Migraine is a primary headache disorder characterized by recurrent headaches that are moderate to severe.The headaches are pulsate.They affect one half of the head and last from two to seventy two hours.Migraine headaches frequent start in chilhood, adolescence, or early adulthood.Before puberty migraine affects more boys than girls.Women have migraine two or three times more than men.The causes of migraine are not known.Migraine cannot be cured, but some treatments can manage its condition.
I. The symptoms of migraine
- Vomiting
- Nausea
- Sensitivity to light, smell, and sound
- Flashes of light
- Blind spots
- Tingling in the arm or leg
- Pain of one side of the head
II. Four Phases of Migraine
1. Prodrome
It occurs hours or days before the headache.
It occurs hours or days before the headache.
Its symptoms :
- Altered mood
- Irritability
- Fatigue
- Constipation
- Depression (Euphoria)
- Diarrhea
- Neck stiffness
- Food cravings
- Uncontrollable yawning
- Hyperactivity
- Sensitivity of smell or sound
It precedes immediately headache.It appears gradually over a number of minutes and generally lasts less than sixty minutes.
Its symptoms include :
- Loss of vision
- Blurring
- Flashes of light
- Seeing various shapes
- Pins and needles sensations in arm or leg
- Numbness
- Loss of position sense
- Speech or Language disturbances
- World spinning
- Motor problems
- The weakness of limb
3. Pain (headache phase ) or Attack
It usually comes regularly.It is aggravated by physical activity.The pain may occur primarily in the back or top of the head.The pain usually lasts four to seventy two hours in adults whereas the pain in young children lasts less than one hour.
The symptoms of pain include
- Vomiting
- Nausea
- Confusion
- Blurred vision
- Nasal stuffiness
- A sense of world spinning
- Diarrhea
- Frequent urination
- Pallor
- Sweating
- Pain on one side or both sides of the head
- Pain that has a pulsating, throbbing quality
- Sensitivity of light, smell, sound
- Lightheadedness followed by fainting
4. Postdrome
It is the migraine effect may persist for some days after the main headache has ended.
The symptoms of Postdrome include
- A sore feeling of migraine area
- Feeling tired or hung over
- Head pain
- Cognitive difficulties
- The changes of mood
- Weakness
- Gastrointestinal symptoms
- Malaise
- Depression
- Euphoric
- Genetic
- Environmental factors
- Changes in brainstem and its interactions with the trigeminal nerve that is a major pain pathway.
- Imbalances in brain chemicals, such as serotonin that regulates pain in the nerve system.
IV. The Trigger Factors of Migraine
- Hormonal changes in woman during pregnancy or monopause.
- Hormonal medications, such as oral contraceptives, hormone replacement therapy.
- Age
- Sex
- Food, including salty food, aged cheese, fasting meal.
- Drinking of alcohol
- Stress
- Fatigue
- Hunger
- Sensory Stimuli like bright light, sun glare, perfume, paint thinner.
- Changes in wake-sleep pattern, including missing sleep or much sleep.
- Physical factor
- Changes in the environment
V. The Classification Of Migraine
Migraine can be divided into seven subclasses :
- Common Migraine or Migraine without aura is headaches accompanied without aura.
- Classic Migraine or Migraine with aura is headaches accompanied by aura.
- Childhood Periodic Syndromes are commonly precusors of migraine, including cyclical vomiting (occasional intense periods of vomiting), abdominal migraine (abdominal pain accompanied by nausea), and benign paroxysmal vertigo of childhood (occasional attack of vertigo)
- Retinal Migraine is migraine headaches accompanied by visual disturbances or temporary blindness in one eye.
- Migraine Complications are migraine headaches with or without aura that are unusual long or unusual frequent or associated with a seizure or brain lesion.
- Probable Migraine is conditions that have some characteristics of migraines, but there is no enough evidence to diagnose it as a migraine with certainty
- Chronic Migraine is a complication of migraines.It is headache that fulfills the criteria of diagnosis for migraine headache and occurs for a greater time interval or greater than fifteen days or three months.
VI. Diagnosis of Migraine
Migraine diagnosis is based on signs and symptoms.According to The International Headache Society uses Criteria of 5, 4, 3, 2, 1 for diagnosing migraine without aura.
5, 4, 3, 2, 1 Criteria include :
Diagnosis is more likely, If someone experiences two of these symptoms, such as photophobia, nausea, or inability to work or study for a day.
Diagnosis is 92 percent in a migraine if someone has four symptoms for the following , pulsating headache, duration of four to seventy two hours, pain on one side of the head, nausea, or symptoms that interfere with someone's life.
