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The causes and symptoms of migraine

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Overview

Migraine is a relatively common health problem that affects around one in every 5 women and around one in every 15 men. Medically, it is a moderate to severe throbbing headache affecting just one side of the head. Migraine is usually first detected in early adulthood.

Other symptoms may accompany the headache. These include nausea, vomiting and increased sensitivity to light or sound.

Medical practitioners have identified several types of migraine. These include:

● Migraine with aura: Headache preceded by specific warning signs, such as seeing flashing lights or blind spots, and tingling on one side of the face or in the limbs.

● Migraine without aura: This type of migraine happens without the specific warning signs listed above. It is the commonest type of migraine.

● Migraine aura without headache (aka silent migraine): In these cases, the patients experience an aura or other migraine symptoms, but does not develop a headache.

The frequency of migraine attacks varies among individuals. Some patients have migraine attacks up to several times a week, while others only have a migraine occasionally. In fact, it is possible for years to pass between migraine attacks.

Migraine attacks can have significant negative impacts on a patient’s daily life. Fortunately, effective treatment strategies are available to these patients. Medications can help in preventing migraine attacks or make them less painful. Several medications are available, so it is important to discuss with your doctor to identify the medicine suitable for you. The right medicines, combined with lifestyle changes and self-help remedies, may help in improving the symptoms significantly.

Symptoms of migraine

It has been found that migraines may have four stages: prodrome, aura, headache and post-drome. However, patients may not experience all of them.

Prodrome

1-2 days prior to a migraine, patients may notice subtle changes that warn of an upcoming attack. These include:

● Mood changes, ranging from depression to euphoria (elated mood)

● Food cravings

● Constipation

● Neck stiffness

● Frequent yawning

● Excessive thirst and urination

Aura

Aura may occur before or even during migraine attacks. However, most patients experience migraines without aura.

Auras are symptoms that occur due to disturbances in the nervous system. These symptoms include changes in vision, sensation, movement and speech. They usually begin gradually, build up over minutes and last for 20-60 minutes. Some examples of auras are:

● Visual disturbances, such as seeing flashes of light, various shapes or bright spots

● Loss of vision

● Pins and needles in a limb

● Weakness or numbness affecting the face or one side of the body

● Speech difficulty

● Hearing noises

● Uncontrollable jerking

Occasionally, a migraine with aura may be associated with limb weakness. This is known as hemiplegic migraine.

Attack

If left untreated, a migraine attack usually last from 4 to 72 hours. During a migraine, patients may experience:

● Pain usually on one side of the head, although it can occasionally affect both sides of the head and even the face and neck

● Pain that is throbbing or pulsing in nature

● Increased sensitivity to light, sounds, and sometimes smells and touch

● Nausea and vomiting

● Blurring of vision

● Light-headedness

Some rarer symptoms include:

· Sweating

· Feeling very hot or very cold

· Abdominal pain

· Diarrhoea

· Poor concentration

Post-drome

This final phase occurs after a migraine attack. Patients may feel drained and washed out, but some patients feel elated. For about 24 hours, patients may experience the following symptoms:

● Dizziness

● Confusion

● Moodiness

● Sensitivity to light and sound

● Weakness

Causes of migraine

We do not know the exact cause of migraines, but they are generally thought to be due to some abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain.

It has been found that migraines may be caused by certain changes in the brainstem and its interactions with the trigeminal nerve. Imbalances in brain chemicals, such as serotonin that helps regulate pain in the nervous system, may also be involved. The research on the role of serotonin in migraines is ongoing.

The reduction in serotonin levels during migraine attacks may lead to the release of substances called neuropeptides from the trigeminal nerve. These neuropeptides then travel to the brain's outer membrane, resulting in the pain experienced in migraine attacks. Calcitonin gene-related peptide (CGRP) is another neurotransmitter that may play a role in generating the pain of migraine.

It is likely that genetics and environmental factors both play a role in the causation of migraine. Those who are genetically susceptible are more likely to experience migraines as a result of a specific trigger.

Migraine triggers

Migraine attacks can be precipitated by a number of triggers, including:

● Hormonal changes: In many women, fluctuations in oestrogen seem to trigger migraine attacks. They often report attacks immediately before or during their periods, when there is a major drop in oestrogen. For some, migraine attacks are more likely to occur during pregnancy or menopause. Medications containing hormones, such as oral contraceptives and hormone replacement therapy, have been found to worsen migraines. Nevertheless, some patients find their migraines occur less frequently when they are taking these medications.

● Foods and drinks: Certain cheeses, salty foods and processed foods have been found to trigger migraines. Even skipping meals and fasting are potential triggers. Some drinks like alcohol and highly caffeinated beverages may also trigger migraines.

● Food additives: Aspartame and monosodium glutamate (MSG) may trigger migraine attacks.

● Stress: Stress in daily life can potentially trigger migraine attacks.

● Sensory stimuli: Bright lights, sun glare and loud noise are all potential triggers. Strong smells from sources like perfume and smoke can trigger migraine attacks in some patients.

● Disturbances in sleep-wake cycle: Missing sleep, sleeping too much and jet lag may all trigger migraines.

● Physical factors: Intense physical exertion, including strenuous exercise and sexual activity, may potentially trigger migraine attacks.

● Environmental factors: These include a change in weather or barometric pressure.

● Medications: Oral contraceptives and medications that dilate blood vessels, such as nitroglycerin, can aggravate migraines.

Because the triggers vary from person to person, it may be worthwhile to keep a migraine diary so you can identify a consistent trigger and can thus avoid this trigger as much as possible.