Definitely, Migraine is a headache in our life. At any time it can break in Migraine prone individuals with moderate to severe headache in association with many psycho somatic symptoms. The word Migraine came from the Greek word Hemikrania meaning pain on the side of the head. Migraine attack is usually unilateral affecting one half of the head with painful throbbing and associated symptoms like Nausea, Vomiting etc. Photophobia (aversion to light), Phonophobia (irritability to sounds), Visual disturbances, Fatigue etc are also associated with the Migraine attack. Around one third of people with Migraine, perceive an Aura which is a transient visual, motor and sensory disturbance indicating the starting of Migraine attack. As experts say, Migraine is not a disease but a condition triggered by multiple factors which may vary from persons to persons. Let us see the reasons, symptoms and methods to avoid migraine attack.
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Why it is attacking some persons only?
Migraine prone individuals have a familial history which is genetical and involves the activity of a gene. In such individuals, a number of factors can induce migraine attack. Hormonal changes, Environmental factors, some food materials, over stress and over excitement, fear etc can trigger the migraine attack. Migraine attack is more in boys than girls before puberty but in adults, its rate is higher in females than males. The exact reason for the migraine attack is still unknown but it is believed that it is a Neuro vascular disorder involving brain cortex and arteries of the fore head. The pain is induced by the irritability on the pain neurons present in the Trigeminal nucleus of the brain stem.
From where it comes? How it is going?
These are the possible questions of a Migraine prone individual. Actual reason for migraine attack is still unknown but possibilities, case studies etc revealed the involvement of mind and physiology as triggering factors. Migraine is considered as a neurohaemal condition involving brain cortex, brain stem and peripheral blood vessels. Brain cortex is the seat of both sensory and motor activities and brain stem is the part of emotion, anxiety etc. Over activities of these centers release some neurotransmitters like Serotonin (the sleep inducing hormone) and agents stimulating the pain centre of brain. These chemicals have an influence on the arteries mainly those present in the Meninges (outer coverings of brain) and the peripheral arteries of the forehead. So the arteries will dialate and contract unnecessarily creating the throbbing which induces pain and associated symptoms. The whole process develops in the presence of any one of the triggering factors like, stress, food, environmental factor etc. After the disappearance of the triggering factor and the removal of neurotransmitters and other chemicals released, the symptoms of migraine disappear. So it is a short living physiological condition which may not results in a disease unless other neuronal conditions are involved.
How can we classify Migraine?
The symptoms, severity, duration etc of migraine vary from person to person. The original classification of migraine came on 1988 and in 2004, it was classified as the Primary head ache along with the Tension head ache and Cluster head ache. Generally two types of Migraine attack are common. Migraine with Aura and Migraine without Aura.
1. Migraine with Aura
This is the Classic Migraine with an Aura before the pain breaks. The aura may appear without a head ache or with a non migraine head ache. Migraine with aura may be Familial Hemiplegic migraine or Sporadic hemiplegic migraine in which the person feel motor weakness. Another kind of migraine with aura is the Basilar type migraine in which the person feel difficulty to speak and show symptoms like world spinning, ringing in ear etc. Some brain stem related symptoms may also appear like spasms in the basilar artery supplying blood to the brain stem.
2. Common migraine
This migraine head ache is without an Aura and may be severe or less severe.
Migraine attack is a recurrent headache with associated autonomic symptoms. About 15-30 % people experience Aura before the migraine starts. Sometimes they also experience migraine without Aura. Usually the migraine headache is short duration one lasting few hours but if it prolongs more than three days, it is termed as Status Migrainosus. There are 4 possible phases of Migraine.
1. Prodrome phase
This phase starts two hours to two days before the Aura or pain. The symptoms include altered mood, irritability, depression, fatigue, craving for some kind of food, muscle stiffness, constipation, diarrhea, over sensitivity to smell and sound etc. These symptoms may also appear in migraine without Aura.
