common Triggers:

• Foods: Aged cheese, processed meats, chocolate, alcohol, MSG
• Hormonal: Menstrual cycle, birth control, menopause
• Environmental: Bright lights, loud sounds, strong smells
• Lifestyle: Stress, sleep changes, skipped meals, dehydration
• Weather: Barometric pressure changes

Preventive Strategies:

• Maintain regular schedule
• Manage stress
• Stay hydrated
• Regular exercise
• Avoid known triggers
• Consider preventive medication if frequent

Migraines involve complex neurological processes:

1. Genetic Component: Family history common
2. Brain Activity: Abnormal brain activity patterns
3. Neurotransmitters: Changes in serotonin and other chemicals
4. Blood Vessels: Dilation and inflammation
5. Trigeminal Nerve: Activation of pain pathways
6. Cortical Spreading Depression: Wave of brain activity (in aura)

The exact mechanism varies, which is why different treatments work for different people.

• Three times more common in women
• Often related to hormonal changes
• May improve during pregnancy
• Can worsen during perimenopause
• Menstrual migraines common

• Less common but can be severe
• May be underdiagnosed
• Different triggers sometimes

• Can start in childhood
• May present differently
• Abdominal migraines possible
• School performance may be affected

• May improve with age
• New onset needs evaluation
• Medication interactions important
• May have other health conditions

Migraines are a specific type of headache disorder with characteristic features: moderate-severe pain, often one-sided, throbbing, with nausea and light/sound sensitivity. Regular headaches are usually milder and lack these features.

There's no cure, but migraines can be effectively managed. Many people find that with proper treatment and trigger management, migraines become much less frequent and severe.

Most migraines are not dangerous, but they can be debilitating. However, migraines with aura slightly increase stroke risk in some populations. Rarely, migraines can be a sign of other conditions, which is why new or changing migraines should be evaluated.

It depends on frequency and severity. For occasional migraines, acute treatment is appropriate. If you have frequent migraines (more than 4 per month), preventive treatment may be recommended to reduce overall frequency.

Yes, but it varies by person. Common triggers include aged cheeses, processed meats, chocolate, alcohol, and foods with MSG or artificial sweeteners. Keeping a food diary can help identify your personal triggers.