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MIGRAINE

Definition

A migraine is a throbbing and pulsating pain in one side of the head.

It lasts for few hours to few days and is commonly accompanied by nausea, vomiting and eyesight problems.

A migraine is preceded by symptoms like flashes of light, tingling in arms or legs, buzzing in ears, etc. (aura)

Symptoms

Migraine may progress through 4 stages:

  1. Prodrome
  2. Aura
  3. Headache episode
  4. Postdrome

Prodrome:

1-2 days before migraine, either one or two of these symptoms may be experienced:

  • No urge for passing stools or hard stools
  • Desire for certain foods
  • Depression
  • Irritability
  • Continuous yawning
  • Neck stiffness

Aura:

Aura may occur before or during migraine attack. It includes symptoms like:

  • Flashes of light
  • Seeing of different shapes
  • Vision loss
  • Difficulty in speech (aphasia)
  • Tingling or pin-pricking sensation in arms or legs.

Headache episode:

Migraine attack usually lasts for 4-72 hrs.

The intensity and frequency of headaches may vary from person to person.

Symptoms may be as follows:

  • Pain on one or both sides of the head
  • Throbbing or pulsating nature of a headache
  • Nausea and vomiting
  • fainting sometimes
  • Sensitivity to light, noise and sometimes smells and touch.

Postdrome:

A stage after migraine attack where in the person feels drained out and weak.

Causes

Although the exact cause of migraine is not clearly known, one of the following may play a role in causing migraine:

  • Genetic factors
  • Environmental factors
  • Imbalances in brain chemicals like Serotonin which helps to regulate the pain
  • Serotonin levels drop during migraine attack à certain nerve releases substances called neuropeptides à travels to brain’s outer covering (meninges) à gives rise to pain.

Triggering factors

  • Hormonal changes in women
  • Before or during menstrual periods
  • During pregnancy or menopause
  • While taking oral contraceptive pills
  • This occurs due to an imbalance in the levels of estrogen hormone.
  • Food and drinks
  • Old cheese
  • Salty foods
  • Processed foods
  • Food additives like sweetener aspartame and preservative monosodium glutamate
  • Alcohol especially wine
  • Drinks containing high levels of caffeine
  • Stress at work or home
  • Sensory stimuli
  • Bright light or excessive sun exposure
  • Loud noises
  • Unusually strong smells of paints, perfumes or smoke etc.
  • Changes in sleep wake pattern
  • Excessive sleeping or decreased sleep can lead to a migraine headache.
  • Environmental and physical factors
  • excessive physical work
  • changes in weather
  • Medications
  • Oral contraceptives
  • Certain blood pressure medicines

Diagnosis

A migraine can be diagnosed by following measures:

  • Medical history of the patient
  • Family history if any
  • Signs and symptoms of the migraine attack
  • Physical and neurological examination of the patient
  • Certain investigations to rule out other serious conditions.

Investigations include:

Blood tests

  • To rule out blood vessel problems
  • Infections of spinal cord or brain

CT Scan and MRI

  • To rule out tumors, infections, brain damage, brain hemorrhages.

Spinal Tap or Lumbar Puncture

  • This is done to extract a sample of cerebrospinal fluid if infection or brain hemorrhage is detected.

Self help

  • Muscle relaxation and body calming exercises like yoga or meditation
  • Enough and sound sleep. Avoid oversleeping.
  • Rest and relax in a quiet and dark place when there is an episode of a headache. Apply an ice pack on painful areas of head and neck.
  • Maintain a headache diary to know better about the triggers and frequencies of headaches.