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What is a migraine?
A severe migraine attack can cause a persistent throbbing or pounding pain, with sensitivity to light, sound and movement. The pain may be on just one side of the head, though there may be pressure on both. Attacks last between four and 72 hours. You may also feel nauseous, be sick, have diarrhoea, or feel exhausted.Who gets migraines?
Migraines affect about 15 percent of adults. They tend to run in families, and are about twice as common in women than men. Migraines also affect around four percent of children, but they are most common in adults aged between 20 and 50.
The most common symptoms of a migraine attack include throbbing headache, sensitivity to light and noise, nausea (feeling sick), vomiting (being sick) and lethargy (lack of energy).
Most sufferers report visual disturbances (aura) that start before or accompany the headache, including flashing lights, black spots, zig-zag patterns or distorted vision. You might also get a stiff neck, have tingling or stiff limbs, or have difficulty speaking.
For many, the symptoms are so severe that they are forced to lie down in a quiet dark room and wait until the migraine stops.
What causes a migraine?
Although the cause of a migraine is not fully understood, most sufferers probably have a genetic predisposition to them. About 80 percent of people who have migraine headaches have a family history of migraines.
It used to be thought that the aura and then headaches in migraines were caused by blood vessels at first contracting and then expanding (dilating) in the brain. However, recent research suggests that migraine symptoms are caused by changes in the activity of neurones (nerve cells in the brain), and that changes in blood vessels happen as a result of this. A chemical messenger in the brain - serotonin - is also thought to be involved in migraine.
In women who suffer from migraines, hormonal changes may also play a part. Some women get menstrual migraines - migraines that only happen in the days before, during, or immediately after a period. Many women have their first migraine in the same year as their first menstrual period.
Some people find that their migraines are triggered by specific events or stimuli such as:
certain foods such as chocolate, cheese, citrus fruits, coffee, tea
alcohol
too much or too little sleep
changes in hormone balance in women - such as periods, the pill, menopause and hormone replacement therapy
emotional stress, or relaxation after a period of stress
irregular meals
physical activity
smoking
bright or flashing lights
loud noise
weather - high pressure conditions, changes in pressure, hot dry winds, change of season and exposure to sun and glare
intense smells such as paint, fumes from cars or perfume
Unfortunately, avoiding triggers is not always possible, and even then this may not prevent an attack - most migraines have no obvious identifiable trigger.
It is often difficult to predict when a migraine attack is going to happen. However, you can often predict the pattern of each attack. In adults, we can divide a migraine attack into four or five phases that lead on from each other.
Learning to recognise the different phases of a migraine attack can be useful. You might suffer from one, all, or a combination of these stages, and the combination of stages may vary from attack to attack. Recognising different symptoms at different times during your headache attack can give a doctor information which may help diagnosis.
Also, taking medication before the symptoms have fully developed may reduce the effect of an attack. A child's migraine attack is often much shorter than an adult’s attack, and it may therefore not be possible to fully make out the different headache phases.
1) The pre-headache, or warning phase or Aura (not always present)
The aura of migraine includes a wide range of neurological symptoms. This stage can last for between 5 and 30 minutes, and usually happens before the headache. Only 15% of migraine sufferers have aura. Migraine without aura does not include this stage.
2) The headache
This stage involves head pain which can be severe, even unbearable. The headache is typically throbbing, and made worse by movement. Some sufferers describe a pressing or tightening pain. The headache is usually on one side of the head, especially at the start of an attack. Some sufferers get pain on both sides of the head, or over the forehead, but not usually at the back of the head. Nausea (sickness) and vomiting (being sick) can happen at this stage, and the sufferer may feel sensitive to light or sound, or both.
3) Resolution
Most attacks slowly fade away, but some stop suddenly after the sufferer is sick, or cries a lot. Sleep seems to be the best 'cure' for many sufferers, who find that even an hour or two can be enough to end an attack. Many children find that sleeping for just a few minutes can stop their attack.
4) Recovery
This is the final stage of an attack, and it can take hours or days for a ‘hangover’ type feeling to disappear. Symptoms can be similar to those of the first stage, and often they are mirrored symptoms. For example, if you lost your appetite at the beginning of the attack, you might be very hungry now. If you were tired, now you might feel full of energy.
Natural remedies
Supplements containing Magnesium and Vitamin B2 are useful. Two herbal remedies have well-established histories of effectiveness - Butterbur and Feverfew. Butterbur, in particular, has been shown to have a preventitive action in double blind, placebo controlled trials (2000). A 62% reduction in 'migraine days' was reported when patients took 2 50mg tablets a day for twelve weeks of a standardised extract containing 15% petasin and isopetasin.
Other treatments
Specially tinted glasses
Dental splints to reduce teeth grinding and clenching your jaw which may trigger attacks.
Physiotherapy
Relaxation therapy
Temperature change
Acupuncture
Recent evidence also indicates that migraines are more common in people with depression, and that depression is more common in people that suffer from migraines. Researchers are investigating whether treating depression can help relieve migraines and vice versa.
Keep a diary. It can help to try and identify, track and avoid triggers.
When to see a doctor
It is possible that migraine symptoms are caused by something more serious. See a doctor if you experience any of the symptoms below.
Aura symptoms that are always on the same side of the body, or last less than five minutes or more than an hour.
Aura symptoms without a headache.
A sudden change in the character of your migraine such as attacks coming more often, or treatment not working.
Headache after you exercise.
Your first ever attack when you're over 50.
Stomach pains with the headache.
Nervous system problems - difficulty in walking, or disturbance of vision between attacks.
A high temperature with the headache.
Over-the-counter medicines
Mild migraine attacks tend to clear up in a few hours. It's best to rest in a quiet, darkened room, and use the painkiller that you would normally take for a non-migrainous headache. Soluble versions of these painkillers may work better than tablets. Take it as soon as you can - treatments for migraine are more effective when you take them early on in an attack.
You might also find that over-the-counter preparations containing the anti-sickness drug buclizine (eg Migraleve) help reduce nausea and sickness. This means that the painkillers can be better absorbed by the body. Ask your pharmacist for more advice.
If these treatments don't help it is worth seeing your GP. You should also contact your GP if you find that your attacks suddenly change in nature, become more frequent, or if any symptoms carry on between attacks.
Prescription-only medicines
There are other treatments for migraine that your doctor can prescribe. The medicines metoclopramide and domperidone can be used to treat nausea and vomiting. They are often combined with over-the-counter painkillers.
Non-steroidal anti-inflammatory drugs (eg ibuprofen or tolfenamic) are sometimes used to treat the headache, and they can also be combined with drugs which reduce sickness.
If standard painkillers don't stop the pain, your doctor may prescribe you triptans such as sumatriptan, fovatriptan or zolmitriptan. These work by correcting the serotonin imbalances in the brain. Response to triptans varies between individuals - you may need to try out different types before finding the most effective one for you.
Triptans are available as tablets, injections, nasal sprays or dissolvable wafers. They shouldn't be used by people who have had a heart attack or stroke, who have high blood pressure, or who are taking certain medications - your GP will be able to give you more information. Some people get side-effects from these drugs, such as dizziness, a feeling of pressure in the neck or chest area, nausea and vomiting.
Preventive drugs
If avoiding triggers doesn't help, and you continue to get severe migraines, you may want to discuss with your doctor taking a daily preventive treatment:
beta-blockers, such as propanolol
tricyclic antidepressants, such as amitriptyline
some anti-convulsants, such as topiramate or valproate
the antihistamine pizotifen
Many women find that migraines get worse as they reach the menopause. Some find that hormone replacement therapy helps, but for others it makes it worse. |
