Why Does Migraine Occur
Previously, it was believed that migraine develops due to the expansion of blood vessels in the brain, but now scientists have come to the conclusion that the disease provokes a number of biochemical processes that trigger neurons in the cerebral cortex.Among the reasons that can cause migraines are the following:
- increased intracranial pressure,
Pearls And Other Issues
- Cortical spreading depression is the probable cause of the aura. It can activate trigeminal nerve afferents and alter hematoencephalic barrier permeability. Trigeminovascular system activation can initiate neurogenic inflammation related to migraine headaches.
- The attacks are recurrent and occur through a cascade of events over hours to days.
- Typical migraines progress through a prodrome, an aura, headache, and the postdrome.
- There is no one approach to treating migraines. Each case must be individualized according to its comorbidities.
How Are Migraines Treated
Migraine headaches are chronic. They cant be cured, but they can be managed and possibly improved. There are two main treatment approaches that use medications: abortive and preventive.
- Abortive medications are most effective when you use them at the first sign of a migraine. Take them while the pain is mild. By possibly stopping the headache process, abortive medications help stop or decrease your migraine symptoms, including pain, nausea, light sensitivity, etc. Some abortive medications work by constricting your blood vessels, bringing them back to normal and relieving the throbbing pain.
- Preventive medications may be prescribed when your headaches are severe, occur more than four times a month and are significantly interfering with your normal activities. Preventive medications reduce the frequency and severity of the headaches. Medications are generally taken on a regular, daily basis to help prevent migraines.
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Who Is At Risk For Migraines
About 12% of Americans get migraines. They can affect anyone, but you are more likely to have them if you:
- Are a woman. Women are three times more likely than men to get migraines.
- Have a family history of migraines. Most people with migraines have family members who have migraines.
- Have other medical conditions, such as depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.
What Questions Should I Ask My Healthcare Provider
- Will my child grow out of their migraines?
- What medications do you recommend for me?
- What should I change about my lifestyle to prevent my migraine headaches?
- Should I get tested?
- What type of migraine do I have?
- What can my friends and family do to help?
- Are my migraines considered chronic?
A note from Cleveland Clinic
Migraine headaches can be devastating and make it impossible to go to work, school or experience other daily activities. Fortunately, there are some ways to possibly prevent a migraine and other ways to help you manage and endure the symptoms. Work with your healthcare provider to keep migraines from ruling your life.
Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.
References
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What Are Headache Disorders
Headache disorders, characterized by recurrent headache, are among the most common disorders of the nervous system. Headache itself is a painful and disabling feature of a small number of primary headache disorders, namely migraine, tension-type headache, and cluster headache. Headache can also be caused by or occur secondarily to a long list of other conditions, the most common of which is medication-overuse headache.
How Often Do Ocular Migraines Occur In Human
Ophthalmic migraines are not unusual, particularly if you are a woman under age 40 with a history of migraines.
About 60 percent of migraine sufferers likewise experience a prodrome that takes place days or weeks before the migraine attack. Symptoms of a migraine prodrome can be subtle and may include modifications in state of mind, cravings for particular foods, or a basic sensation of being tired.
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Whats A Migraine Journal
- Keeping a migraine journal is not only beneficial to you, but it helps your healthcare provider with the diagnosis process. Your journal should be detailed and updated as much as possible before, during and after a migraine attack. Consider keeping track of the following:
- The date and time of when the migraine began specifically when the prodrome started, if youre able to tell its happening. Track time passing. When did the aura phase begin? The headache? The postdrome? Do your best to tell what stage youre in and how long it lasts. If theres a pattern, that may help you anticipate what will happen in the future.
- What are your symptoms? Be specific.
- Note how many hours of sleep you got the night before it happened and your stress level. Whats causing your stress?
- Note the weather.
- Log your food and water intake. Did you eat something that triggered the migraine? Did you miss a meal?
- Describe the type of pain and rate it on a one to 10 scale with 10 being the worst pain youve ever experienced.
- Where is the pain located? One side of your head? Your jaw? Your eye?
- List all of the medications you took. This includes any daily prescriptions, any supplements and any pain medication you took.
- How did you try to treat your migraine, and did it work? What medicine did you take, at what dosage, at what time?
- Consider other triggers. Maybe you played basketball in the sunlight? Maybe you watched a movie that had flashing lights? If youre a woman, are you on your period?
When To Call A Professional
If you have a history of migraine, you should contact your doctor if you develop headaches that differ from your usual headache or other migraine symptoms. Examples include:
- Headaches that get worse over time
- New onset of migraine in a person over age 40
- Severe headaches that start suddenly
- Headaches that worsen with exercise, sexual intercourse, coughing or sneezing
- Headaches with unusual symptoms such as passing out, loss of vision, or difficulty walking or speaking
- Headaches that start after a head injury
In addition, you may want to see your health care professional if you have headaches that do not get better with over-the-counter medications severe headaches that interrupt work or the enjoyment of daily activities or daily headaches.
