Migraine Headaches
- Interesting facts
- What is Migraine Headache?
- Migraine Phases & Symptoms
- Causes
- Risk Factors
- Migraine Headaches Triggers
- Diagnosis
- Understanding the difference between headache and migraine
- An estimated 10-20% of the US population suffers from migraine headaches.
- With increased age, attacks usually decrease in severity and frequency.
- Studies on twins show that genes have a 60 to 65% influence on the development of migraine.
- Magnesium deficiencies have been observed in people with both tension-type and migraine headaches. Researchers have noted a drop in magnesium levels before or during a migraine attack.
Migraine is a neurological disease. It is characterized by severe, recurring headache, usually located on one side of the head and one or more of the following associated symptoms: nausea; vomiting; and increased sensitivity to light, sound and smell. Other associated symptoms may include lightheadedness, diarrhea and scalp tenderness. Migraine is three times more common in women than in men.
Migraines are often classified by whether or not auras accompany them. Common migraines are without auras. About 75% of migraines are the common type. Classic migraines are those with auras.
Migraines progress through distinct phases, each with its own distinct symptoms and characteristics. Not all migraine sufferers experience all phases, and those who do, don't necessarily experience them with each attack.
Prodrome
About 60% of migraine sufferers experience prodrome, a series of symptoms that precede the actual headache. It occurs within hours or up to days before a migraine attack. Prodrome symptoms vary among migraine suffers and may include:
- sensitivity to light or sound
- muscle stiffness, especially in the neck
- dizziness
- changes in appetite
- food cravings
- increased thirst
- constipation or diarrhea
- increased urination
- fatigue
- restlessness
- drowsiness
- mood changes (depression, irritability, euphoria)
- difficulty performing mental tasks
- cold feeling
- hyperactivity
Aura
About 20% of migraine sufferers experience migraine aura, a phase characterized by changes in visual perception. Auras usually occur five to twenty minutes prior to the actual headache, so they don't provide as much warning as the prodrome phase. Aura symptoms usually effect the senses, especially sight, but they can also effect muscle strength. Aura symptoms include:
- scintillation scotomas (bright rim around an area of visual loss and flashing lights or jagged lines that block the visual field)
- visual resizing or reshaping of objects
- numbness or tingling of the face, arm, or hand on one side of the body
- muscular weakness
- mild paralysis on one side of the body
- difficulty speaking or loss of speech
Migraine headache
Although Migraine pain can occur at any time of day, statistics have shown
the most common time to be 6 a.m. It is not uncommon for Migraineurs to
be awakened by the pain.
Migraine headache symptoms are distinct from other types of headaches, such
as tension-type or cluster headaches. Symptoms that distinguish migraines
from other headaches, include:
- headache on one side of the head (unilateral), behind the eyes (retrorbital), or around the eyes (periorbital)
- pain intensity is moderate to markedly severe
- headach worsens with physical activity physical activity (such as climbing stairs)
- pain has a pulsating or throbbing quality
- attacks last 4 to 72 hours, sometimes longer
Other symptoms that occur during migraine attacks include:
- loss of appetite
- nausea, vomiting, diarrhoea
- visual disturbances (blind spots, distorted vision, flashing lights or zigzag patterns)
- stuffed-up nose
- pale face
- sensations of heat or coldness
- sweating
- tenderness of the scalp
- prominence of veins or arteries in the temple
- accumulation of small pockets of fluid on the scalp or face
- impaired concentration
- depression
- fatigue
- nervousness
- irritability
Postdrome
After a migraine attack, there is usually a postdrome phase (sometimes called postheadache), in which migraine sufferer may feel exhausted and mentally foggy for a while. Postdromal symptoms have been shown to be accompanied and possibly caused by abnormal cerebral blood flow for up to 24 hours after the end of the headache stage. The symptoms of prodrome may include:
- fatigue
- irritability
- poor concentration and comprehension
- scalp tenderness
- mood changes
The precise mechanisms of a migraine headache are not completely understood. Several theories have been proposed to explain what is responsible for migraine.
