A Complete Guide to Migraine: Causes, Symptoms and Treatment Options

Migraine is more than just a severe headache. It is a neurological condition that can disrupt daily life, causing intense pain and a variety of debilitating symptoms. Unlike a regular headache, migraine often comes with additional effects like nausea, sensitivity to light, and even visual disturbances known as aura. Understanding the causes, recognising the symptoms, and knowing the available treatment options are essential for managing migraine effectively. This guide delves into what migraine is, what triggers it, the symptoms to watch out for, and the treatment methods that can help alleviate its impact.

What is a Migraine?

A migraine is a neurological disorder that causes intense, pulsating headaches, typically accompanied by other symptoms such as nausea, vomiting, and heightened sensitivity to light, sound, and smells. The pain usually affects one side of the head, but it can also occur on both sides. Migraines are more than just a headache; they are a complex condition involving changes in brain activity and chemistry.

The headache phase of a migraine can last from four hours to three days, depending on the severity of the condition and how well it is managed. A migraine episode is often preceded by warning signs or an "aura," and it is followed by a postdrome phase, where the individual may feel exhausted or mentally foggy.

Types of Migraines

There are several types of migraines, each with unique features:

• Migraine without Aura: The most common type, where the headache begins without any warning signs, although some individuals may experience mild symptoms in the lead-up.
• Migraine with Aura: About 20% of migraine sufferers experience an aura, which may include visual disturbances like flashing lights or blind spots, and sensory symptoms like tingling or numbness in the hands or face.
• Chronic Migraine: Chronic migraines occur when a person experiences headaches on 15 or more days per month, often lasting for several hours or days at a time. This can be particularly debilitating and difficult to manage.
• Hemiplegic Migraine: A rare but severe form of migraine that involves temporary paralysis or weakness on one side of the body. This type of migraine can be mistaken for a stroke.

What Causes Migraines?

A combination of genetic, environmental, and lifestyle factors plays a role in triggering migraines.

Genetic Factors

Genetics play a significant role in the development of migraines. Studies have shown that migraines tend to run in families, meaning those with a family history of migraines are more likely to experience them. Specific genetic mutations may affect how the brain processes pain, making it more sensitive to triggers.

Neurological Changes

Migraine attacks are associated with changes in brain activity, particularly in areas responsible for processing pain. The brainstem, which controls various functions such as blood pressure and pain perception, is believed to be involved in migraine attacks. Additionally, the trigeminal nerve, which transmits pain signals from the head to the brain, plays a critical role in the development of migraines.

During a migraine attack, there is often an imbalance in the brain’s levels of neurotransmitters, such as serotonin. This chemical imbalance can cause the brain to become hypersensitive to stimuli, making it more prone to migraine attacks.

Hormonal Changes

Hormonal fluctuations are one of the most well-established migraine triggers, especially in women. Changes in oestrogen levels during menstruation, pregnancy, or menopause can increase the likelihood of migraines. Hormonal birth control and hormone replacement therapy may also influence migraine frequency in some women.

Environmental Triggers

Certain environmental factors can trigger a migraine attack. These include:

• Bright lights or glare: Migraines can be triggered by intense light or glare, particularly in environments with harsh artificial lighting.
• Strong smells: Strong scents like perfumes, cleaning products, or food odours can act as triggers.
• Weather changes: Shifts in weather, including changes in temperature, humidity, or barometric pressure, are common migraine triggers.
• Noise: Loud or jarring sounds can increase the sensitivity to pain in individuals prone to migraines.

Lifestyle Factors

Various lifestyle habits may contribute to the onset of migraines. Some of these factors include:

• Stress: Emotional or physical stress is a significant trigger for many people with migraines.
• Dietary factors: Certain foods like aged cheese, chocolate, caffeine, and alcohol can provoke migraines in some individuals.
• Sleep disturbances: Both insufficient sleep and oversleeping can trigger migraines.
• Dehydration: Not drinking enough water can lead to dehydration, which is a well-known migraine trigger.

What Are the Common Symptoms of a Migraine?

Migraines come with a variety of symptoms that extend beyond just a headache. These symptoms may occur in different stages of the migraine attack, including the prodrome, aura, headache, and postdrome phases. Below are some of the most common symptoms:

• Fatigue or excessive sleepiness: People may feel unusually tired or sleepy before the migraine attack begins, often in the prodrome phase.
• Mood changes: Irritability, depression, or other mood swings can occur before the migraine attack, signalling its onset.
• Frequent urination: An increase in urination is often observed in the days leading up to a migraine.
• Neck stiffness: Some individuals experience muscle tension or stiffness in the neck and shoulders before the migraine attack.
• Food cravings or changes in appetite: A sudden craving for specific foods or a noticeable change in eating habits can sometimes occur prior to a migraine.
• Sensitivity to light and sound: People may become more sensitive to light (photophobia) and sound (phonophobia) before or during a migraine.
• Visual disturbances: This can include seeing flashing lights, zigzag lines, or blind spots in vision, often during the aura phase.
• Tingling or numbness: Some individuals experience tingling or numbness in the face, hands, or other parts of the body, usually on one side.
• Speech difficulties: Temporary speech issues, like trouble forming words or slurred speech, can occur during the aura phase in some cases.
• Throbbing or pulsating pain: The headache phase is characterised by throbbing or pulsating pain, often on one side of the head.
• Nausea and vomiting: These are common symptoms during the headache phase, where nausea can be accompanied by vomiting in more severe cases.
• Sensitivity to light: Light sensitivity increases, making bright lights or normal surroundings uncomfortable.
• Sensitivity to sound: Even normal background noises can feel unbearably loud during a migraine.
• Dizziness and balance issues: Some people may feel dizzy or experience difficulty maintaining balance.
• Fatigue and irritability post-migraine: After the migraine, individuals often feel tired or irritable, struggling with concentration and mental fatigue.
• Neck pain or stiffness: Pain in the neck can linger after the migraine attack.