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What Can I Do To Prevent Migraines
One of the best ways to prevent migraines is to try to avoid the things that might trigger your attacks. Most people benefit from trying to get stable sleep, eating regular meals, drinking plenty of fluids to keep hydrated, and trying to manage stress. Taking regular exercise may also help prevent migraines since it helps with breathing, improving blood sugar balance and maintaining general wellbeing. Although you should take care not to engage in very strenuous activity that your body is not used to as this can sometimes act as a migraine trigger.
Keeping a diary of your migraines can be a useful way to record when and where you experience attacks, check for any patterns, and try to identify your triggers. Take the diary when you see your GP so you can communicate your symptoms with them and they can find the best way to help you.
Are There Different Kinds Of Migraine
Yes, there are many forms of migraine. The two forms seen most often are migraine with aura and migraine without aura.
Migraine with aura . With a migraine with aura, a person might have these sensory symptoms 10 to 30 minutes before an attack:
- Seeing flashing lights, zigzag lines, or blind spots
- Numbness or tingling in the face or hands
- Disturbed sense of smell, taste, or touch
- Feeling mentally “fuzzy”
Only one in five people who get migraine experience an aura. Women have this form of migraine less often than men.
Migraine without aura . With this form of migraine, a person does not have an aura but has all the other features of an attack.
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When To Contact A Medical Professional
- You are experiencing “the worst headache of your life.”
- You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a migraine before.
- A headache starts suddenly.
Schedule an appointment or call your provider if:
- Your headache pattern or pain changes.
- Treatments that once worked no longer help.
- You have side effects from your medicine.
- You are taking birth control pills and have migraine headaches.
- Your headaches are more severe when lying down.
Vasoactive Substances And Neurotransmitters
Perivascular nerve activity also results in release of substances such as substance P, neurokinin A, calcitonin gene-related peptide, and nitric oxide, which interact with the blood vessel wall to produce dilation, protein extravasation, and sterile inflammation. This stimulates the trigeminocervical complex, as shown by induction of c-fos antigen by PET scan. Information then is relayed to the thalamus and cortex for registering of pain. Involvement of other centers may explain the associated autonomic symptoms and affective aspects of this pain.
Neurogenically induced plasma extravasation may play a role in the expression of pain in migraine, but it may not be sufficient by itself to cause pain. The presence of other stimulators may be required.
Although some drugs that are effective for migraine inhibit neurogenic plasma extravasation, substance P antagonists and the endothelin antagonist bosentan inhibit neurogenic plasma extravasation but are ineffective as antimigraine drugs. Also, the pain process requires not only the activation of nociceptors of pain-producing intracranial structures but also reduction in the normal functioning of endogenous pain-control pathways that gate the pain.
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Understanding What Causes Headaches And Finding Treatments To Relieve The Pain
Nearly everyone has had headache pain, and most of us have had it many times. A minor headache is little more than a nuisance thats relieved by an over-the-counter pain reliever, some food or coffee, or a short rest. But if your headache is severe or unusual, you might worry about stroke, a tumor, or a blood clot. Fortunately, such problems are rare. Still, you should know when a headache needs urgent care and how to control the vast majority of headaches that are not threatening to your health.
How Long Is A Migraine Attack
There are four phases of a migraine attack: prodrome, aura, headache and postdrome. Not everyone experiences every phase during a migraine attack, and each attack may be different, even within the same person.
The headache portion of an attack can last from four hours to three days. An entire migraine attackincluding prodrome, aura, headache and postdromemay last anywhere from a bit more than one day to slightly more than a week at its very longest, though this is not typical. Most typically, a migraine attack will last for one to two days.
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How Often Do Ocular Migraines Occur
Ophthalmic migraines are commonly called ocular migraines. While a severe type of headache is typically the main symptom of migraines, visual disturbances with or without the headache pain can likewise be a kind of migraine with the very same migraine procedures connected to changes in blood circulation in the brain.
Different triggers will frequently be the reason a migraine takes place however in many cases, those changes that occur in blood flow actually take place to the area of the brain responsible for vision. These are all eye migraines and ocular migraines is among them. Along with pain, other symptoms can include nausea, congestion and visual symptoms.
The look of weird visual disturbances, usually lasting less than an hour, but without any headache, could mean you are having an uncommon ocular migraine. Although they can occur consistently, they typically do not follow a regular pattern. There can be short or extended periods of time in between attacks.
