Migraine: Causes, Signs & Symptoms, Diagnosis, Prevention, and Treatment
Introduction to Migraine
Migraine is a complex neurological disorder characterized by recurrent episodes of intense, throbbing headaches, often accompanied by nausea, vomiting, and sensitivity to light and sound. Unlike a regular headache, migraine significantly affects daily activities, productivity, and overall quality of life. According to global health statistics, migraines affect more than 1 billion people worldwide, making it one of the most common disabling conditions.
Migraine attacks can last from a few hours to several days, and the pain can be so severe that it forces sufferers to rest in a dark, quiet room. It typically affects women three times more than men, largely due to hormonal factors.
Understanding migraines—including their causes, triggers, signs, diagnosis, and treatment—helps individuals manage symptoms and reduce the frequency and severity of attacks.
What Is Migraine?
Migraine is a neurological disorder involving abnormal brain activity that affects nerve signals, chemicals, and blood vessels. It is usually episodic but can become chronic if left untreated.
Migraine is categorized into two main types:
1. Migraine Without Aura (Common Migraine)
• Most common type.
• Headache occurs without sensory disturbances.
• Moderate to severe pain, often one-sided.
2. Migraine With Aura
• Aura precedes the headache.
• May involve visual changes, numbness, or speech difficulty.
• Symptoms develop gradually and last 20–60 minutes.
Other types include:
Chronic migraine (occurs more than 15 days/month)
• Hemiplegic migraine
• Retinal migraine
• Menstrual migraine
• Vestibular migraine (with dizziness)
Causes of Migraine
The exact cause of migraine is still under research, but several factors contribute to its development. These include:
1. Genetic Factors
Migraine often runs in families. If one parent has migraine, there is a 50% chance a child will develop it; if both parents have it, the risk increases to 75%.
2. Neurological Changes
Migraines involve:
• Abnormal nerve signaling
• Altered brain electrical activity
• Changes in blood flow
• Release of inflammatory substances around the brain
The trigeminal nerve plays a crucial role in transmitting pain during migraines.
3. Hormonal Fluctuations
Hormonal changes, especially estrogen fluctuations, trigger migraines in women. This explains why:
• Migraines worsen during menstruation
• Improve during pregnancy
• May change after menopause
4. Environmental Triggers
Common triggers include:
• Bright lights
• Loud noise
• Strong smells
• Weather changes
• High altitudes
5. Food and Dietary Triggers
Some individuals experience migraine after consuming:
• Caffeine
• Alcohol, especially red wine
• Aged cheese
• Chocolate
• Processed meats (containing nitrates)
• MSG (Monosodium Glutamate)
• Artificial sweeteners (aspartame)
6. Stress and Emotional Factors
Stress is one of the most common triggers. Both physical and emotional stress can initiate or worsen migraine attacks.
7. Sleep Disturbances
Both too much and too little sleep can trigger migraines, including shift work and jet lag.
8. Certain Medications
Some medications like oral contraceptives and vasodilators can trigger migraines in susceptible individuals.
Signs and Symptoms of Migraine
Migraine symptoms typically progress through four stages; not everyone experiences all stages.
1. Prodrome Stage (Early Warning Signs)
Occurs hours or days before the headache.
Common signs:
• Mood changes (irritability, depression)
• Food cravings
• Stiff neck
• Increased urination
• Constipation or diarrhea
• Frequent yawning
• Sensitivity to smells
2. Aura Stage
Affects 20–25% of migraine sufferers.
Common aura signs:
• Visual disturbances (flashing lights, zig-zag lines, blind spots)
• Numbness or tingling in face or hands
• Difficulty speaking
• Temporary vision loss
• Aura usually lasts 5–60 minutes.
3. Headache Stage
The main phase of migraine.
Headache characteristics:
• Throbbing or pulsating pain
• Usually one-sided (but can be both sides)
• Moderate to severe intensity
• Pain worsens with physical activity
Associated symptoms:
• Nausea and vomiting
• Sensitivity to light (photophobia)
• Sensitivity to sound (phonophobia)
• Blurred vision
• Dizziness
• Fatigue
• This phase lasts 4–72 hours.
4. Postdrome Stage (Migraine Hangover)
Symptoms after the headache ends:
• Fatigue
• Dizziness
• Mood swings
• Weakness
• Difficulty concentrating
Diagnosis of Migraine
Diagnosing migraine involves medical history, physical examination, and sometimes tests.
