Dr. Goyal Rewa is a neurologist and headache expert who specializes in migraine treatment. He specializes in diagnosing and treating migraines, cluster headaches, and other debilitating headaches.

 

What is Migraine? – Types, Causes and Treatments of Migraine

 

A migraine is nothing like a typical headache. A migraine headache comes with a throbbing pain or a pulsing sensation, usually on one side of the head.

Migraine headaches are often triggered by movement, light, and sound and are followed by excruciating pain, tiredness, fatigue, loss of energy, nausea, and visual disturbances. Some instances may even have irritability, difficulty speaking, temporary loss of vision and other severe symptoms.

These attacks can continue for hours to days and may aggravate so severely that they obstruct your daily activities. 

For a viewpoint of a person suffering with migraine the word “ache” doesn’t do justice to the pain as sometimes it’s mild, but usually, it’s described as a drilling, hammering and throbbing sensation. At the same time, numbness takes all over you leaving you with a feeling of an icepick in your head.

 

What is a migraine?

Migraine is a common neurological disease with a throbbing –hammering pain and lasts as a pulsing headache, particularly on one side of the head. 

Migraines can likely worsen with physical activity, lights, sounds or smells, and some attacks may last for at least four hours or even days. Studies have shown that migraine is the sixth most disabling disease in the world.

 

 

What are the different types of headaches? Is migraine a primary headache?

There are over 150 types of headaches, which can be broadly categorised into two categories – primary headaches and secondary headaches. 

A migraine is a primary headache, meaning any other underlying medical condition doesn’t cause migraines.

Primary headache disorders are clinical diagnoses, i.e., no particular medical condition, blood test or imaging study to diagnose it. Secondary headache is caused due to another health issue.

 

 

What is an aura?

An aura is usually known as the onset stage of migraine headaches, where the sensory, motor and speech symptoms indicate and act like warning signals.

The aura stage commonly happens before the headache pain but can sometimes appear during or even after. The aura stage can typically last from 10-60 minutes.

 

Symptoms of migraine aura –

The aura symptoms are curable, and the aura symptoms may include –

1. Blind spots in vision
2. Numb or tingling sensation
3. Bright flashing dots, sparkles, or lights
4. Speech changes
5. Constant ringing in the ears
6. Temporary vision loss
7. Seeing wavy or jagged lines
8. Changes in smell, taste and vision
9. Having a “funny” feeling

 

 

What are the types of migraines?

There are numerous types of migraines. At times, the same type of migraine can go by different names –

Migraine with aura: A migraine with aura is known as complicated migraine, and around 15% to 20% of people with migraine headaches experience an aura before the actual pain starts.

 

 

Migraine without aura: It is the common migraine, and the migraine headache strikes without the aura stage. The symptoms are the same, except for the aura stage.

 

Migraine without head pain: Also

known as “silent migraine” or “acephalgic migraine,” has the aura

symptoms, but the headache typically doesn’t follow.

 

Hemiplegic migraine: Hemiplegic migraine temporarily paralyses you. Hemiplegia (paralysis) is neurological or sensory changes on one side of your body. The onset of hemiplegic migraine may begin with temporary numbness, extreme weakness on one side of your body accompanied by a tingling sensation, a loss of sensation and dizziness or vision changes. Such a migraine may include headaches sometimes and sometimes may not.

 

Retinal migraine: Retinal migraine is also known as ocular migraine. In retinal migraines, you may notice temporary, partial or complete vision loss in one of your eyes. It also comes with a dull ache behind the eye that may gradually spread to the rest of your head. The vision loss may last for a minute or may prolong for months.

 

 

Chronic Migraine:  A chronic migraine is a repetitive condition that occurs at least 15 days per month. The symptoms of chronic migraine frequently change along with the severity of the pain. 

Migraine with brainstem aura: Migraine with brainstem aura is accompanied by the conditions of vertigo, slurred speech, double vision or loss of balance which usually happens in the aura stage. The headache may affect the back of your head, as the symptoms occur suddenly and may lead to nausea, inability to speak and ringing in the ears.

 

Status migrainosus: Status migrainosus is a rare migraine condition lasting longer than 72 hours. The effects of status migrainosus can be terrible. It can also happen as a side effect of certain medications or result from medication withdrawal.

 

 

 

What are the four stages or phases of migraine? How long do migraines last?

 

There are four stages of migraine. The four stages of migraine in chronological order are – prodrome (premonitory), aura, headache and postdrome. 

The different phases of migraine are –

Pro-drome: The first stage of migraine can last for a few hours or extend to a few days. Although, this doesn't happen often. Pro-drome is also known as the "preheadache" or "premonitory" phase.

Aura: The aura phase can last as little as 5-10 minutes or as long as 60 minutes. Most people don't experience the aura stage; however, most experience both simultaneously.

Headache: A migraine headache lasts from about 4 to 72 hours. The word "ache" doesn't do justice to the pain as sometimes it's mild, but usually, it's described as a drilling, hammering and throbbing sensation. At the same time, some numbness takes over you leaving you with a sense of an icepick in your head. This pain usually begins on particularly one side of the head but gradually overshadows the other side.