Vasogenic theory. The first hypothesis was developed in the 1940’s to explain migraine. It was proposed that a migraine begins with a spasm, or partial closing, of the arteries leading to the main part of the brain (called the cerebrum). The first spasm decreases blood supply to part of the brain, which causes the aura that some people experience. These same arteries then become too relaxed, which increases blood flow and causes pain. Brain studies during migraine have shown that blood flow to the brain is in fact abnormal, which likely contributes to the symptoms.
Central theory. The major idea of the central theory is that there are changes in neurons before there are changes in vessels. This theory states that migraines begin with an electrical wave that spreads across certain parts of the brain. This occurrence is called the “cortical spreading depression” and it may explain the aura of migraine. The chemicals (neurotransmitters) dopamine and serotonin were also found to play a role in migraine headaches. Dopamine and serotonin are normally found in the brain, but they can cause blood vessels to act in uncharacteristic ways if they are present in abnormal amounts or if the blood vessels are unusually sensitive to them. Although the central theory presents a more sophisticated explanation of migraine, inconsistencies in research have led to the development of a newer theory.
Trigeminovascular theory. It is presently believed that both earlier theories provide insight into the causes of headache. Currently the most popular theory for what are causes of migraine is the trigeminovascular theory. It proposes that migraine begins in the brain and results from a chemical imbalance. The trigeminovascular system includes the face, eyes, nose, mouth, and jaw. A trigger of some type sparks a sequence of biological and chemical events that are responsible for the aura. Headache occurs when the trigeminal nerve, which innervates part of the scalp and face, releases chemicals that cause arteries in the brain to become inflamed. This in turn causes pain from the pulsing of the arteries. Despite the greater sophistication of the trigeminovascular theory, it does not everything about migraine, so research continues.
Being a female. Females have higher risk of migraines than males. In fact, women are three times as likely to have migraines as men are. Headaches tend to affect boys and girls equally during childhood but increase in girls after puberty.
Hormone fluctuations in women. Most migraines in women develop during the hormonally active years between adolescence and menopause. Fluctuations of estrogen and progesterone, rather than their presence, appear to increase the risk for migraines and their severity in some women.
Age. More than 20% of adults with migraines report that their headaches started before age 10, and over 45% say they started before age 20. The prevalence of migraine declines in both men and women after age 40. Although uncommon, late-life migraine occurs in about 1% of the population, usually in men. In such cases, it often occurs as migraine with visual disturbances but without headache.
Family history. Migraine headaches can be inherited. If both parents suffer from migraines, their children have a 75% chance of getting them. When only one parent gets migraines, there is a 50% chance that children will be afflicted.
Medications. The following drugs, medications, substances or toxins are some of the possible causes of migraine as a symptom:
- birth control pills
- tibolone
- livial
- tegaserod
- zelnorm
Triggers are specific factors that may increase the risk of having a migraine attack. Triggers do not cause migraine. Instead, they are thought to activate processes that cause migraine in people who are prone to the condition. A certain trigger will not induce a migraine in every person. And, in a single migraine sufferer, a trigger may not cause a migraine every time.
- Dietary: [2] skipping meals, fasting, specific foods, medications
- Sleep: [2] changes in sleep patterns, napping, oversleeping, too little sleep
- Hormonal: estrogen level changes and fluctuations, menstrual cycles[1], birth control pills, hormone replacement therapies, peri-menopause, menopause, ovulation
- Environmental and sensory stimulus:
- Weather: [1] season, weather and temperature changes, extreme heat or cold, humidity, barometric pressure changes
- Bright lights: [2] bright or glaring lights, fluorescent lighting, flashing lights or screens
- Odors/pollution: [2] smog, smoke, perfumes, chemical odors
- Other: high altitude, airplane travel
- Stress: [1] periods
of high stress (including life changes), accumulated stress, reacting
quickly and easily to stress, repressed emotions.
