Migraine Management

Migraine: Treatment and Management

 

 

Migraine is a chronic neurological disorder characterized by recurrent moderate to severe headaches often in association with several autonomic nervous system symptoms.

A migraine is a severe, painful headache that is often preceded or accompanied by sensory warning signs such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting, and increased sensitivity to light and sound. The excruciating pain that migraines bring can last for hours or even days.

Migraine headaches result from a combination of blood vessel enlargement and the release of chemicals from nerve fibers that coil around these blood vessels. During the headache, an artery enlarges that is located on the outside of the skull just under the skin of the temple (temporal artery). This causes a release of chemicals that cause inflammation, pain, and further enlargement of the artery.

Although much about the cause of migraines isn't understood, genetics and environmental factors appear to play a role.

• Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway.
• Imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system — also may be involved. Researchers continue to study the role of serotonin in migraines.
• Serotonin levels drop during migraine attacks. This may cause your trigeminal system to release substances called neuropeptides, which travel to your brain's outer covering (meninges). The result is headache pain.

Triggers of Migraine:

Whatever the exact mechanism of the headaches, several things may trigger them. Common migraine triggers include:

• Hormonal changes in women: Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen.
• ·Hormonal medications, such as oral contraceptives and hormone replacement therapy, also may worsen migraines. Some women, however, may find their migraines occur less often when taking these medications.
• Foods: Aged cheeses, salty foods, and processed foods may trigger migraines. Skipping meals or fasting also can trigger attacks.
• Food additives: The sweetener aspartame and the preservative monosodium glutamate, found in many foods, may trigger migraines.
• Drinks: Alcohol, especially wine, and highly caffeinated beverages may trigger migraines.
• Stress: Stress at work or home can cause migraines.
• Sensory stimuli: Bright lights and sun glare can induce migraines, as can loud sounds. Unusual smells — including perfume, paint thinner, secondhand smoke, and others — can trigger migraines in some people.
• Changes in wake-sleep pattern: Missing sleep or getting too much sleep may trigger migraines in some people, as can jet lag.
• Physical factors: Intense physical exertion, including sexual activity, may provoke migraines.
• Changes in the environment: A change of weather or barometric pressure can prompt a migraine.
• Medications: Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.

Symptoms of migraine can occur a while before the headache, immediately before the headache, during the headache, and after the headache. Although not all migraines are the same, typical symptoms include:

• Moderate to severe pain, usually confined to one side of the head, but switching in successive migraines
• Pulsing and throbbing head pain
• Increasing pain during physical activity
• Inability to perform regular activities due to pain
• Nausea
• Vomiting
• Increased sensitivity to light and sound

Stages of Migraine:

Migraine headaches often begin in childhood, adolescence, or early adulthood. Migraines may progress through four stages, including prodrome, aura, headache, and postdrome, though you may not experience all the stages.

Prodrome of Migraine:

One or two days before a migraine, you may notice subtle changes that signify an oncoming migraine, including:

• Constipation
• Depression
• Food cravings
• Hyperactivity
• Irritability
• Neck stiffness
• Uncontrollable yawning

Aura may occur before or during migraine headaches. Auras are nervous system symptoms that are usually visual disturbances, such as flashes of light. Sometimes auras can also be touching sensations (sensory), movement (motor), or speech (verbal) disturbances. Most people experience migraine headaches without aura. Each of these symptoms usually begins gradually, builds up over several minutes, and then commonly lasts for 20 to 60 minutes. Examples of aura include:

• Visual phenomena, such as seeing various shapes, bright spots, or flashes of light
• Vision loss
• Pins and needles sensations in an arm or leg
• Speech or language problems (aphasia)
• Less commonly, an aura may be associated with limb weakness (hemiplegic migraine).