Those with fewer than three of these symptoms are probably 17 percent in a migraine.
VII. Treatment Of Migraine
Treatments have three main aspects namely the avoidance of trigger, the control of Acute Symptom, and pharmacological prevention.
I. The use of Medications :
1. Pain-Relieving Medication
2. Preventive Medications are to reduce the frequency and severity of migraine attack.
II. Devices and Surgery
Medical devices :
III. Alternative Medicine
Migraine diagnosis is based on signs and symptoms.According to The International Headache Society uses Criteria of 5, 4, 3, 2, 1 for diagnosing migraine without aura.
5, 4, 3, 2, 1 Criteria include :
- Four or more attacks-for migraine with aura, two attacks are sufficient for diagnosis.
- Four hours to three days in duration.
- Two or more of the following :
- Unilateral that affects half the head
- Pulsating
- Moderate or severe pain intensity
- Routine Physical Activity
4. One or more of the following :
- Nausea
- Vomiting
- Sensitivity of light (Photophobia) and sound (Phonophobis).
Diagnosis is more likely, If someone experiences two of these symptoms, such as photophobia, nausea, or inability to work or study for a day.
Diagnosis is 92 percent in a migraine if someone has four symptoms for the following , pulsating headache, duration of four to seventy two hours, pain on one side of the head, nausea, or symptoms that interfere with someone's life.
Those with fewer than three of these symptoms are probably 17 percent in a migraine.
VII. Treatment Of Migraine
Treatments have three main aspects namely the avoidance of trigger, the control of Acute Symptom, and pharmacological prevention.
I. The use of Medications :
1. Pain-Relieving Medication
- Analgesics, including Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB), aspirin, acetaminophen (Tylenol) are to relieve mild migraine.If they are taken too long periods of time, these drugs will cause gastrointestinal bleeding, ulcers, and medication-overuse headaches.
- Triptans are to relieve pain and symptoms of migraine, such as Sumatriptan (Imitrex), Frovatriptan (Frova), Almotriptan (Axert), Eletriptan (Relpax), Zolmitriptan (Zomig), Naratriptan (Amerge), Rizatriptan (Maxalt).People at risk of stroke and heart disease are not recommended to consume these medications.A single-tablet combination of Sumatriptan and Naproxen Sodium (Treximet) has proved to be more effective in relieving migraine symptoms than either medications on its own.
- Ergotamine and Dihydroergotamine can be used to treat pain more than 48 hours.
- Anti-Nausea Medications, including Metoclopramide (Reglan), or Prochlorperazine (Compro), Chlorpromazine.
- Glucocorticoid, including Prednisone, Dexamethason should not be used frequently because of steroid toxicity risk.A glucocorticoid may be used in conjunction with other medications to improve pain relief.
- Ibuprofen and Triptan can be used for improving pain in children with migraines.Triptan side effects can cause nausea, vormiting, taste disturbance, dizziness, fatigue, low energy, nasal symptoms.Paracetamol is not effective in providing pain relief.
2. Preventive Medications are to reduce the frequency and severity of migraine attack.
- Cardiovascular drugs include Beta Blockers, such as Propranolol (Inderal La, Innopran XL), Metoprolol Tartrate (Lopressor) and Timolol (Betimol), Calcium Channel Blockers, such as Verapamil (Calan, Verelan), The Angiotensin-converting Enzyme Inhibitor Lisinopril (Zestril).
- Antidepressants, such as Amitriptyline and Fenlafaxine (Effexor XR).
- Anti-Seizure Drugs include Valproate sodium (Depacon) and Topiramate (Topamax).
- OnabotulinumtoxinA treats chronic migraine headaches in adults.
II. Devices and Surgery
Medical devices :
- Biofeedback helps people be conscious of some physiological parameters so as to control them and try to relax.It is used for the treatment of migraine.
- Neurostimulation uses implantable neurostimulator for the treatment of intractable chronic migraines with encouraging results for severe cases.
- A Transcutaneous Electrical Nerve Stimulation Device is used for the prevention of migraine.
Migraine Surgery improves decompression of certain nerves around the head and neck.
III. Alternative Medicine
- Acupuncture treats headache pain.
- Massage Therapy reduces the migraine frequency.
- Herbs, and vitamin and mineral consumption are to prevent migraine and decrease the severity of migraine.
IV. Lifestyle And Home Remedies
- Doing the exercises of muscle relaxation, such as yoga, meditation.
- Rest and Relax
- Keeping a head diary
- Don't over sleep by getting an enough amount of sleep each night.
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