A Layman’s Guide to Migraine

A migraine is more than a headache.

Experiencing throbbing, pounding headache? Zigzags of bright lights across your field of vision? Disturbed sleep and nagging sensitivity to light?

Well, you could be suffering from migraine headaches.

A migraine is usually a moderate or severe headache that causes intense, throbbing pain usually in one area of your head.

It is a neurological condition that can cause debilitating, throbbing pain and can leave you dysfunctional.

It can also be called a genetically influenced complex disorder, in which complex brain events occur over hours to days in a recurrent matter.

Migraines typically begin during teens years to early twenties, but they can begin anytime between early childhood and late-adulthood.

Migraine headaches without aura are mostly common, but migraines with aura can be severe and difficult to bear.

Around 1 billion people worldwide are affected by migraine. In India alone around 21.3 crore (213 million) people were affected by it, and 60% of them were women, according to a study in 2019.

According to American research journal Lancet Global Health, prevalence of migraine was higher in women aged 35–59 years than in men of the same age group. Prevalence was found to have increased with age and peaked at around age 40–44 years, followed by a gradual decrease in both men and women.

Stages and Symptoms of Migraine Headache

A migraine headache typically involves four stages and its symptoms vary in each stage.

1. Prodrome
2. Aura
3. Headache
4. Postdrome

Prodrome Migraine

May last a few hours or even days. You may or may not experience any symptoms. It’s also known as pre-headache or premonitory phase.

Symptoms include:

• Sensitivity to light, sound or smell
• Fatigue
• Craving for food or lack of appetite
• Mood swings
• Severe thirst
• Bloating
• Constipation or diarrhea

Aura Migraine

The aura phase can last upto 60 minutes or may end in just five minutes. Most people don’t experience aura symptoms , and some people experience both the aura and the headache at the same time.

Symptoms include:

• Seeing flashes of light or things that aren’t there
• Not able to see clearly or can’t at all
• Tingling or numbness on one side of your body
• Difficulty speaking
• Feeling of heaviness in arms and legs
• Ringing in the ears
• Noticing changes in smell, taste or touch
• Tunnel vision
• Loss of consciousness, but that’s rare

Headache

Headache begins as a dull ache and grows into a throbbing pain or sensation of an icepick in your head. It normally gets worse during your physical activity.

Headache pain may move from one side of your head to your other or may feel like it’s affecting your whole head.

Most people (about 80%) may experience nausea along with headache and about half of them may throw-up. You may also feel like fainting.

Most migraine headaches typically last for 4 hours, but severe ones may go on for 3 days or more.

These headaches can occur twice a month, and some may get these every few days, while others get them once or twice a year.

Postdrome

It’s usually called a migraine hangover, and about 80% of people who have had migraines experience it. This phase usually lasts a few hours but can linger for more than a day.

In this phase, your headache is gone but you may experience fatigue, drowsiness, decreased energy levels, problems concentrating, irritability, nausea and sensitivity to light.

You may also have brief episodes of head pain while moving your head.

Symptoms include:

• Feeling exhausted, drained-out or feeling irritable
• Feeling euphoria or feeling usually happy
• Muscle pain or weakness
• Food cravings or lack of appetite
• Unable to understand things

Causes

The exact cause of migraine headaches is not known clearly, but there seems to be a correlation between changes occurring in your brain and your genes.

Research found variations in many genes, which have been found to be associated with the development of migraines with aura or without aura. These associated genes have been found to be active in the muscles that surround blood vessels within the brain, disrupting blood flow, which might cause migraines.

Migraines can occur in you, because your parents might have passed on migraine triggers like fatigue, bright lights or weather changes to you.

For many years, researchers believed that migraines occurred because of changes in blood flow in the brain. But now they believe that this can only contribute to the pain, not what starts it.

Migraines can occur when the blood flow in your brain is altered and some nerves in your brain begin sending abnormal pain signals throughout your head. These signals trigger the release of various brain chemicals in your brain, leading to inflammation, especially of your blood vessels and the membrane that covers your brain and spinal cord.

This inflammation causes many signs and symptoms of your migraine, including the throbbing pain, nausea, and sensitivity to light. But it is not yet clear what leads to the abnormal nerve signaling.

Migraines have no clear pattern of inheritance, although more than half of affected people have at least one family member who also has suffered the condition.

Combination of genetic, environmental and lifestyle factors can result in migraines. Non-genetic factors can contribute to the development of a migraine, such as alcohol or lack of sleep.

What Triggers Your Migraine

Migraines could be triggered by many factors, such as:

• Alcohol
• Smoking
• Traveling
• Caffeine
• Missing meals
• Weather changes
• Sunlight, flashlights etc.
• Lack of sleep
• Overexertion
• Loud noises
• Abrupt changes in schedule
• Dehydration
• Hunger
• Dieting or not drinking enough water
• Certain types of foods
• Sensitivity to certain chemicals and preservatives in foods
• Strong smells (smoke, perfumes or other strong odours)
• Too much painkillers for headache (can cause a rebound headache)
• Some medications that cause blood vessels to swell
• Teeth grinding at night
• Menstruation or hormonal changes in women

And there are other factors that can trigger migraines in you, such as:

• Sex (migraines affect women 3 times more than men)
• Age (migraine headaches start between ages 10 and 40, but most women find their migraines manageable or even see them vanish after 50)
• Family history (a person with one parent with migraine has a 50% chance of developing it. If both parents have it, the chances are around 75%)
• Medical conditions (conditions such as epilepsy, bipolar disorder, depression etc. may trigger migraines in you.)

Diagnosis

There are no specific tests to diagnose migraine headaches, but your Doctor can identify a pattern of your recurring headaches with the associated symptoms to diagnose properly.

Migraines are not usually the results of any underlying medical conditions, so they wouldn’t show up on tests, including your brain MRI.

Though migraines have a strong genetic link, there are no genetic tests that can determine a clear diagnosis.

The diagnosis of your migraine is based on your migraine history, physical examination and validation of your diagnostic criteria. The necessary information can be collated from these clinical questions, such as:

• Your demographics: age, gender, race and profession
• When did your headache start?
• Where does it hurt? Location
• What is the intensity of your pain?
• How is the pain? Which are the qualitative characteristics of the pain?
• How long does the pain last?
• At which moment of the day does your pain appear?
• How has it evolved since it started?
• What is the frequency of appearance?
• What are the triggering conditions?
• Are you having simultaneous symptoms?
• Is it related to sleep?
• How does it get better or worse?
• Which medications you’re on to get better? What is the frequency of your medication?

In a word, a proper clinical diagnosis, based on the above data, is the best option to diagnose your migraine headaches.

Treatment for Your Migraine

There is no cure for your migraine headaches, but with proper clinical diagnosis and treatment protocols, they can be managed.

Doctors diagnose your migraine through your symptoms, severity and how often they occur.

Based on the review of your medical history and physical examination, your Doctor may suggest tests to rule out other possible medical conditions. Then, he will prescribe medications to reduce the severity and frequency of your migraine symptoms.

Bottomline

Migraines are more than just your normal headaches, as it is a genetic brain disease that requires proper medical help to manage.

Migraines usually respond well to specific treatments, but do not self-medicate or resort to over-the-counter medications. Always consult your Doctor, and be safe.

It is always your well-informed choices that can help you towards preventive healthcare and overall wellbeing.

If you have a question related to this blog post, write to us here and we will update this post with a response. 

Sources: Cleveland Clinic, WebMd, National Library of Medicine, Johns Hopkins, Medline Plus, NHS, Goan Connection, Medical News Today and American Migraine Foundation.

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