2. Aura phase
It is a transient Focal neurological phase before the starting of headache. The symptoms last few minutes or less than one hour. Symptoms can be visual, sensory or motor. Many people experience more than one symptom but visual effects are seen in 99% of cases. Visual effect is characterized by the appearance of a Scotoma which is an area of partial alteration of the visual field with flickers. The Scotoma is scintillating and starts from centre of vision as a small flickering which then spread out to the side of the visual field with zigzagging lines. The flickering is usually black and white or yellow in colour but other colours may also appear. During the growth of Scotoma, some people lose part of visual field known as Hemianopia while others feel blurring. As the aura phase advances, the flickering Scotoma acquires a C shape and finally vanishes from the periphery of visual field. Usually the whole process lasts less than 20 minutes. The visual disturbances are not related to eye problems and will not affect vision.
3. Pain phase
After the disappearance of Aura, pain starts. This is unilateral, throbbing and moderate to severe in intensity. Usually it appears slowly but aggravated in physical activity. Bilateral pain and neck pain also may occur sometimes. Bilateral pain is common in migraine without aura. Occasionally pain starts in the back or top of the head. The pain lasts for 2-72 hours in adults but less than 2 hours in children. The frequency of attack varies considerably from a few attacks in a life time to several in a week or one in a month. Pain is associated with Nausea, Vomiting, sensitivity to light (Photophobia), sensitivity to sound (Phonophobia), irritability, fatigue etc. In Basilar migraine, neurological symptoms may also appear which includes, sense of world spinning, light headedness, confusion etc. Nausea occurs in more than 90% cases but Vomiting occurs about one third cases. Other symptoms include blurred vision, nasal stiffness, frequent urination, diarrhea, neck stiffness etc.
4. Postdrome phase
This phase appears after the Aura and pain phase which is the sensory aura characterized by the feeling of pins-and-needles on one side of hand and arm which spreads to face on the same side. Postdrome phase last from few hours to few days. Numbness usually occurs after the tingling passes with a sense of loss of position. Other symptoms include disturbances in speech, world spinning, motor symptoms like weakness. Sometimes Aura reappears without pain. This is the Silent Migraine. Some people have a sore feeling in the area of migraine while others feel impaired thinking for few days after the migraine attack. Some people may also feel tired or hung over, cognitive difficulties, gastrointestinal disorders, mood changes etc. In short, some people may feel refreshed or Euphoric ( A medically recognized mental and emotional condition in which a person experiences intense feelings of well-being, happiness, excitement, and joy), while some feel depression after a migraine attack.
In summary, the stages and symptoms of Classic migraine are
1. Prodrome stage – Up to 24 hours before migraine. Heightened or dull perception, irritability, withdrawal, food craving.
2. Aura phase – Up to 1 hour before migraine. Flashing lights, shimmering Zig-Zag lines, luminous blind spots aura around objects, numbness and pins in hands.
3. Pain phase – Headache lasting 4-72 hours, pulsating, throbbing pain either unilateral or both sides of the head and behind eyes. Light and sound intolerance, nausea, vomiting, and occasionally speech difficulty.
4. Postdrome phase –Up to 24 hours after migraine attack. Achy muscles, tired, drained, some have a period of Euphoria (Feeling of well beings and happiness).
Interestingly, migraine is also there in abdomen. Frequent spasms, pain etc in the stomach may be a kind of migraine. It also causes headache. Gastrointestinal problems, constipation, diarrhea etc may be the reasons. Fibre rich food, drinking excess water, fruits etc can help a lot.
How it is affecting some people only?
Migraine attack is common in many people but varies in symptoms and severity. The underlying cause of migraine is unknown but experts say that there are multiple reasons of which familial history is the most important. In migraine prone individuals one or more unfavorable factors can trigger the attack. A number of physiological and psychological factors can induce migraine attack. The important causes are
Genetic factor is one important cause of migraine. Studies have revealed that genetics can influence the likelihood to develop migraine and this genetic relationship is more in migraine with aura. Single gene disorders like Familial hemiplegic migraine is caused by an Autosomal dominant gene but it is rare. The disorder is related to variants of gene coding for proteins involved in ion transport.
2. Psychological factors
Many psychological states like, Anxiety, Depression, Fear, Excitement, Over stressed condition can induce migraine attack.
