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Migraine - causes, symptoms, treatment

 

A migraine is an intense headache that is usually felt as a throbbing or pulsing pain on one side of the head and may last up to 72 hours. Nausea, vomiting, or sensitivity to light and sound may occur with the headache.

Medications can help to relieve the pain and other symptoms, and even prevent some migraines. Coping strategies and lifestyle changes may also help.

General information

Migraines are a type of recurring headache. They can be so severe that the pain is disabling and reduces the quality of life of people affected. 

Migraine is one of the most common health conditions worldwide, affecting about 15% of people.  

Migraine headaches usually first appear during adolescence or early adulthood. They may occur infrequently or several times per month – the frequency varies from person to person. They tend to peak during a person’s 30s and become less frequent and less severe in later life.

Women are three-times more likely to have migraine headaches than men. A tendency to get migraines appears to be inherited, i.e. migraine runs in families.

Causes

The exact mechanism by which migraines occur is not known. The current theory is that it is a disorder of nerves and blood vessels in the brain.

Migraine attacks may be triggered by dietary, hormonal, emotional, physical, and environmental factors, including:

  • Certain sensory stimuli, such as loud noises, bright lights, strong odours or perfumes, smoking, and exposure to second-hand smoke
  • Sudden intense exercise or other physical exertion, including sexual activity
  • Stress and anxiety at work or home
  • Changes in sleep patterns, such as getting too much or not enough sleep
  • Drinking alcohol
  • Certain foods, including chocolate, aged cheeses, salty foods, fermented foods, and meats containing nitrates (eg: bacon, hot dogs, salami)
  • Food additives, such as monosodium glutamate (MSG) and artificial sweeteners 
  • Missing meals or fasting
  • Changes in hormone levels during a menstrual cycle or with the use of oral contraceptives and / or hormone replacement therapy
  • Variations in the environment, eg: a change in the weather or atmospheric pressure

Signs and symptoms

The main symptom of a migraine is usually a headache that gets worse with movement and is disabling, ie: prevents a person from carrying out normal activities.  

A migraine attack may progress through four phases, the signs and symptoms of which can overlap:

  1. Early signs: Subtle changes one or two days before a migraine occurs that indicate a migraine may be coming, including constipation, yawning, mood changes, food cravings, and neck stiffness.
  2. Aura: Some people experience aura before or during the headache. Aura symptoms, which develop over five minutes and last for up to one hour, may include: Visual disturbances, such as flashes of light, zig-zag patterns, or blind spots; numbness or tingling on one side of the face or in an arm or leg; and feeling dizzy or off balance.
  3. Headache: This phase can last from 2 to 72 hours, and is defined by a moderate to severe headache that is throbbing or pulsing, and usually only on one side of the head. A person may also be more sensitive to light, sounds, odours, and touch; and experience chills and sweating, nausea and vomiting, blurred vision and light-headedness.
  4. Hangover”: After a migraine attack, a person may feel drained and washed out. Confusion, moodiness, dizziness, weakness, and sensitivity to light and sound may also be experienced the following day.

You should see your doctor immediately, or go to an A&E clinic, if you have any of the following signs and symptoms that might indicate a more serious medical problem such as a ruptured brain aneurysm, stroke or meningitis

  • Severe and sudden headache that causes intense pain
  • Headache with a fever over 38 degrees, stiff neck, mental confusion, seizures, double vision, weakness, numbness, or difficulty speaking
  • Headache after a head injury, especially if the headache gets worse
  • Chronic headache that gets worse after coughing, physical exertion, straining, or a sudden movement
  • Age older than 50 years and a severe headache is experienced for the first time.

Diagnosis

There is no specific test to diagnose a migraine. For a diagnosis to be made, your GP will take your medical history and will need to identify a pattern of recurring headaches and any associated symptoms.

Keeping a diary of your migraine attacks can help with the diagnosis and treatment. A migraine diary should note the date, time, and activity when the migraine began, how long it lasted, the symptoms, any medication taken and their effects.

Your GP may also recommend tests to rule out other possible causes for your headache if your condition is unusual, complex, or suddenly becomes severe.

