Migraine

Migraine is a neurological condition known for causing painful headache attacks accompanied by a range of symptoms beyond intense headaches. These additional symptoms can include:

• Nausea
• Vomiting
• Difficulty speaking
• Numbness or tingling sensations
• Sensitivity to light and sound

Migraine often has a genetic component and can affect individuals of all ages, although it is more commonly diagnosed in women compared to men. Diagnosis is typically based on clinical history, reported symptoms, and ruling out other potential causes. Migraine headaches are categorised as episodic or chronic and can also be classified as with or without aura, depending on the presence of sensory disturbances preceding the headache.

What does migraine feel like?

People describe migraine pain as:

• Pulsating
• Throbbing
• Perforating
• Pounding
• Debilitating

In addition to these sensations, migraine pain can also feel like a severe, dull, steady ache. Initially mild, untreated migraine pain can escalate to moderate or severe levels. The pain typically affects the forehead area and is commonly experienced on one side of the head, though it can also occur bilaterally or shift in location. Most migraine attacks last approximately 4 hours, but untreated or non-responsive episodes can extend from 72 hours to a week. In cases of migraine with aura, the pain may coincide with the aura symptoms or might not occur at all.

What are the symptoms of migraine?

Migraine symptoms can manifest in distinct stages, starting with the prodrome phase, where early signs may appear 1 to 2 days before the headache itself:

• Food cravings
• Depression
• Fatigue or low-energy
• Frequent yawning
• Hyperactivity
• Irritability
• Neck stiffness

For migraines with aura, the aura phase follows the prodrome, characterised by sensory disturbances such as:

• Difficulty speaking clearly
• Prickling or tingling sensations in the face, arms, or legs
• Visual disturbances like shapes, light flashes, or temporary vision loss
• Movement and speech issues

The attack phase is when the migraine pain peaks, lasting from hours to days, and may overlap with the aura:

• Increased sensitivity to light and sound
• Nausea
• Dizziness or feeling faint
• Throbbing head pain on one side
• Vomiting

After the attack, the postdrome phase occurs, marked by mood changes ranging from euphoria to fatigue, often with a lingering mild headache.

What causes migraine attacks?

Migraine causes are linked to abnormal brain activity affecting nerve signalling, chemicals, and blood vessels, though a definitive cause remains unidentified. Common triggers include:

• Bright lights
• Extreme weather conditions
• Dehydration
• Barometric pressure changes
• Hormonal fluctuations (e.g., during menstruation, pregnancy, menopause)
• Stress
• Loud noises
• Intense physical exertion
• Skipping meals
• Altered sleep patterns
• Certain medications (e.g., oral contraceptives, nitroglycerin)
• Strong smells
• Specific foods
• Smoking
• Alcohol consumption
• Travel

If you experience a migraine attack, your doctor may recommend keeping a headache journal. This tool can be invaluable in identifying your unique triggers. By noting down your activities, food intake, and medication use before an attack, you can start to recognise patterns and take steps to avoid or manage these triggers.

What is the treatment for migraines?

Migraine cannot be cured, but your doctor can assist in managing migraine attacks by equipping you with tools to alleviate symptoms when they occur, potentially reducing the frequency of attacks overall. The treatment plan is tailored based on several factors:

• Your age
• Frequency of migraine attacks
• Type and severity of migraines
• Duration, intensity of pain, and impact on daily life
• Presence of associated symptoms like nausea or vomiting
• Other health conditions and medications you may be taking

Your treatment plan may involve a combination of approaches:

• Lifestyle adjustments such as stress management and avoiding triggers
• Over-the-counter pain or migraine medications like NSAIDs (Nonsteroidal anti-inflammatory drugs) or acetaminophen (Tylenol)
• Daily prescription medications to prevent migraines and reduce their frequency
• Prescription medications taken at the onset of an attack to manage symptoms and to avoid escalation
• Medications to alleviate nausea or vomiting
• Hormone therapy if migraines are linked to menstrual cycles
• Counselling or therapy for comprehensive management
• Acute medications, taken at the first signs of a migraine attack, include:
• NSAIDs: e.g., ibuprofen or aspirin, for mild-to-moderate attacks without nausea
• Triptans: e.g., sumatriptan, eletriptan, rizatriptan, first-line for nerve pain in migraines
• Antiemetics: e.g., metoclopramide, chlorpromazine, prochlorperazine, used with NSAIDs to reduce nausea
• Ergot alkaloids: e.g., Migranal, Ergomar, reserved for those not responding to triptans or analgesics