In the most severe cases, migraine can ruin relationships, careers and increase the risk of developing serious health conditions. While there is currently no cure for a migraine, most sufferers can find ways to manage the condition and reduce the impact it has on their lives.
What is a Migraine?
A migraine is a severe headache, usually affecting only one side or the front of the head, and often accompanied by other symptoms, such as nausea, tiredness, and sensitivity to external stimuli. There are two types of migraine: a migraine with aura and migraine without aura. Around one-third of migraine sufferers experience a migraine with aura, characterized by early warning signs, called an aura, before the actual migraine attack.
What Causes Migraine?
A migraine is thought to be caused by a change in the levels of chemicals in the brain, particularly serotonin levels, which decrease during a migraine attack. Low levels of serotonin can cause blood vessels in the brain to contract (narrow). This narrowing of the blood vessels is believed to be responsible for the aura symptoms, or warning signs. Next, the blood vessels dilate (widen), which is thought to cause a headache and other associated symptoms. The cause of the change in brain chemicals is not yet clear, but there are certain factors known to trigger a migraine attack in susceptible people.
Migraine triggers differ from one person to the next. Certain foods can trigger a migraine in susceptible people. These trigger foods vary widely from person to person, but the most common trigger foods include:
- Coffee and other products containing caffeine
- Citrus fruit, such as oranges and lemons
- Foods containing an additive called tyramine
- Heavily processed foods, such as cooked meat.
Dehydration is also a common cause of a migraine. Also, dieting, restricting food groups and skipping meals can trigger a migraine, as lack of food or irregular meals can cause blood sugar levels to drop. Similarly, foods containing high amounts of sugar, with little or no nutritional value, can also trigger a migraine, as they cause blood sugar levels to spike and drop sharply.
Physical and emotional triggers for a migraine include:
- Irregular sleep patterns
- Bad posture
- Muscular tension, particularly in the neck and shoulders
For some people, strong emotions, even positive emotions like joy and excitement, can trigger a migraine.
Hormones are thought to play a part in some cases, as many women experience an increase in migraine attacks around the time of their period, typically in the 2-3 days before and after the start of their period, when estrogen levels are low. This is known as a menstrual migraine. Around 10-15% of all female migraine sufferers only experience migraine attacks during this time. Menopause and HRT (hormone replacement therapy) can also trigger a migraine in some women.
Environmental factors can also trigger a migraine in some people. These may include:
- Strong smells
- Smoky or stuffy rooms
- Loud noises
- Humid weather conditions
- Sudden changes in temperature
- Flickering screens, such as computer or television screens
- Strong lighting.
Some people are also sensitive to certain products, such as perfume, air freshener or hairspray, which could trigger a migraine or cause symptoms to worsen.
Medications can trigger a migraine in some people. Regular painkiller use can lead to rebound headaches and migraine, caused by medication overuse, while some prescription medications, including the contraceptive pill and HRT (hormone replacement therapy), may also trigger a migraine.
Symptoms of A migraine
The symptoms of a migraine are as wide and varied as the triggers. Every migraine sufferer will experience a different set of symptoms. There are, however, some symptoms that are commonly experienced during a migraine attack.
During the aura stage, or early warning stage, symptoms can include:
- Visual disturbances, such as flashing lights, blind spots or zigzag patterns
- Pins and needles or tingling in the neck, shoulders or limbs
- Stiffness of the neck or shoulders
- Feeling dizzy, disoriented or confused
- Lack of coordination or loss of balance
- Problems with speaking
- Food cravings
- Changes in mood.
The aura stage usually starts 15 minutes to an hour before the onset of a headache. In severe cases, sufferers may lose consciousness during the aura stage, although this is rare.
During the headache stage, sufferers experience a severe headache, which usually affects only the front or one side of the head, although the pain may shift position during an attack. The pain is usually experienced as an intense throbbing sensation, which may cause nausea and worsen with movement. Other symptoms during this stage include:
- Abdominal pain
- Increased need to urinate
- Sensitivity to light, noise or smells
- Feeling hot or cold
- Extreme tiredness
- Strong desire to lie down in a cold, dark room.
This stage usually lasts between 4 hours and three days, although symptoms may come and go during this time.
