Migraine is a genetically influenced complex neurological disorder characterized by episodes of moderate-to-severe headaches, typically unilateral and frequently accompanied by nausea and heightened sensitivity to light and sound. These episodes, known as migraine attacks, can last hours to days and significantly impact daily activities and the quality of life of individuals.
How are migraines classified?
According to the Headache Classification Committee of the International Headache Society migraines can be classified into:
Migraine without aura: symptoms include moderate-severe, unilateral, pulsating recurrent headache attacks lasting 4 to 72 hours. Symptoms get aggravated by physical activity, and associated with nausea, light (photophobia), and sound sensitivity (phonophobia).
Migraine with aura: this subtype is characterized by recurrent, fully reversible attacks lasting minutes, typically presenting with 1 or more unilateral symptoms such as visual, sensory, speech and language, motor, brainstem, or retinal disturbances, usually followed by headache and other migraine symptoms.
Chronic migraine: This is defined as a headache that occurs on 15 or more days in a month for more than 3 months, with migraine features present on at least 8 or more days in a month.
Probable migraine: This is a symptomatic migraine attack that lacks 1 of the features required to fulfil the criteria for 1 of the above and does not meet the criteria for another type of headache.
Menstrual migraines: Affects people who menstruate around the first day of their menstrual cycle for at least two out of three cycles. People living with menstrual migraine can have migraine attacks at other times of the month(menstrual related migraine)or only during the beginning of the cycle.
Episodic migraines: Recurrent gastrointestinal disturbances, benign paroxysmal positional vertigo and torticollis may may be associated with episodic migraines. (https://www.ncbi.nlm.nih.gov/books/NBK560787/)
What are the phases of migraine?
Prodrome: begins 24 hours prior to experiencing a headache.
Aura: An aura is a group of sensory, motor and/or speech symptoms that act as a warning sign of a migraine headache. It can last from 5 to 60 minutes with headache appearing with the symptoms or later.
Headache: A migraine headache lasts between four hours to 72 hours.
Postdrome: lasts for up to 48 hours or less. Symptoms feel like an alcohol hangover, hence it is also termed as “migraine hangover”.
All four stages can last in total anywhere from minimum 4 to 72 hours.
What are the symptoms of migraine?
A migraine headache pain may feel like throbbing, pounding, pulsing or dull. Symptoms of each phase may include:
Prodrome symptoms:
Mood changes
Difficulty concentrating
Trouble sleeping
Fatigue
Nausea
Increased hunger and thirst
Frequent urination
Aura symptoms:
Muscle weakness
Vision changes
Tinnitus (ringing in ears)
Sensitivity to touch
Numbness and tingling
Difficulty speaking or concentrating
Headache symptoms: Head pain gradually gets more intense. It can affect one side of your head or both. It can occur with other symptoms like:
Migraines are believed to result from a combination of genetic, environmental, and neurological factors. Research indicates that these headaches are linked to abnormal brain activity that affects nerve signals, chemicals, and blood vessels within the brain. A retrospective study found that 76% of the patients reported triggers. Some factors are probable contributors, while others are possible or unproven. These factors include:
Stress
Skipped meals
Weather changes
Excessive or insufficient sleeping
Odours, such as perfumes, colognes, and petroleum distillates
Neck pain
Exposure to light
Alcohol consumption
Smoking
Heat
Certain foods
Exercise
Sexual activity
Hormonal changes
How common is migraine?
Migraine is highly prevalent, affecting approximately 12% of the population, with annual rates reaching up to 17% among women and 6% among men. Among children, it is more prevalent in girls than boys. The prevalence of migraine increases during puberty, peaks between ages 35 and 39, and tends to decrease later in life, particularly after menopause. (https://www.ncbi.nlm.nih.gov/books/NBK560787/)
How is migraine diagnosed?
A neurologist, will likely diagnose migraines based on your family history, medical history, symptoms, and a physical and neurological examination.
If the symptoms are more complex, the neurologist may require further testing.
Blood tests
Magnetic resonance imaging
Computed tomography
Electroencephalogram
What is the treatment for migraine?
The treatment of migraine headaches involves a multifaceted approach aimed at alleviating symptoms, preventing attacks, and improving patients' overall quality of life. Effective management typically combines acute treatments for immediate relief during attacks, preventive strategies to reduce frequency and severity, and personalized lifestyle modifications addressing individual triggers and patient needs.
Symptoms of migraine can be relieved by following medication:
Pain relievers: Over-the-counter or prescription medication like aspirin or ibuprofen (Advil, Motrin IB, others) may be helpful, but usually only against mild migraine pain.
Triptans: Pain pathway blockers in the brain such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) may be prescribed by the physician.
Dihydroergotamine: Used as nasal spray or injection for migraines that tend to last longer than 24 hours.
Lasmiditan: This newer oral tablet is approved for the treatment of migraine with or without aura. Lasmiditan can have a sedative effect and cause dizziness, so people taking it are advised not to drive or operate machinery for at least eight hours.
Oral calcitonin gene-related peptides antagonists, known as gepants: Ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) are oral gepants, effective at treating migraine symptoms such as nausea and sensitivity to light and sound.
Zavegepant is a gepant and the only migraine medicine that comes as a nasal spray. It brings migraine pain relief within 15 minutes to 2 hours after taking a single dose. The medicine continues working for up to 48 hours. It also can improve other symptoms related to migraine, such as nausea and sensitivity to light and sound.
Opioid medicines: For people who can't take other migraine medications, narcotic opioid medications might help. Because they can be highly addictive, these are usually used only if no other treatments are effective.