Factors related to stress include anxiety, worry, shock, depression, excitement, mental fatigue, loss and grief. Relaxation after stress is also a frequent migraine trigger. - Stress letdown: weekends, vacations, ending a project or stressful task (including presentations, papers, or exams)
- Physical: [2] Intense
physical exertion: sexual activity, over-exercising when out of shape,
exercising in heat, marathon running.
Eyestrain (if you wear glasses, make sure your prescription is current): bright or glaring lights, fluorescent lighting, flashing lights or computer screens. - Medications: birth control pills; blood vessel dilating drugs (e.g., nitroglycerin); drugs for high blood pressure (e.g., hydralazine, reserpine); diuretics; anti-asthma medications (e.g., aminophylline); too-frequent use of analgesics, ergotamine
Food triggers
- Dairy products: cheese (especially matured cheeses; cottage cheese and cream cheese tend to be all right), buttermilk, sour cream
- Fruits: oranges and other citrus fruits, bananas, figs, raisins, papayas, avocados (especially if overripe)
- Vegetables: beans such as broad, fava, garbanzo, lima, navy, pinto, pole. Sauerkraut, string beans, raw garlic, snow peas, olives, pickles, onions
- Meat, fish, poultry: aged, canned, cured or processed meat, pickled herring, salted dried fish, sardines, anchovies, chicken livers, sausage, bologna, pepperoni, salami, summer sausage, hot dogs
- Any food containing nitrates, nitrites, nitrates or tyramine
- Desserts and sweets: chocolate, chocolate ice cream, pudding, cookies, cakes, or pies; yeast-containing doughs and pastries
- Alcohol, especially beer, red wine, brandy, and whisky
- Caffeine (found in tea, coffee, cola drinks, and chocolate)
- Vinegar
- Smoked foods
- Nuts
- Yeast
- Wheat
- Foods containing monosodium glutamate
- Foods that contain the amino acid tyramine
Diagnosis of migraine headache is made by establishing the history of the migraine-related symptoms and other headache characteristics as well as a family history of similar headaches. By definition, the physical examination of a patient with migraine headache in between the attacks of migraine does not reveal any organic causes for the headaches. Many physicians order a series of blood tests to screen for thyroid disease, anemia or infections that could cause headaches. At times different types of brain scans like computed tomographic (CT) scans and/or magnetic resonance imaging (MRI) scans may be needed to rule out serious brain disorders. If a brain aneurysm is suspected, an angiogram may be ordered.
The diagnosis of migraine is not always easy, especially when a patient's symptoms do not fall into an easily recognizable pattern. The diagnosis rests solely on what a patient describes to a doctor. Only a detailed physical examination and history-taking by the physician can determine this. Patients are asked about their symptoms, how often the headaches occur, where the pain is, its duration and whether other symptoms come before, during or after the headache. A diary can help document headache characteristics and relating them to lifestyle, diet, menstruation and medication usage.
Understanding the difference between headache and migraine
While migraine headaches affect millions of people, they are still less common than tension headaches. Tension headaches cause a more steady pain over the entire head rather than throbbing pain in one spot. Most of the time, migraine attacks happen once in awhile, but tension headaches can occur as often as every day. While fatigue and stress can bring on both tension and migraine headaches, migraines can be triggered by certain foods, changes in the body’s hormone levels, and even changes in the weather. There are also differences in how these two types of headaches respond to treatment with medicines. While some over-the-counter drugs used to treat tension headaches sometimes help migraine headaches, the drugs used to treat migraine attacks do not work for tension headaches.
Sources & References
- 1. Wober C, Holzhammer J, Zeitlhofer J, Wessely P, Wober-Bingo l C. Trigger factors of migraine and tension-type headache: experience and knowledge of the patients. J Headache Pain. 2006 Sep;7(4):188-95. Epub 2006 Aug 11. PubMed
- 2. Kelman L. The triggers or precipitants of the
acute migraine attack. Cephalalgia. 2007 May;27(5):394-402. Epub 2007
Mar 30. PubMed