Migraines – causes, symptoms and treatments

Migraine headaches are a common neurological condition that affects millions of people worldwide. These debilitating headaches can cause severe pain, often on one side of the head, and are characterised by throbbing or pulsating sensations. In this comprehensive guide, we will explore the causes, symptoms, and treatment options for migraines.

Understanding migraines

What are migraines?

Migraines are a type of headache that is typically more intense and severe than a regular headache. They are often accompanied by other symptoms such as nausea, vomiting, and increased sensitivity to light, noise, and odour. Migraines can last anywhere from four to 72 hours and can significantly impact a person’s daily life.

Different types of migraines

There are several types of migraines, each with its symptoms. The two main types are:

• Migraine with aura: This type of migraine is characterised by the presence of neurological symptoms known as “aura” (warning signs) that occur before or during the headache. Aura symptoms can include visual disturbances, numbness or tingling sensations, difficulty speaking, and muscle weakness
• Migraine without aura: This is the most common type of migraine and does not involve the presence of aura symptoms. It is characterised by moderate to severe head pain on one side of the head, along with other symptoms such as nausea, vomiting, and sensitivity to light and sound

Other less common types of migraines include abdominal migraine, basilar-type migraine, hemiplegic migraine, menstrual migraine, migraine without headache, ophthalmoplegic migraine, and retinal migraine.

Causes and triggers of migraines

The exact cause of migraines is still not fully understood, but research suggests that a combination of genetic and environmental factors plays a role. Here are some common triggers and risk factors that can contribute to the onset of migraines:

• Hormonal changes: Fluctuations in hormone levels, particularly in women, can trigger migraines. This is why many women experience migraines during menstruation, menopause or hormonal changes during pregnancy
• Environmental factors: Certain environmental stimuli, such as bright lights, loud noises, strong smells, and weather changes, can trigger migraines in susceptible individuals
• Stress and emotional factors: Emotional stress, anxiety, and tension can trigger migraines in some people. It is important to manage stress levels and practice relaxation techniques to reduce the risk of migraines
• Dietary triggers: Some foods and beverages have been associated with triggering migraines in certain individuals. Common dietary triggers include caffeine, alcohol, aged cheeses, processed foods, and food additives like artificial sweeteners
• Sleep disturbances: Both lack of sleep and excessive sleep can trigger migraines in some individuals. It is important to maintain a regular sleep schedule and ensure an adequate amount of sleep
• Physical exertion: Strenuous physical activity, including intense exercise or overexertion, can trigger migraines in susceptible individuals. It is important to engage in regular exercise but avoid excessive strain

Symptoms of migraines

Migraine symptoms are characterised by recurring episodes of severe head pain, but they can also involve a range of other symptoms. Here are some common symptoms experienced during a migraine:

• Throbbing or pulsating headache: The primary symptom of a migraine is a severe headache that is often described as throbbing or pulsating. The throbbing pain is typically felt on one side of the head but can sometimes affect both sides
• Nausea and vomiting: Many individuals with migraines experience nausea and may also vomit during an episode. This can further contribute to feelings of discomfort and debilitation
• Sensitivity to light, sound, and odour: Migraine sufferers often become hypersensitive to light, sound, and certain odours during an attack. Exposure to bright lights, loud noises, or strong smells can intensify the headache pain
• Aura symptoms: Some individuals experience migraine aura symptoms before or during a migraine attack. These symptoms can include visual disturbances like seeing flashing lights or zigzag lines, double vision, and blind spots as well as sensory changes such as numbness or tingling sensations
• Fatigue and weakness: Many individuals feel exhausted and weak after a migraine attack. This postdrome phase can last for hours or even days, during which the person may experience feelings of fatigue and difficulty concentrating

It is important to note that the symptoms and severity of migraines can vary greatly from person to person. Some individuals may experience migraines infrequently, while others may have frequent and debilitating attacks.