The symptoms and signs of an ocular migraine:
What Is An Aura
An aura is a group of sensory, motor and speech symptoms that usually act like warning signals that a migraine headache is about to begin. Commonly misinterpreted as a seizure or stroke, it typically happens before the headache pain, but can sometimes appear during or even after. An aura can last from 10 to 60 minutes. About 15% to 20% of people who experience migraines have auras.
Aura symptoms are reversible, meaning that they can be stopped/healed. An aura produces symptoms that may include:
- Seeing bright flashing dots, sparkles, or lights.
- Blind spots in your vision.
- Numb or tingling skin.
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I Get Migraines Right Before My Period Could They Be Related To My Menstrual Cycle
More than half of migraines in women occur right before, during, or after a woman has her period. This often is called “menstrual migraine.” But, just a small fraction of women who have migraine around their period only have migraine at this time. Most have migraine headaches at other times of the month as well.
How the menstrual cycle and migraine are linked is still unclear. We know that just before the cycle begins, levels of the female hormones, estrogen and progesterone, go down sharply. This drop in hormones may trigger a migraine, because estrogen controls chemicals in the brain that affect a woman’s pain sensation.
Talk with your doctor if you think you have menstrual migraine. You may find that medicines, making lifestyle changes, and home treatment methods can prevent or reduce the pain.
How Long Does A Migraine Attack Last
Time is an important factor when it comes to migraine management. Find out how to recognize a migraine attack and when to take action.
When a migraine attack starts, you might have a lot of questions about what is happening, how long it will last and how you can treat your symptoms. Understanding the timing involved in a migraine attackspecifically the headache phasewill go a long way in helping you manage your migraine and knowing when to take action.
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Migraine And Other Vascular Disease
People who suffer from migraine headaches are more likely to also have cardiovascular or cerebrovascular disease . Reliable evidence comes from the Women’s Health Study, which found that migraine with aura raised the risk of myocardial infarction by 91% and ischemic stroke by 108% and that migraine without aura raised both risks by approximately 25%. Migraines during pregnancy are also linked to stroke and vascular diseases. A 2017 analysis of the Women’s Health Study found that women who experience migraine headaches, particularly migraine without aura, may be at increased risk for hypertension. Compared with women without a history of migraine, those who experienced migraine with aura had about a 9% increased risk for hypertension while those who experienced migraine without aura had about a 21% increased risk.
Migraine with aura for women in midlife has a statistically significant association with late-life vascular disease in the cerebellum. This association is not seen in migraine without aura.
What Are The Treatments For Migraine
There is no absolute cure for migraine. However, lots of treatments are available to help ease the symptoms of a migraine attack.
When a migraine attack occurs, most people find that lying down in a quiet, dark room is helpful. Sleeping can also help. Some people find that their symptoms die down after they have vomited .
Most people affected by migraine will already have tried paracetamol, aspirin and perhaps anti-inflammatory drugs such as ibuprofen before they seek advice from their doctor. If ordinary painkillers alone are not relieving your symptoms, your GP might prescribe you a triptan to be taken in addition to over-the-counter painkillers . Triptans are available in different forms to suit individuals , although it is important to note that some people develop short-term side effects when taking triptans. Your doctor may also prescribe you anti-sickness medication. If your situation does not improve after treatment, you might be referred to a specialist migraine clinic.
It is important to avoid taking painkillers on more than two days per week or more than 10 days per month as this can in fact make things worse by triggering medication overuse headaches.
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Enhancing Healthcare Team Outcomes
Management of a migraine patient will require the efforts of an interprofessional healthcare team. The interprofessional care provided to the patient must use an integrated care pathway combined with an evidence-based approach to planning and evaluating all joint activities. Primary care clinicians obtain the assistance of an internist, a neurologist, or a headache specialist if there’s any doubt about the diagnosis. Nurses and psychologists can assist team management by teaching lifestyle changes, mental health supervision, drug overuse detoxification, and medication use recommendations.
Pharmacists can aid the team in checking for appropriate dosing and determining drug interactions, especially if the patient is treated for chronic migraines. Nursing must coordinate activities between the various disciplines and often serve as initial contact points for patients and other team members. All interprofessional team members must document any changes in patient status as they observe them and notify the appropriate other parties on the healthcare team so additional diagnostic and/or therapeutic measures can occur if necessary. Open communication among team members is crucial to optimal patient care.
An interprofessional team that provides an integrated approach to patient care can help achieve the best possible outcomes. Collaboration, shared decision-making, and communication are crucial for a good result.
What Else Can I Do To Prevent Migraines
While there are no sure ways to keep from having migraine headaches, here are some things that may help:
- Eat regularly and do not skip meals.
- Keep a regular sleep schedule.
- Exercise regularly. Aerobic exercise can reduce tension and keep your weight in check. Obesity can contribute to migraines.
- Keep a migraine journal to track what triggers your migraines and what treatments are most helpful.
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