Migraines

Migraines are accompanied by several symptoms and can last from a few hours to several days if left untreated. Symptoms include:

• Pain on one or both sides of the head
• Pulsing or throbbing pain in the head
• Sensitivity to light and noise
• Nausea and vomiting
• Dizziness
• Sadness
• Irritability
• Fatigue or sleepiness
• Low energy
• Neck pain
• Sensory disturbances shortly before onset (aura)

Aura. For some people, an aura happens before a migraine is about to occur or during an episode. An aura can be a visual disturbance, like wavy lines, dots, or flashing lights, or disruption in touch, taste, or smell. An aura usually lasts for 20 to 60 minutes and can present with the following symptoms:

• Trouble speaking
• Vision loss
• Pins and needles in an arm or leg
• Numbness or weakness in the face or on one side of the body
• Hearing noises or music
• Uncontrollable movements (like jerking)

There are several phases to a migraine, but not all phases may be seen in many patients. These include:

First Phase: Prodromal

This can occur hours or days before the actual headache begins.

• Irritability
• Fatigue
• Muscle pain
• Depression

Second Phase: Aura

An abnormal sensation that is felt or seen that signifies a headache is about to start that usually occurs from 20-60 minutes before the headache episode.

Third Phase: Pain
Classically seen as a one-sided headache that is throbbing in nature.

Fourth Phase: Postdromal
When the headache is over certain feelings can last for a few days such as tiredness, difficulty thinking, and soreness.

Why some people get migraines is not known but is thought to be due to environmental and genetic factors. The majority of people who suffer from these headaches have someone else in the family who does as well. It is important to note that some people report triggers that can initiate an attack such as certain foods, sinus infections, and stress.

• Obesity
• Depression
• Female sex
• Stressful life events
• Overuse of acute migraine medication
• Poverty
• Ineffective acute treatment for migraines

After taking a full medical history, your doctor will ask you to carefully explain your symptoms, especially when migraines occur and how often. You will be given a thorough physical examination that includes checking your reflexes, and circulation, sensation, and motor responses. Your eyes will be checked to see if you have swelling in your optic nerve to rule out other conditions (i.e., brain tumor or aneurysm). Because migraine symptoms mimic so many other conditions, your doctor will most likely ask you to get the following tests:

Complete blood count (CBC). Will show if you have anemia, infection, inflammation, and some types of cancer.

Thyroid tests. Thyroid problems can cause headaches and fatigue, early migraine symptoms.

Electrolyte levels. Will show signs of liver and kidney failure and malnutrition, all of which will cause fatigue, a common symptom of a migraine.

Encephalogram (EEG). Detects abnormal electrical activity in the brain to distinguish between seizure activity and migraines.

Electrocardiogram (ECG). Looks at the electrical activity of the heart. Heart problems, like arrhythmias, heart defects, and heart failure, can cause symptoms of dizziness, headaches, and fatigue – common symptoms of migraines.

Lumbar puncture. Also known as a spinal tap. If your doctor is concerned you have an infection or inflammation around the brain, you may be asked to get a lumbar puncture. This diagnostic test extracts spinal fluid using a needle in the lowest region of the spine.

Treatment of migraines involves preventing attacks and treating those that have already started. An important aspect of treatment for migraines is the identification of the triggers and avoiding them before an episode occurs. You must keep a diary of your symptoms and include anything you may suspect is triggering a migraine attack. If you canidentify the triggers of your migraines, you may be able to avoid episodes. However, if these triggers are not easily identified, your doctor will advise medications, both over the counter and prescription, to help relieve your symptoms. Treatments that your doctor may prescribe include:

Abortive or pain-relieving medications. Best taken as soon as the first symptoms of a migraine begin. There are quite a few options available to you to help relieve the pain and discomfort of a migraine episode. These include:

• Over-the-counter or prescription pain relievers
• Anti-nausea drugs
• Opioid medications
• Dihydroergotamines
• Lasmitidan
• Ubrogepant
• Triptans

Preventative medications. Some prescription medications are available to you that may prevent the frequency and severity of migraines. These include:

• Antidepressants
• Anti-seizure drugs
• Blood pressure-lowering medications
• Botox injections
• Calcitonin gene-related peptide (CGRP) monoclonal antibodies

Complementary or alternative medicine treatments can help you cope with the symptoms of migraine episodes and possibly reducethe severity and frequency of migraines. Consult with your primary healthcare provider before beginning any new treatment or taking supplements.

Acupuncture. This therapy base in Chinese medicine uses hair-thin needles inserted into various points in the body to help relieve symptoms of pain. Acupuncture is effective in reducing the frequency of migraines and provides some pain relief in several studies.

Stress management. There are several options available to you to help manage stress. These include relaxation techniques, breathing exercises, visualization, and guided meditation.

Magnesium. This mineral has been found in studies to reduce the frequency of migraines, especially those related to menstrual cycles and auras. Magnesium can be taken as a supplement and is found in leafy greens, nuts, seeds, and whole grains.

Mindfulness meditation and biofeedback. These therapies help you to learn how your body reacts to stress and pay attention to your heart rate and muscle tension. Increasing your awareness of how your body reacts to stress and actively practicing relaxation can help you to reduce your stress triggers.

Massage. A certified massage therapist can work with you to help reduce muscle tension that increases pain related to your migraine attacks. There are also self-massage techniques you can use to reduce tension in your neck and face. Follow this link here to learn these techniques.

• Improve sleep hygiene
• Avoid coffee
• Do not smoke tobacco
• Monitor diet for triggers
• Regular mealtimes
• Keep a headache diary and include possible triggers
• Exercise regularly
• Stay hydrated
• Maintain a healthy weight

Migraines may be triggered by dietary, physiological, and/or environmental factors:

Dietary. Food sensitivities may cause migraines. Red wine, chocolate, coffee, and aged cheese, or yeasted bread are common triggers. Foods that contain chemicals similar to neurotransmitters may aggravate migraines. These include monosodium glutamate (MSG) and foods that contain nitrates, like lunch meat and hot dogs.

Physiologic. Hormonal changes that occur before menstrual periods, pregnancy, and menopause may trigger a migraine episode in women. Stress is the most common trigger of migraine attacks.  These include emotional distress, lack of sleep, hunger, and excessive exercise. Sleep apnea can also trigger a migraine.

Environmental. Bright lights, noises, and excessive sensory stimuli can trigger an attack. Painful stimuli in the head or neck, like a sinus infection, temporomandibular joint pain, neck injury, or muscle spasms, can also trigger a migraine. Some people with migraines say that a weather change or change in barometric pressure can push a migraine attack.

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