You may be referred to a neurologist (brain and nervous system specialist) for further assessment and treatment if a diagnosis is unclear, you have chronic migraine (occurring on 15 or more days per month), or initial treatment has failed to control your symptoms.

Treatment

There is no cure for migraine headaches – the aim of treatment is to relieve the symptoms as soon as they start and try to prevent further attacks. More than one treatment may help and it may take time to determine what treatments work best. This will involve trying different types or combinations of medicines.

Pain-relievers

Over-the-counter pain-relievers, such as paracetamol, aspirin, and ibuprofen, can help to reduce symptoms. They tend to be most effective when taken at the first appearance of the signs and symptoms of a migraine attack.

Triptans

These are prescription drugs developed specifically for migraine headaches. It is thought that triptans work to relieve migraine pain and other symptoms by blocking pain pathways and constricting blood vessels in the brain. Some people find it effective to combine a triptan with a pain-reliever.

Anti-emetics

Anti-sickness medicines, known as anti-emetics, can reduce the vomiting and nausea associated with a migraine headache. They may even be beneficial in people who do not experience nausea or vomiting during their migraine attack. Anti-emetics are prescription medications and are usually taken with pain-relievers and triptans.

Preventative medicines

Preventative medicines may be prescribed to reduce the severity or frequency of migraines. They are used when other medications don’t work; when migraines are severe, long lasting or frequent; and when avoiding possible triggers has not helped to prevent migraine attacks. These include various medications that were initially developed and used to prevent seizures in people with epilepsy, treat angina and high blood pressure, and antidepressants.

Medication overuse

Taking too many pain relievers to treat migraines and other types of headache can result in a rebound headache, which may feel like a tension-type headache or migraine-like attack. Rebound headaches usually improve within two to four weeks of stopping the medication that has been overused.

Self-help

Some simple self-help steps can help to relieve migraine signs and symptoms:

  • Sleep or lie down in a quiet, cool, dark room
  • Avoid strenuous activity
  • Place a cold flannel on your neck or forehead
  • Avoid drinking alcohol or sugary drinks
  • Try to relax by listening to music or through meditation
  • Do not read, watch TV, or drive.

Prevention

The following lifestyle changes and coping strategies may help to reduce migraine frequency and severity:

  • Recognise what triggers your migraines and try to avoid or minimise them. Keep a headache diary can help to identify your triggers
  • Establish a daily routine with regular sleep patterns and regular meal times
  • Manage stress and anxiety. Relaxation and stress-reducing exercises such as yoga, tai chi, and meditation can help to lower stress levels. Cognitive behavioural therapy (CBT) and other coping strategies may also be helpful
  • Exercise regularly. Aerobic exercise (e.g., walking, swimming, cycling) helps to reduce tension. But it is important to warm up slowly because sudden, intense exercise can trigger migraines
  • Lose weight, if overweight or obese. Obesity may be a factor in migraines
  • If you are a woman who has migraines that seem to be triggered or made worse by oestrogen, talk to your doctor about avoiding or reducing medications that contain oestrogen
  • Limit caffeine intake 
  • Stay hydrated by drinking water throughout the day.

Further information and support

Neurological Foundation of New Zealand
Freephone: 0508 BRAINS (0508 272 467)
Email: admin@neurological.org.nz
Website: https://neurological.org.nz

Healthline
Freephone: 0800 611 116
Website: www.healthline.govt.nz

References

Goadsby P.J., Holland P.R., Martins-Oliveira M., et al. (2017). Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev. 2017 Apr;97(2):553-622.
Mayo Clinic (2018). Migraine (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201 [Accessed: 21/03/19]
MedlinePlus (2017). Migraine (Web Page). Bethesda, MD: US National Library of Medicine (NIH). https://medlineplus.gov/ency/article/000709.htm [Accessed: 21/03/19]
NHS inform (2019). Migraine (Web Page). Glasgow: National Health Information Service, National Health Service (NHS) Scotland. https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/migraine [21/03/19]
Obermann M., Holle D. Recent advances in the management of migraine. F1000Research. 2016 Nov 21;5:2726.
O’Toole, M.T. (Ed.) (2017). Migraine. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.

Created: April 2019

 

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