While the most common symptom of a migraine is a debilitating headache, some people experience migraine without a headache. Children and some adults may experience “a stomach migraine”, with the intestinal symptoms of a migraine, such as abdominal pain, diarrhea, and nausea, without a headache. While other people experience only the visual symptoms most commonly associated with the aura stage.
Once the headache stage has passed, sufferers may continue to feel tired, weak, lethargic and queasy, have difficulty concentrating and experience food cravings for several days.
The 5 Stages of A migraine
There are five recognized stages of a migraine, although not all sufferers will experience every stage.
1. The prodromal stage
The prodromal stage typically starts a few hours before the aura or headache stage, although some people experience the prodromal stage for several days before it develops into a headache. During this stage, there may be changes in mood, such as irritability, depression or anger. Friends and family may also notice a change in mood or behavior. Some people experience food cravings, especially for salty or sweet food, and there may be an increase or decrease in appetite. There may also be a noticeable increase or decrease in energy levels, along with unexplained muscle aches or stiffness.
2. The aura stage
The aura stage is experienced by around one-third of all migraine sufferers and typically lasts 15 minutes to an hour. During this stage, there may be visual disturbances, confusion, and other symptoms. These symptoms usually disappear once the headache stage is reached.
3. The headache stage
The headache stage usually lasts between 4 hours and three days. During this time, sufferers often experience a whole range of symptoms, including a severe headache.
4. The resolution stage
Some people find that a headache and associated symptoms fade over a period, often with the help of sleep, while others experience a sudden end to their symptoms, perhaps after vomiting or an emotional outburst, such as crying.
5. The postdromal stage
This stage is a period of recovery, which can last from a few hours to several days. During this time, some people continue to feel tired, weak, exhausted and confused. There may also be food cravings or extreme thirst.
Medical Treatments for A migraine
There is currently no known cure for a migraine. Treatment is aimed at preventing attacks and reducing the severity of symptoms. Finding the right treatment can take time and patience, as not all treatments will be effective for everyone.
Painkillers are commonly used to reduce the pain of a migraine. Many painkillers bought over the counter, such as paracetamol and aspirin, may be effective for some people, but many migraine sufferers find these painkillers give little or no relief. Stronger painkillers prescribed by a doctor may offer better relief. To be effective, painkillers must usually be taken in the early stages of a migraine. Many people find that they are unable to digest tablets in the later stages.
Anti-inflammatory medications, such as ibuprofen, can also help to alleviate symptoms, but a doctor should be consulted before trying these medications, as they are not suitable for those with certain medical conditions.
Anti-sickness medications can be bought over the counter or prescribed by a doctor. These are usually available in tablet form or as suppositories. They may also be available as a combination preparation with pain relief.
Triptans can be highly effective in the treatment of a migraine. The Triptans helps by counteracting the dilation of blood vessels, thought to be the cause of migraine, by causing the blood vessels around the brain to narrow (contract). Some people have found great relief from migraine with the use of triptans, while others report little or no effect. Triptans are available from a pharmacist in tablet form, or on prescription in a higher dose. Triptans also prescribed in the form of a nasal spray or injection.
Preventative treatment may also be prescribed in the case of a chronic migraine. Most commonly, beta-blockers (usually prescribed for high blood pressure or angina), amitriptyline (an antidepressant drug), anticonvulsants and drugs to control serotonin levels may be prescribed in an attempt to prevent migraine. However, these preventative treatments do not work for everyone, and most have unpleasant side effects.
If medical treatments provide little or no relief, referral to a specialist or migraine clinic may be advised. A specialist will be able to rule out any underlying causes and suggest a different treatment. There are several experimental treatment options available in severe cases.
Pregnant and breastfeeding women should talk to a doctor before taking any medication for migraine, as many treatments are unsuitable and may harm the baby.
Migraine has been linked to a small increase in the risk of having an ischaemic stroke, and also an increased risk of developing mental health problems, such as depression. However, these risks are extremely small and should not be a worry for most people.
Aside from medical treatments, there are ways to take control of a chronic migraine. Keeping a journal to record significant events, symptoms, and triggers associated with migraine can provide valuable information. A migraine journal can help to identify triggers, warning signs and effective treatments.