1. Medical History
The doctor will ask about:
• Headache frequency
• Location of pain
• Nature of symptoms
• Triggers
• Family history
2. Physical and Neurological Examination
To rule out conditions like:
• Stroke
• Brain tumor
• Infection
3. Diagnostic Tests
These tests help rule out other causes:
MRI Scan
Checks for abnormalities like tumors, bleeding, infections.
CT Scan
Helps rule out brain hemorrhage or structural abnormalities.
Blood Tests
Helpful if infection or inflammation is suspected.
Lumbar Puncture (Rare)
Done if meningitis or bleeding is suspected.
Prevention of Migraine
Preventive measures help reduce the frequency and severity of migraine attacks.
1. Avoiding Migraine Triggers
Identify triggers using a migraine diary and avoid them.
2. Healthy Lifestyle Habits
• Maintain regular sleep schedule
• Eat balanced and timely meals
• Drink plenty of water
• Exercise regularly
• Practice yoga or meditation
3. Manage Stress
Helpful techniques:
• Deep breathing
• Mindfulness
• Cognitive-behavioral therapy (CBT)
• Stress management techniques
4. Dietary Management
Avoid foods that trigger migraine. Increase:
• Magnesium-rich foods
• Omega-3 fatty acids
• Fresh fruits and vegetables
5. Hormonal Regulation
Women may need hormonal management if migraines are linked to menstrual cycles.
6. Preventive Medications
Doctors may prescribe:
• Beta-blockers (propranolol)
• Antidepressants (amitriptyline)
• Anticonvulsants (topiramate)
• CGRP inhibitors (newer drugs)
Treatment of Migraine
Treatment depends on severity and frequency.
1. Acute (Abortive) Treatments
Used at the onset of an attack.
a. Over-the-Counter Pain Relievers
• Ibuprofen
• Paracetamol
• Aspirin
b. Triptans
These drugs narrow blood vessels and block pain pathways.
• Sumatriptan
• Rizatriptan
c. Ergot Derivatives
Used when triptans are not effective.
d. Anti-Nausea Medications
For nausea and vomiting:
• Metoclopramide
• Domperidone
2. Preventive (Prophylactic) Treatments
Used for frequent or severe migraines.
a. Beta-Blockers
• Propranolol
• Metoprolol
b. Anti-Seizure Drugs
• Topiramate
• Valproate
c. Antidepressants
• Amitriptyline
• Venlafaxine
d. Botox Injections
Used for chronic migraine (more than 15 days/month).
e. CGRP Inhibitors
New migraine-specific preventive injections:
• Erenumab
• Fremanezumab
3. Natural and Home Remedies
• Rest in a dark, quiet room
• Apply cold compress
• Stay hydrated
• Herbal remedies (feverfew, ginger)
• Magnesium supplements
Complications of Migraine
If untreated, migraines may lead to:
• Chronic migraine
• Medication-overuse headache
• Depression and anxiety
• Sleep disorders
• Stroke (rare but possible in migraine with aura)
Living with Migraine
Managing migraines is a long-term process. With lifestyle modifications, medication, and proper management, most people can keep migraine attacks under control.
Keeping a migraine diary helps track triggers, symptoms, and treatment responses, helping doctors adjust therapy effectively.
Frequently Asked Questions (FAQs)
1. What is the main cause of migraine?
The exact cause is unknown, but a combination of genetics, hormonal changes, brain chemical imbalance, and triggers like stress and certain foods contribute.
2. Can migraine be cured permanently?
There is no permanent cure, but symptoms can be effectively managed with lifestyle changes and medication.
3. How long does a migraine last?
Most migraines last between 4 to 72 hours.
4. Is migraine dangerous?
Migraine is not usually dangerous but can significantly affect daily life. Rare complications like stroke may occur.
5. Does caffeine trigger migraine?
For some people, caffeine triggers migraine; for others, it provides relief. It depends on individual sensitivity.
6. What deficiency causes migraine?
Low levels of magnesium, vitamin D, or riboflavin (B2) may contribute.
7. What are the best home remedies for migraine?
• Cold compress
• Hydration
• Ginger tea
• Rest in a dark room
• Massage
8. When should I see a doctor?
Seek medical advice if:
• Headaches become frequent
• Symptoms worsen
• Headaches start suddenly after age 50
• Neurological symptoms occur (difficulty speaking, paralysis, vision loss)
Conclusion
Migraine is a chronic neurological condition that affects millions globally, but with proper understanding and management, individuals can reduce the severity and frequency of attacks. Recognizing triggers, adopting healthy lifestyle habits, and following medical advice are the key steps to living a migraine-free life. With continuous research and advancements in treatment, managing migraines has become more effective than ever.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group)