Postdrome: The post-drome or the withdrawal phase goes on for a day or two and is often called a migraine "hangover". Around 80% of people suffering from migraine experience migraine hangovers.

 

Typically, one goes through these four stages for 8 to 72 hours.

 

What are the symptoms of the four stages of migraine?

About 30% of people experience symptoms before their headache starts.

 

 Stage 1 –

Symptoms of the Prodrome stage of migraine include –

1. Constipation
2. Temperament changes from depression to euphoria
3. Food desires
4. Neck stiffness
5. Enhanced urination
6. Retention of fluid
7. Incessant yawning

 

 Stage 2 –

Symptoms of the Aura stage of migraine include –

1. Visual peculiarities, like seeing different shapes, splendid spots or blazes of light
2. Vision loss
3. Tingling sensations in an arm or leg
4. Numbness or weakness in the face or one side of the body
5. Trouble talking

 Stage 3 –

Symptoms of the Headache stage of migraine include –

1. The aggravation is typically on one side of your head, yet frequently on the two sides
2. The torment that pulsates or heartbeats
3. Aversion to light, sound, and, once in a while, smell and contact
4. Nausea and vomiting

 

 

 Stage 4 –

Symptoms of the Post-drome stage of migraine include –

1. Feeling depressed
2. Lack of ability to concentrate
3. Fatigue
4. Feeling euphoric
5. Not being able to understand things

 

 

What causes a migraine?

 

The particular cause of migraine is yet to be fully understood. But, when you have a headache, specific nerves in your blood vessels send pain signals to your brain. These signals, as a response, release inflammatory substances into your head's nerves and blood vessels. This process still needs to be clarified.

What factors trigger migraine?

 Several factors can trigger migraine attacks. Some of the most common elements of migraine triggers include –

Emotional stress: Emotional stress is one of the most common triggers of migraine headaches. Stressful events can lead the brain to release large amounts of cortisol, which might trigger a migraine. 

Other emotional conditions such as anxiety, worry and excitement can increase muscle tension and dilate blood vessels making the migraine more severe.

Skipping meals: Skipping or delaying meals might also cause your migraine.

Sensitivity to specific chemicals and preservatives in foods: Added preservatives in certain foods and beverages such as aged cheese, beverages containing alcohol, and chocolate and food additives such as nitrates (found in pepperoni, hot dogs and luncheon meats) and fermented or pickled foods may trigger migraine attacks.

These foods alone are responsible for triggering up to 30% of migraines

Caffeine: Too much caffeine intake or a sudden caffeine withdrawal can a cause of triggering migraines. When your blood vessels seem sensitised to caffeine, a withdrawal might trigger a migraine attack. 

Frequent usage of painkillers: Frequent pain relevant may also cause a rebound headache.

Hormonal changes in women: Well, women are more likely to suffer migraines than men. This could be even more common around the period of the menstrual cycle. The abrupt drop in estrogen can trigger migraines.

Also, hormonal changes due to birth control pills, hormone replacement therapy, puberty, menopause, etc., can cause migraines. However, men tend not to be affected by the hormonal impacts of migraine.

Light exposure: Flashing lights, fluorescent lights, light from the TV or computer, and sunlight can trigger migraines.

 

Other possible triggers of migraines include –

 

1. Changing weather conditions
2. Overexertion
3. Changes in diet, dehydration
4. Changes in sleeping pattern
5. Being exposed to loud noises
6. Exposure to strong fragrances and odors
7. Certain medications

 

How to treat migraine?

Migraine treatment is aimed at ceasing the symptoms and preventing future attacks.

Several medications have been designed to treat migraines. Drugs used to combat migraines fall into two broad categories:

Pain-killing medications: Pain-relieving medications are also known as acute or abortive treatments. These medicines are the drugs taken during migraine attacks to stop further symptoms.

Such medicines include - pain relievers include aspirin or ibuprofen (Advil, Motrin I.B., others), Triptans, Dihydroergotamine (D.H.E. 45, Migranal), Lasmiditan (Reyvow), Ubrogepant (Ubrelvy), CGRP antagonists, Opioid medications, and Anti-nausea drugs.

Preventive medications: Preventive medications are taken regularly. These medicines can be taken daily to reduce the severity or frequency of migraines.

Blood pressure-lowering medications (propranolol - Inderal, InnoPran XL, and metoprolol tartrate (Lopressor), Antidepressants (amitriptyline), Anti-seizure drugs (Valproate and topiramate Topamax, Qudexy XR, others), Botox injections, CGRP monoclonal antibodies (Erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy), galcanezumab-gnlm (Emgality), and eptinezumab-jjmr (Vyepti)

 

Your treatment choices depend on the severity and frequency of the headaches. But, you must first consult your doctor before trying any of these medicines to ease your pain.

Your treatment choices depend on the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have.