Attack

When untreated, a migraine usually lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or much less often. During a migraine, you may experience the following symptoms:

• Pain on one side or both sides of your head
• Pain that has a pulsating, throbbing quality
• Sensitivity to light, sounds, and sometimes smells
• Nausea and vomiting
• Blurred vision
• Lightheadedness, sometimes followed by fainting

Postdrome

The final phase, known as postdrome, occurs after a migraine attack. During this time you may feel drained and washed out, though some people report feeling mildly euphoric.

 

How is migraine diagnosed?

Physicians will look at family medical history and check the patient for the symptoms described above to diagnose migraine. The International Headache Society recommends the "5, 4, 3, 2, 1 criteria" to diagnose migraines without aura. This stands for:

• 5 or more attacks
• 4 hours to 3 days in duration
• At least 2 of unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
• At least 1 additional symptom such as nausea, vomiting, sensitivity to light, sensitivity to sound.

Tests such as electroencephalography (EEG), computed tomography (CT), magnetic resonance imaging (MRI), and spinal tap may also be performed that check for:

• Bleeding within the skull
• Blood clot within the membrane that covers the brain
• Stroke
• Dilated blood vessels in the brain
• Too much or too little cerebrospinal fluid
• Inflammation of the membranes of the brain or spinal cord
• Nasal sinus blockage
• Postictal headache (after stroke or seizure)
• Tumors

Treatment of Migraine:

Homeopathic Treatment of Migraine:

Homeopathy cures migraine permanently. However, it is a chronic disorder and may take a few months to get cured. Even when the medicine is properly selected and working in the right direction, the headaches are not going to disappear in one go. Initially one will see a reduction in the severity and the frequency of the headaches. This gradually over some time would lead to the complete cure. The homeopathic approach to the treatment of migraine patients is more individualistic. This means, that homeopathy believes that migraine is a personality disorder and hence the treatment should be determined only based on an in-depth study of the patient's personality. This approach helps treat most cases of migraine successfully.

Allopathic Treatment of Migraine:

Pain-relieving medications: Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.

• Pain relievers: Aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others), may help relieve mild migraines.
• Triptans: Many people with migraine attacks use triptans to treat their migraines. Triptans work by promoting constriction of blood vessels and blocking pain pathways in the brain.
• Ergots: Ergotamine and caffeine combination drugs (Migergot, Cafergot) are less effective than triptans. Ergots seem most effective in those whose pain lasts for more than 48 hours.
• Dihydroergotamine (D.H.E. 45, Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine. It's available as a nasal spray and in injection form. This medication may cause fewer side effects than ergotamine and is less likely to lead to medication-overuse headaches.
• Anti-nausea medications: Because migraines are often accompanied by nausea, with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications are chlorpromazine, metoclopramide (Reglan), or prochlorperazine (Compro).
• Opioid medications: Opioid medications containing narcotics, particularly codeine, are sometimes used to treat migraine headache pain for people who can't take triptans or ergot. Narcotics are habit-forming and are usually used only as a last resort.
• Glucocorticoids (prednisone, dexamethasone). A glucocorticoid may be used in conjunction with other medications to improve pain relief. Because of the risk of steroid toxicity, glucocorticoids shouldn't be used frequently.

Preventive medications: These types of drugs are taken regularly, often daily, to reduce the severity or frequency of migraines.

You may be a candidate for preventive therapy if you have four or more debilitating attacks a month if attacks last more than 12 hours, if pain-relieving medications aren't helping, or if your migraine signs and symptoms include a prolonged aura or numbness and weakness.

Preventive medications can reduce the frequency, severity, and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks.

Cardiovascular drugs: Beta-blockers, which are commonly used to treat high blood pressure and coronary artery disease, may reduce the frequency and severity of migraines.

Antidepressants: Certain antidepressants help to prevent some types of headaches, including migraines. Tricyclic antidepressants may be effective in preventing migraines. Another class of antidepressants called selective serotonin reuptake inhibitors hasn't been proven to be effective for migraine headache prevention.

Anti-seizure drugs: Some anti-seizure drugs, such as valproate sodium (Depacon) and topiramate (Topamax), seem to reduce the frequency of migraine headaches.

 

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