One of the most nagging headaches, Migraine is episodic (occurs anywhere from once or twice a year to 1-4 times a month) in nature. It is associated with accompanying symptoms like vomiting, blurring of vision etc. Some patients may get headaches more frequently, almost daily.
Though the exact causes of migraines are unknown, blood vessel contractions and other changes in the brain as well as inherited abnormalities in certain areas of the brain have been linked to it. A migraine pain center or generator is situated in the brain. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels. This causes them to constrict, followed by expansion and the release of inflammatory substances like prostaglandins, serotonin etc. that cause the pulsation to be painful.
Migraines can begin at any age, but most develop them around adolescence or in their 20s. It occurs more often in women than men and most migraine sufferers have a family history of the disease.
A migraine attack could be triggered by certain factors like:
Foods such as chocolate, cheese, alcohol, nuts, preservatives etc.
Changes in hormone levels ( during a woman’s menstrual cycle or with the use of birth control pills)
Bright lights and flickering lights
Physical or emotional stress
Changes in the weather.
Changes in sleep patterns
Smoking or exposure to smoke
A Migraine headache usually starts as a dull ache and gets worse within minutes to hours. Patients usually complain of a throbbing, pounding or pulsating pain which is worse on one side of the head and lasts 6 to 48 hours. This could be accompanied by nausea and vomiting, sensitivity to light or sound, chills, sweating, increased urination, fatigue, loss of appetite, numbness, tingling, or weakness, problems concentrating, trouble finding words, visual disturbances, or Aura, (symptoms such as temporary blind spots, blurred vision, eye pain, seeing stars or zigzag lines and tunnel vision which are considered a warning sign that a migraine is coming up).
Depending on the signs and symptoms, migraines are classified into the Classic Migraine and Common Migraine. Classic migraines start with an aura. The person may have trouble communicating, feel depressed, irritable and restless. The symptoms may last for 5 to 15 minutes or more. As these symptoms disappear, a throbbing headache begins on one side of the head along with symptoms like nausea, vomiting, and sensitivity to light and noise. Common migraines don’t start with an aura and may start more slowly than classic migraines, last longer and interfere more with daily activities. The pain of common migraines may be on only one side of the head. Nausea, vomiting, and sensitivity to light and noise usually accompany the headache.
Diagnosis is usually done by the symptoms and the pattern of headache, family history of migraine and the response to analgesics taken to stop the headache. Neurological tests are done to rule out diseases of the brain or nerves like epilepsy or multiple sclerosis that may also cause headaches and migraines. Patients are usually asked to maintain a headache diary which will help the doctor identify the triggers for the migraine episodes.