A migraine is a severe headache that may be preceded or accompanied by symptoms such as flashes of light, blind spots, tingling in your arms and legs, nausea, vomiting and sensitivity to light and sound.
In most people, a throbbing pain is felt only on one side of the head. You may also feel pain around your eyes, temples, face, jaw or neck. The pain may increase with physical activity, which can affect your daily routines.
Migraines are common but can be distressing, draining and affect your whole body. You may feel vaguely unwell for a day or two before a migraine headache comes on. Once it has started, a migraine headache can last for a few hours or even several days.
Causes
The exact cause of migraine is not yet known but both genetic and environmental factors may play a part. It is believed that abnormal brain activity involving nerve pathways, chemical imbalances and blood flow to the brain may be responsible.
Migraines tend to first occur between the ages of 10 and 45. Sometimes, they begin earlier or later. Migraines may run in families. They occur more often in women than men and some women, though not all, have fewer migraines when they are pregnant.
Migraine attacks may be triggered by several things, including caffeine withdrawal, drinking alcohol, exercise or other physical stress, loud noises or bright lights, missed meals, odours or perfumes, smoking or exposure to smoke, stress and anxiety.
They can also be triggered by certain foods such as chocolate, dairy products, especially certain cheeses, foods with monosodium glutamate (MSG) and meats containing nitrates.
Foods and drinks with tyramine, which include red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans, fruits, onions, peanuts and other nuts, as well as seeds and processed, fermented, pickled or marinated foods are also known to trigger migraines. What triggers a migraine varies from person to person.
True migraines are not a result of a brain tumour or other serious medical problem. Only a health care provider can determine if your symptoms are due to a migraine disorder or other condition.
Symptoms
There are two main types of migraine, namely migraine with an aura or classic migraine and a migraine without an aura, also referred to as a common migraine.
An aura is a group of nervous system or neurological symptoms. These symptoms are considered a warning sign that a migraine is coming.
Most often, your vision is affected. Other symptoms can include temporary blind spots or coloured spots, blurred vision, eye pain and seeing stars, zigzag lines or flashing lights.
Other nervous system symptoms include yawning, difficulty concentrating, nausea, trouble finding the right words, dizziness, weakness, numbness and tingling. Some of these symptoms are less likely to affect you with a common migraine headache.
An aura often occurs 10 to 15 minutes before the headache but can occur just a few minutes to 24 hours before. A headache does not always follow an aura.
Migraine headaches usually start as a dull ache and become worse within minutes to hours. You will feel some throbbing, pounding or pulsating. This becomes worse on one side of the head with pain behind the eye or in the back of the head and neck. This can last for four to 72 hours.
Other symptoms that may occur with the headache include chills, increased urination, fatigue, loss of appetite, nausea and vomiting, sensitivity to light or sound and sweating.
In some people symptoms may linger, even after the migraine goes away. This is called a migraine hangover. Symptoms of this can include feeling mentally dull such as your thinking not being clear or sharp, needing more sleep and neck pain.
Diagnosis
To help diagnose whether you have a migraine headache or not the doctor may ask about your symptoms and family history of migraines. A complete physical and neurological exam may be done to determine if your headaches are due to muscle tension, sinus problems or a brain disorder.
There is no specific test to prove that your headache is actually a migraine. In most cases, no special tests are needed, though tests may be done to exclude other possible conditons. Your doctor may order a brain CT scan or MRI scan if you have never had one before.
Tests may also be done if you have unusual symptoms with your migraine, including weakness, memory problems or loss of alertness.
An electroencephalogram (EEG) may be needed to check for seizures. A lumbar puncture, also known as a spinal tap, might be done as well.
Treatment
There is no specific cure for migraine headaches. The goal is to treat your migraine symptoms right away and to prevent symptoms by avoiding your triggers.
A key step is learning how to manage your migraines at home. A headache diary can help you identify your headache triggers. Your doctor can use this to help you plan how to avoid these triggers.
Lifestyle changes can help manage migraines. These include healthier sleep habits, such as getting enough sleep and going to bed at the same time each night, healthier eating habits, including not skipping meals, and avoiding your food triggers.
You should also manage your stress and lose weight, if you are overweight.
If you have frequent migraines, your doctor may prescribe medicine to reduce the number of attacks. You need to take the medicine every day for it to be effective.
Medicines may include anti-depressants, blood pressure medicines, such as beta blockers, and anti-seizure medicines.
Some people find relief from minerals and vitamins. It is best to take those recommended by your doctor. Some of these medicines may not be safe for pregnant or breast-feeding women to take.
Treating a migraine attack
Hydration with fluids is often helpful, with or without the use of medicines. Over-the-counter pain-relieving medicines, such as acetaminophen, naproxen, ibuprofen or aspirin are often helpful when your migraine is mild.
You should note that taking medicines more than three days a week may lead to rebound headaches. These are headaches that keep coming back due to overuse of pain killers.
Taking too much acetaminophen can damage your liver. Excessive use of naproxen, ibuprofen or aspirin can irritate your stomach or damage your kidneys.
If these treatments do not help, ask your doctor about prescription medicines. These include nasal sprays, suppositories or injections.
Some migraine medicines narrow the blood vessels. If you are at risk of having a heart attack or have heart disease, talk to your doctor before taking these medicines.
