About Migraines
The causes of migraines are believed to involve temporary changes in chemicals, nerves, and blood vessels within the brain. The brain chemicals, or neurotransmitters, include serotonin and calcitonin gene-related peptide (CGRP). These neurotransmitters play a role in the pain associated with migraine.
Non-modifiable risk factors (factors a person cannot change or control) for migraine headaches include:
- Age: Migraine headaches can occur at any age, but they often start during adolescence or early adulthood. Migraines tend to peak between 30-40 years old and become less frequent and less severe in later years.
- Sex assigned at birth: Females are more likely to experience migraines than males.
- Genetic factors: Having a family history of migraines increases the risk.
- Hormonal changes: For females with migraine, migraines often occur at the start of a menstruation period. Migraines often improve after menopause.
Modifiable risk factors (factors a person potentially can change or control) for migraine headaches may include:
- Lifestyle factors: Certain lifestyle choices, such as poor sleep habits, irregular eating patterns, and high stress levels, can contribute to migraine headaches.
- Certain medical conditions: Obesity, asthma, and anxiety disorders have been associated with an increased risk of migraines.
- Medication use/overuse: Overusing certain medications intended to treat acute migraine attacks can actually lead to more frequent or severe headaches.
- Certain factors may trigger migraines for some people. Common migraine triggers include:
- Overexertion (too much exercise or physical activity)
- Wine, especially red wine
- Caffeine
- Loud sounds
- Strong smells, such as perfume and cigarette smoke
- Flashing or bright lights
- Certain foods, such as aged cheeses or processed foods like hot dogs or salami
- Food additives, such as monosodium glutamate (MSG) or aspartame
It's important to note that these risk factors may vary from person to person. It's always best to consult with a healthcare professional for personalized advice on managing migraines.
Migraines may have four stages of signs and symptoms. People with migraines may not experience all stages.
Prodrome: Early warning signs of migraine headaches may start 1-2 days before a migraine and can include:
- Constipation
- Hyperactivity or difficulty concentrating
- Mood changes, such as depression and irritability
- Neck stiffness
- Frequent urination
- Food cravings or increased hunger or thirst
- Trouble sleeping
Aura: Some people experience sensory or muscle symptoms that start about 20-30 minutes before a migraine headache starts. An aura usually lasts less than an hour. Aura may include:
- Visual changes: Seeing bright spots, flashes of light, wavy lines or other shapes, temporary vision loss or blind spots
- Difficulty speaking
- Weakness or numbness, usually in the face or one side of the body
- Tingling in an arm or leg (“pins and needles” sensation)
Migraine headache: This stage of migraine may last between 4 hours and 3 days. Common symptoms include:
- Severe pain on one or both sides of the head
- Throbbing, pulsating, or pounding pain in the head
- Nausea and vomiting
- Sensitivity of light, sound, or strong smells
Post-drome: Symptoms after a migraine attack include:
- Fatigue (feeling extremely tired or exhausted)
- Neck stiffness
- Confusion or trouble focusing
Please note that these symptoms can vary depending on the individual and the type of migraine headache they are experiencing. It is always important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.
To diagnose migraine headaches, doctors typically perform the following examinations, tests, and procedures:
- Medical history assessment: Doctors evaluate your symptoms and medical history to understand the pattern and characteristics of your headaches.
- Physical examination: A thorough physical examination is conducted, focusing on neurological assessments to check for any abnormalities in reflexes, strength, and coordination.
- Neurological examination: A neurological exam helps assess the functioning of the nervous system and identify any neurological abnormalities.
- Blood tests: Blood tests are done to check for signs of infection, inflammation, electrolyte imbalances, or other systemic issues that could contribute to the headaches.
- Imaging studies: In some cases, doctors may order imaging tests such as computed tomography (CT) scans or magnetic resonance imaging (MRI) scans to rule out other severe conditions like bleeding in the brain, injury, or structural abnormalities.
Based on initial findings or individual factors, additional examinations, tests, and procedures may be performed, including:
- Electroencephalogram (EEG): This test measures the electrical activity in the brain and can help identify any abnormal brain wave patterns associated with migraines or help rule out other conditions.
- Lumbar puncture or spinal tap: This procedure involves collecting a sample of cerebrospinal fluid surrounding the brain and spinal cord to check for signs of infection or bleeding.
It's important to note that these additional tests are not always necessary for diagnosing or determining the severity of migraines. The decision to perform them depends on individual circumstances.
Treatment aims to provide a sustained pain-free response as quickly as possible, without recurrence, and with minimal adverse events. Treatment options may include:
- Medications
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Triptans
- Calcitonin gene-related peptides (CGRP) receptor blockers (also called gepants)
- Ergotamines
- Antinausea medications
- Beta-blockers
- Antidepressants
- Anticonvulsants (antiseizure medications)
- Calcium channel blockers
- CGRP receptor blockers (gepants and monoclonal antibodies)
- Lifestyle modifications: In addition to medication-based treatments, lifestyle modifications may be helpful:
- Identify trigger foods: Foods such as chocolate and hard cheese are associated with migraines for some people.
- Cut out caffeine: Reducing or eliminating caffeine intake may help in managing migraines.
- Regular physical activity: Engaging in regular physical activity can help in managing migraines.
- Regular eating and sleeping schedule: Maintaining a regular eating and sleeping schedule can help in preventing migraines.
It is important to treat any existing comorbidities such as anxiety and depression, as they can worsen migraine symptoms. Psychiatric coexisting conditions should be addressed along with migraine treatment.
Treatment decisions should be based on individual factors such as frequency of migraines, level of impairment, previous treatment history, overall health, and patient preferences. Talking with a healthcare professional is recommended to determine the most suitable treatment approach for each individual. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information