Migraines often start in childhood, adolescence or early adulthood. A migraine headache may cause intense throbbing or a pulsing sensation in one area of the head. The condition is typically accompanied by nausea, vomiting as well as sensitivity to light and sound. The painful attacks might last for hours or even days. In some patients, they are so severe that all they want to do is lying down in a dark room. Although there is no cure for migraines, a number of treatments and lifestyle changes help ease the symptoms.
The most common symptoms include:
- Throbbing headache
- Sensitivity to light and noise
- Lack of energy
However, migraines may progress through four stages. But not every patient experiences all stages:
- Prodrome (one or two days before the migraine starts):
Subtle changes, such as depression, constipation, yawning, food cravings, hyperactivity, irritability, stiff neck.
- Aura (before or during migraine headache):
Symptoms might include visual disturbances, e.g. flashes of light, movement or speech disturbances, vision loss, needles sensations in a leg or an arm. But many patients don’t experience this stage. If these symptoms do occur, they start gradually, build up over several minutes and then usually last for 20 to 60 minutes.
- Attack (an untreated migraine may last between four hours and three days – several times per month or less often):
The patient may suffer from symptoms, such as throbbing pain on one side or both sides of the head, sensitivity to light and sounds, nausea, vomiting, blurred vision, dizziness, fainting.
- Postdrome (after migraine attack)
The patients often feel drained. However, some people might be mildly euphoric.
Although the causes of migraine are not yet fully understood, it’s known that:
- Migraines run in families
- Women are three times more likely than men to get the disorder
- Migraines usually start in childhood, adolescence or early adulthood
- Patients with depression, anxiety, asthma, epilepsy are more likely to get migraines
But it isn't clear why some people suffer from this painful condition and others don't. However, various triggers might also bring on a migraine. If a person has several triggers, it increases the chance of getting the disorder.
Triggers might be:
- Not eating
- Red wine
- Monosodium glutamate
- Poor sleep habits
- A change from the routine
- Strong odors
If the affected person gets headaches on more than 15 days a month for at least three months, and if he/she has a migraine on eight of these days, the migraine is chronic. This condition may have a big effect on the patient’s life. He/she typically takes increasing amounts of medicine to ease the symptoms. But in the long run this can result in further headaches (“medication-overuse headaches”).
In addition, some pain relievers, e.g. ibuprofen, might lead to abdominal pain, bleeding, ulcers and other complications, particularly if the patient takes the medication in large doses or for a long period of time.
In rare cases, other complications might occur, such as serotonin syndrome or migrainous infarction.
There are three different levels of migraine treatment: preventative, acute and rescue treatment.
If patients suffer from very bad headaches, the physician may prescribe preventative medications. The drugs have usually been developed to treat other diseases but can also stop migraine attacks from happening. Among these medicaments are: anticonvulsants, antidepressants, antihistimines, beta-blockers, anti-inflammatory drugs and others. The doctor has to decide how long the patient should take this medication (normally between three and 18 months). These medicaments may break a cycle of migraine in some people. But the doctor can only find the right medication, if the affected person watches and records any attacks that happen while taking the preventative medication.
Stronger pain killers and other medicines might stop a migraine attack. A physician who prescribes acute treatments usually bases his/her decision on an assessment of disability, i.e. the effects of the migraine attacks in order to choose the right care for the patient. The goal is to create an individual plan to manage the headaches at an early stage. If this works, the doctor doesn’t have to increase the level of treatment again and again if lower levels fail.
“Rescue medication” might be used if acute treatment doesn’t work. The doctor may prescribe an anti-nausea medicament together with anti-inflammatory or pain-relieving medication to ease the symptoms. If rescue treatment is necessary, it also means that the acute treatment might not work properly and has to be changed.
Apart from taking preventive medications, the patient might also benefit from lifestyle changes – after having talked to his/her doctor about the most useful measures. The number and severity of migraine headaches might be reduced by:
- Avoiding certain foods, drinks, odors that caused migraines in the past
- Reducing caffeine and alcohol
- Avoiding tobacco
- Following regular sleep patterns
- Eating at regular times
- Controlling stress
- Exercising on a regular basis (e.g. aerobic, walking, swimming, biking)
- Maintaining a healthy weight
- Losing weight if overweight
- Avoiding or reducing medications with estrogen