Diagnosis of migraines

Diagnosing migraines involves comprehensively evaluating a person’s medical history, symptoms, and physical examination. There is no specific test to definitively diagnose migraines, but healthcare professionals rely on the following criteria:

• Detailed medical history and family history: The healthcare provider will ask about the frequency, duration, and characteristics of the headaches, as well as any associated symptoms
• Physical examination: A physical examination will be conducted to rule out other potential causes of the headaches. The healthcare provider will assess neurological function and look for any signs of underlying medical conditions
• Diagnostic criteria: Migraines are diagnosed based on specific diagnostic criteria established by medical organisations like the International Headache Society. These criteria consider the frequency, duration, and specific symptoms of the headaches

In some cases, additional tests or imaging studies may be ordered to rule out other potential causes of the headaches. These tests may include blood tests, neuroimaging (such as MRI or CT scans), or electroencephalography (EEG) to evaluate brain activity.

Treatment options for migraines

The goal of migraine treatment is to relieve symptoms, prevent future attacks, and improve the overall quality of life for individuals with migraines. Treatment options can vary depending on the frequency and severity of the migraines. Here are some common approaches to managing migraines:

Acute treatment

Acute or “abortive” treatment aims to alleviate the symptoms of a migraine attack as soon as they occur. These treatments are typically taken at the onset of a migraine and include:

• Over-the-counter pain relievers: Non-prescription pain relievers such as non-steroid anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can be effective in reducing mild to moderate migraine pain
• Triptans: Triptans are a class of medications specifically designed to treat migraines e.g. sumatriptan. They work by constricting blood vessels and blocking pain pathways in the brain. Triptans are available as tablets, nasal sprays, or injections
• Anti-nausea medications: Medications such as metoclopramide or ondansetron may be prescribed to alleviate nausea and vomiting associated with migraines

Preventive treatment

Preventive medication aims to reduce the frequency and severity of migraines, particularly for individuals who experience frequent or severe attacks. These treatments are taken regularly, regardless of whether a migraine is currently occurring, and may include:

• Beta-blockers: Medications commonly used to treat high blood pressure, such as propranolol or timolol, can be effective in preventing migraines
• Antidepressants: Certain antidepressant medications, such as amitriptyline or venlafaxine, are effective in preventing migraines
• Anti-seizure medications: Medications typically prescribed for epilepsy, such as topiramate or valproate, can also be effective in preventing migraines
• Botox injections: In some cases, injections of botulinum toxin type A (Botox) may be recommended for individuals with chronic migraines (more than 15 headache days per month)

Your GP may decide to refer you to a neurologist for further assessment and treatment if a diagnosis is unclear or medication is not effective.

Lifestyle changes

In addition to medication, making certain lifestyle modifications can help manage migraines and reduce their frequency. Here are some strategies that may be beneficial:

• Identify and avoid triggers: Keep a headache diary to identify potential migraine triggers, such as certain foods, stressors, or environmental factors, and try to avoid them when possible
• Maintain a regular sleep schedule: Establish a consistent sleep routine and aim for an adequate amount of sleep each night. Avoid excessive sleep or sleep deprivation, as both can trigger migraines
• Practice stress management: Engage in stress-reducing activities such as meditation, deep breathing exercises, yoga, biofeedback or mindfulness practices to help manage stress levels
• Bodywork: Physical treatments like chiropractic, massage, acupressure, acupuncture, and craniosacral therapy might ease headache symptoms
• Stay hydrated: Drink plenty of water throughout the day to stay well-hydrated, as dehydration can contribute to migraine attacks
• Regular exercise: Engage in regular physical activity, such as walking, swimming, or cycling, as exercise has been shown to reduce the frequency and severity of migraines
• Maintain a balanced diet: Eat regular, well-balanced meals and avoid skipping meals or fasting, as low blood sugar can trigger migraines. Limit the consumption of trigger foods, such as caffeine, alcohol, and processed foods

It is important to work closely with a healthcare provider to develop an individualised treatment plan that addresses the unique needs and triggers of each person.

Additional support and resources

Living with migraines can be challenging, but there are numerous resources available to help individuals manage their condition and find support. Here are some organisations and websites that offer valuable information and support for individuals with migraines:

• The Migraine Trust
• American Migraine Foundation
• National Headache Foundation 
• Migraine Research Foundation
• Migraine.com

Remember, everyone’s experience with migraines is unique, and it may take time to find the most effective treatment approach. With the help of healthcare professionals and a supportive network, individuals can manage their migraines and improve their quality of life.

Sources

• Migraine – Symptoms and causes – Mayo Clinic
• Migraine: What It Is, Types, Causes, Symptoms & Treatments
• Migraine – NHS
• Migraine – National Institute of Neurological Disorders and Stroke