Migraines

MIGRAINES

What is Migraine?

Migraine is a neurovascular headache and is caused by an interaction between blood vessels and nerve abnormalities. Migraine is the second most common type of primary headache.


Migraine typically lasts anywhere between 4 to several days and is associated with severe pain mostly on one side of the head. However it is possible to affect both sides of the head. Women are more likely to get migraines than men.


Causes of Migraines

It is yet unknown what exactly causes a migraine. Inflammatory processes in the blood vessels of the brain could be involved in the development of migraines. Additionally, a stressful and hectic daily life can promote the development of migraines.


Oftenly, when an individual is predisposed to migraines, they have specific aggravating factors that will bring a migraine on. These factors can vary from person to person and each person has a different trigger.


Few triggers that may cause migraines are:

  Genetics reason if someone in your family has same medical condition

  Joint dysfunction like Temporomandibular Joint Disorder (TMD)

  Fluctuating hormone levels in women

  Menopause

  Clenching or grinding your teeth

  Contraceptives medications

  An injury or trauma to the head

  Stress or depression or anxiety

  Too much sleep or too little sleep

  Caffeine, high sugar and artificial sweeteners

  High use of alcohol or red wine

  Change in environment or weather

  Bright or flickering lights

  Loud noises

  Strong smells


Symptoms of Migraines

Migraines may have various symptom phases. These phases vary from person to person.Various migraine phases are:


Attack Phase:  Symptoms can occur in the Attack phase and can last from hours to days and vary from person to person. Symptoms can include:

  Severe throbbing one sided headache and sometimes pain spread to the whole head

  Worsening pain with physical activity

  Lightheadedness or fainting

  Nausea, vomiting

  Facial tingling or numbness

  Sensitivity to light, noise or smells


Aura Phase:  Sensory disturbances related symptoms can occur before or during a migraine. Symptoms start gradually and last for 20 to 60 minutes. Symptoms can include:

Positive Auras:  Bright or shimmering light or shapes at the end of the field of vision. They can get bigger and fill the field of vision

Negative Auras:  Dark holes, blind spots, or tunnel vision

  Speech disturbances

  Confusion

  Tingling, numbness, or weakness in arm or leg


Prodrome Phase:  Symptoms can occur a few hours or even a few days before suffering a migraine. Symptoms can include:

  Fatigue and drowsiness

  Change in mood

  Change in appetite

  Increased thirst

  Sensitivity to light or sound

  Neck stiffness


Types of Migraines

There are many types of migraines, and they can be categorized by their symptoms. Understanding the type of migraines may help you and your doctor to treat you more effectively. Here they are:


Abdominal migraine:  Signs can include severe nausea or vomiting and possible abdominal pain. This type is the most common in children and adolescents.

Hemiplegic migraine:  Signs can include temporary motor weakness like one-sided whole-body paralysis. This type is more common in infants and children.

Menstrual migraine:  Migraine may be triggered in a woman either just before or during her menstrual cycle.

Migraine with brainstem aura:  Formally known as Basilar Migraine. Signs can include dizziness, slurred speech, ringing in the ears, walking abnormality, motion or spinning imbalance, double vision and a lower level of consciousness.

Ocular (Retinal) migraine:  Signs can include visual disturbances like flashes of light, wavy lines or blind spots in one eye for approximately 30 minutes.

Silent (Acephalgic) migraine:  Signs can include aura symptoms without a headache.

Vestibular migraine:  Signs can include extreme sensitivity to motion and dizziness.


How are Migraines diagnosed?

Your family doctor or a neurologist can diagnose migraines based on your family history, medical history, symptoms, lifestyle and a physical examination. Mostly, these details are enough to determine or rule out a migraine.


Your doctor may consider further testing like a CT scan or an MRI (Magnetic Resonance Imaging), if your condition is unusual, complex or uncertain. These tests can help doctors to diagnose tumors, strokes, bleeding in the brain, infections and other neurological conditions.


Treatment & Prevention of Migraines

Currently there is no cure for migraines, but there are several treatments and medications available to relieve symptoms. Common migraine treatments include:


Medications:

Migraines medications either focus on relieving migraine symptoms or on preventing future attacks. You can take pain-relieving medications during a migraine attack to stop the symptoms. However, if you suffer from very severe or frequent migraines, your doctor can suggest regular or daily medications that could help you manage your condition long-term.


Pain relieving medications:

OTC Medicines:  Over the counter medications are helpful during your migraine treatment plan and work best when taken during the early sign of a migraine. Keep in mind that overuse of OTC pain killers may cause medication-overuse headaches. Other risks may include ulcers and bleeding in the gastrointestinal tract.

