Migraines

Neurological

Migraines are recurrent episodes that occur as a form of headache accompanied by other neurological symptoms such as nausea, dizziness, and vertigo. People with a migraine may also experience extreme sensitivity to light, sound, or movement of the head. These headaches are often debilitating and can last from hours to days. There are over 39 people in the United States who suffer from migraine headaches. Any person can have a migraine at any age, but it is more common in women and during the ages between 30 and 50. Migraine episodes can be so severe that they interfere with the day’s normal activities and cause emotional distress. Some medications may help prevent some migraines from happening or make them less painful.

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Symptoms

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.

Risk Factors

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

Diagnosis

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.

Treatments

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

Alternative Treatments and Home Remedies

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.

Lifestyle Changes

  • 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

References

Elrington, G. (2002). Migraine: Disease and management. Journal of Neurology, Neurosurgery, and Psychiatry, 72 (Suppl. II), ii10-ii15: https://jnnp.bmj.com/content/jnnp/72/suppl_2/ii15.full.pdf

Kuruvilla, D. (2018, November 29). Holistic treatments for migraines. Retrieved from American Migraine Foundation: https://americanmigrainefoundation.org/resource-library/holistic-treatments-for-migraine/

May, A. & Schulte, L. H. (2016, August). Chronic migraine: risk factors, mechanisms, and treatment. Nature Reviews Neurology, 12(8), 455-464. Retrieved from PubMed: https://pubmed.ncbi.nlm.nih.gov/27389092/

Mayo Clinic Staff. (2020, January 16). Migraine. Retrieved from Mayo Clinic Staff: https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201

Migraine Research Foundation. (2021). Migraine facts. Retrieved from Migraine Research Foundation: https://migraineresearchfoundation.org/about-migraine/migraine-facts/#:~:text=Nearly%201%20in%204%20U.S.,ages%20of%2018%20and%2044.

Moawad, H. (2020, January 28). How migraines are diagnosed: How to know you are experiencing a migraine. Retrieved from Verywellhealth: https://www.verywellhealth.com/migraine-diagnosis-4583064

Teixido, M. & Carey, J. (2014, May 14). Migraine: More than a headache. Retrieved from Johns Hopkins Medicine: https://www.hopkinsmedicine.org/otolaryngology/_docs/Migraine%20patient%20handout.pdf

University Health Services. (2014). Headaches. Retrieved from the University of California, Berkeley: https://uhs.berkeley.edu/sites/default/files/HeadachesMigraines.pdf

Yancey, J. R., Sheridan, R. S., &Koren, K. G. (2014, April 15). Chronic daily headache: Diagnosis and management. American Family Physician, 89(8), 642-648. Retrieved from American Academy of Family Physicians: https://www.aafp.org/afp/2014/0415/afp20140415p642.pdf

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