What Are the Different Stages of a Migraine Attack?

A migraine typically progresses through four stages, although not everyone will experience all of them, and some people may skip certain stages entirely. These stages help define the progression of the migraine and provide insight into the timing and impact of the attack.

Prodrome (Pre-Migraine Stage)

This is the initial stage, occurring hours or days before the headache begins. It serves as a warning sign for an upcoming migraine. During this phase, changes in mood, energy levels, and other bodily functions can be observed. The duration of this stage can range from a few hours to a couple of days. Prodrome can act as a precursor to the more severe symptoms that follow.

Aura (Visual and Sensory Disturbances)

The aura stage may occur before or during the onset of the headache, and it is not always experienced by every migraine sufferer. It is typically marked by neurological disturbances, which can affect vision, speech, or other senses. This stage usually lasts between 5 minutes and 60 minutes. Not everyone with migraines experiences an aura, and some may only experience it occasionally.

Headache (Pain Phase)

The headache phase is often the most well-known part of a migraine attack. This stage is characterised by intense, throbbing pain, typically on one side of the head. It is often accompanied by other symptoms such as nausea, sensitivity to light, and sound. The headache phase can last anywhere from 4 hours to 72 hours if untreated. It may be severe enough to interfere with daily activities and require a dark, quiet space for relief.

Postdrome (Post-Migraine Stage)

Once the headache subsides, the postdrome phase follows. This phase is sometimes referred to as the "migraine hangover," as individuals often feel drained, mentally foggy, or irritable, even though the pain has passed. The postdrome phase can last anywhere from a few hours to a couple of days. Although the pain is gone, the individual may still experience fatigue, mood changes, or difficulty concentrating.

What Are the Best Treatment Options for Migraines?

Although there is no cure for migraines, there are various treatments available that can help manage the condition and provide relief during an attack. Treatment can be divided into acute (for immediate relief) and preventive (to reduce the frequency of attacks) options

Acute Treatment Options

Over-the-Counter Medications

For many individuals, non-prescription pain relievers such as ibuprofen, paracetamol, or aspirin can be effective in relieving mild to moderate migraine pain. These medications work by reducing inflammation and pain, though they may not be sufficient for more severe migraines.

Prescription Medications

For more severe migraines, stronger medications may be prescribed. These include:

• Triptans: These drugs help to constrict blood vessels in the brain and reduce inflammation, providing relief from pain.
• Ergotamines: These medications are effective for certain individuals, especially those who don’t respond well to triptans.
• Anti-nausea medications: Nausea is a common symptom of migraines, and these types of medications can help alleviate this symptom.

Pain Management Techniques

Non-pharmacological approaches, such as applying cold compresses to the forehead, resting in a quiet and dark room, or using relaxation techniques like deep breathing, can help reduce migraine pain.

Preventive Treatment Options

Medications

For individuals who suffer from frequent or chronic migraines, preventive medications may be prescribed to reduce the frequency and severity of attacks. These include

• Beta-blockers: Commonly used for high blood pressure, these can also help reduce migraine attacks.
• Anti-seizure medications: These drugs are sometimes prescribed for migraine prevention.
• CGRP inhibitors: A newer class of medication that targets proteins linked to migraines, preventing their occurrence.

Botox Therapy

Botox injections are often used for individuals with chronic migraines. These injections help block the release of chemicals that cause pain, reducing the frequency of migraines. Botox has been proven to be effective for people who experience migraines 15 or more days a month.

Dietary Adjustments

Certain foods and drinks are known to trigger migraines. Keeping a food diary to identify specific triggers can help individuals make necessary changes to their diet. In addition, eating smaller, more frequent meals can help avoid blood sugar fluctuations that might trigger a migraine.

How Can You Cope with Migraines in Daily Life?

Migraine sufferers can take several steps to reduce the frequency and intensity of their attacks and improve their overall quality of life.

Track and Avoid Triggers

One of the most effective ways to manage migraines is by identifying and avoiding triggers. Keeping a migraine diary can help pinpoint foods, environmental factors, and lifestyle habits that contribute to an attack.

Practice Stress Management

Since stress is a significant trigger for many people, managing stress through relaxation techniques such as deep breathing, yoga, and meditation can help reduce the frequency of migraines.

Get Regular Exercise

Regular physical activity can help keep migraines at bay. Exercise promotes overall well-being, reduces stress, and improves sleep quality, all of which can lower the risk of migraines.

Ensure Adequate Sleep

Having a regular sleep schedule is essential for those prone to migraines. Aim for 7-8 hours of sleep each night and avoid irregular sleeping patterns or naps that might trigger an attack.

Stay Hydrated

Dehydration is a common migraine trigger. Drinking plenty of water throughout the day can help prevent migraines from occurring.

When to Seek Medical Help

Although migraines are common and can often be managed with over-the-counter treatments, there are times when medical attention becomes necessary. Seek professional help if:

• Migraines become more frequent or severe
• You experience a sudden, intense headache
• Traditional treatments no longer provide relief
• New symptoms, such as vision loss or speech difficulties, occur

A neurologist can help determine the best course of action and provide a treatment plan to manage migraines effectively.

Consult Today

If migraines are affecting your ability to function, it’s crucial to seek medical advice. With the right treatment plan, it is possible to manage migraines and reduce their impact on daily life. Max Hospitals helps diagnose and treat migraines to ease their effect on daily life. Schedule a consultation with neurologists at Max Hospitals to explore effective treatment options.