  Ibuprofen

  Advil

  Motrin IB

  Caffeine

  Aspirin

  Acetaminophen


Anti-Nausea medicines:  When a migraine is accompanied by nausea and vomiting, it is recommended to take anti-nausea drugs.

  Chlorpromazine

  Metoclopramide

  Prochlorperazine


Triptans:  Triptans are prescription drugs that block pain pathways in the brain and balance the chemicals in the brain. Triptans can be taken as pills, shots or nasal sprays.

  Almotriptan

  Eletriptan

  Relpax

  Sumatriptan

  Imitrex

  Tosymra

  Rizatriptan

  Maxalt

  Zolmitriptan

  Zomig

  Ergotamine

  Cafergot

  Ergomar


Opioid medicines:  Narcotic opioid medications containing codeine can help relieve migraine symptoms. Your doctor may prescribe these if you cannot take triptans or ergots for some reason. This class of drugs is highly addictive and so are generally used as a last resort if no other treatments are effective.

  Vicodin

  OxyContin

  Percocet

  Oxymorphone

  Morphin

  Codeine

  Fentanyl


Sensitivity relief medicines:   This drug eases pain, nausea, and sensitivity to light or sound.

  Reyvow


Preventative medications:

If you suffer from frequent or severe migraines, your doctor may prescribe drugs that need to be taken on a regular basis. Here is an outline of some of the classes of drug your doctor may want to use to help you reduce the frequency and severity of your migraines.


CGRP receptor antagonists:  This class of drugs works on a protein that’s found around the brain called the Calcitonin Gene-Related Peptide (CGRP) which is believed to be responsible for some of the migraine pain.

  Aimovig

  Ajovy

  Nurtec

  Ubrelvy


Beta-blockers:  This class of drugs commonly prescribed for high blood pressure. Beta-blockers can also help reduce both the frequency and intensity of migraines as they decrease the effect of stress hormones on your heart and blood vessels. Possible side effects of beta-blockers are such as fatigue, nausea, dizziness when standing, depression or insomnia.

  Atenolol

  Tenormin

  Metoprolol

  Toprol XL

  Nadolol

  Corgard

  Propranolol

  Inderal

  Timolol


Calcium channel blockers:  This class of drugs is generally used to control blood pressure as they moderate the constriction and dilation of your blood vessels but this also makes them helpful in the management of migraine pain. Possible side effects are such as low blood pressure, weight gain, dizziness or constipation.

  Diltiazem

  Cardizem

  Cartia XT

  Tiazac

  Nimodipine

  Verapamil

  Calan SR

  Verelan


Antidepressants:  This class of drugs effects on various brain chemicals including serotonin. An increase of serotonin can reduce inflammation and constrict blood vessels, helping alleviate migraines. Possible side effects are such as weight gain and decreased libido.

  Amitriptyline

  Fluoxetine

  Prozac

  Imipramine

  Nortriptyline

  Pamelor

  Paroxetine

  Paxil

  Pexeva


Anticonvulsants:  This class of drugs is generally used to prevent seizures caused by epilepsy and other conditions but they may also alleviate migraine symptoms by calming overactive nerves in the brain. Possible side effects are nausea, vomiting, diarrhea, weight gain, sleepiness, dizziness or blurred vision.

  Divalproex-Sodium

  Depakote

  Depakote ER

  Gabapentin

  Levetiracetam

  Keppra

  Pregabalin

  Lyrica


Botulinum toxin type A (Botox):  Botox (Botulinum toxin type A) injections in forehead or neck muscles for the treatment of chronic migraine. Generally, these have to be repeated every three months and can be expensive.

  Botox


Alternative treatments or therapies:

Alternative treatments or therapies can be helpful to some people to get relief from migraine pain. They include:

  Biofeedback uses electronic devices to teach you to control body functions such as heartbeat, blood pressure, and muscle tension

  Hormone therapy can be helpful if your migraines are related to your menstrual cycle.

  Research has found that some vitamins, minerals and herbs can prevent or treat migraines. These include riboflavin (vitamin B12), coenzyme Q10, Magnesium and melatonin

  Resting with your eyes closed in a dark, quiet room

  Putting a cool compress or ice pack on your forehead

  Doing physical treatments like chiropractic, massage, acupressure, acupuncture and craniosacral therapy

  Writing down lifestyle habits like eating, drinking, sleeping, exercise and stressful events in a diary can help you identify what appears to trigger your migraines and what it might be helpful to maintain or avoid in your daily routine. Diary can also help you figure out what positive action to take.


Lifestyle changes:

You may ease migraine symptoms by making some simple lifestyle tweaks and trying some home remedies like:

  Drinking plenty of liquids

  Exercise regularly

  Loss weight if you are overweight

  Learn relaxation techniques like meditations, yoga or deep breathing

  Eat and sleep on a regular schedule


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