3. Neurological factors
Over activity in the cortex due to Tension, Stress, anxiety etc causes the release of neurotransmitters especially, the Serotonin which can cause migraine attack. Cortical spreading depression is the burst of neuronal activity followed by a period of inactivity which is common in migraine with Aura. There are explanations for this and most accepted one is the activation of the glutamate receptor NDMA (N-methyl-D-aspatate) which is mainly involved in Synaptic plasticity and Memory. Activation of NDMA causes the opening of Ion channel. The release of neurotransmitters causes vasodilatation of blood vessels especially in the fore head followed by vasoconstriction. The blood vessels will throb leading to the migraine attack. The pain is induced by the peripheral activation of sensory nerve fibres surrounding the blood vessels like Dural arteries, Pial arteries (Meninges arteries) and Extracarnial arteries like those of the scalp.
4. Environmental factors
Environmental factors like sunlight, humidity, cold, air-conditioning, pungent odour of chemicals, perfumes etc can trigger migraine attack. Poor indoor air quality, poor light, flashing lights, light from computer screen, CFL etc can also cause migraine attack.
A number of food materials can act as triggers for migraine attack. Chocolate, Ice cream, cocoa, food preservatives, flavoring agents, sauce, chilly, spicy food, Mono sodium glutamate, calcium rich foods like milk, egg etc can trigger migraine. But this varies from person to person and also in the same person at different times.
6. Physiological factors
Many physiological factors are also involved. Calcium loading in the cells, hormonal variations, hunger, gastrointestinal disorders such as constipation or diarrhea, hormone treatment, influence of contraceptive pills etc can induce migraine attack.
How to cope up with the situation?
A Migraine prone person should realize that he has the tendency of migraine attack if there is over activity and other unfavorable situations. The best way is to avoid such situations and make the life stress free. What will we do if there is a migraine attack? As you know, migraine headache can appear at any time if there is triggering factor. The following tips will be useful if there is a migraine triggering.
1. Classic migraine is more severe than simple migraine since it involves visual disturbances along with headache. So complete rest without any physical activities for half to one hour is necessary.
2. Rest in a room with low light for half an hour till the aura completely disappears. You can have meditation, relaxation techniques or even a sound sleep.
3. Soft music in low volume will also help to relieve the anxiety during the migraine attack.
4. Drink sufficient cold water (not too cold) to eliminate the accumulated chemicals during the migraine. Frequent urination is one condition after the migraine to eliminate wastes from the body.
5. Ask your family members or colleagues not to disturb for some time because physical activity or even talk can change the mood which can aggravate the condition.
6. Do not read or write till the aura disappears and the Postdrome symptoms diminishes. This will take 20 minutes to few hours.
7. Do not watch TV or use Computer till the visual field is ok because direct light to the eyes can increase the photophobia.
8. Do not drive vehicles during a migraine attack since cognitive functions will be disturbed during the migraine attack.
9. After the migraine attack, there will be hunger and craving for some kind of food (interestingly , such foods may be the triggering factor for the migraine). So it is better to have a soft vegetarian diet with raw vegetables and fruit juice. A cup of coffee has a stimulatory effect on nerves, so it is better. Avoid spicy food and pungent odors (as that of fast food) for few days after a migraine attack.
10. Bath in cold water (not ice cold) will make the body and mind fresh. But bath should be few hours after the migraine attack.
11. Medication is required only if the condition is recurring many times in a day or appearing repeatedly.
12. Preventive medicines do not abort migraine attack but reduces the chance of its appearance by changing the vascular conditions and permeability of cells. So prolonged medication for 6 months or higher is practiced in preventive therapy.
13. Along with preventive therapy, it is also necessary to keep the body tension free and avoid situations of hard physical activity and stressful situations.
14. If the Prodrome symptoms start appear in the morning just after wake up, it is necessary to take complete rest on that day to avoid the triggering of migraine.
How to solve the problem?
Migraine attack is mainly a condition due to genetic reason. The other factors only accelerate its occurrence and act as triggering factors. But if we know, we are prone to migraine; there are methods to prevent its frequent occurrence. Preventative methods include medication, life style changes, nutritional supplements etc.
Preventive medicines are available for migraine. Remember, the preventive medicines do not abort the migraine but changes the physiological conditions responsible for migraine. Drugs like Flunarizine (Sibelium) act as an effective calcium antagonist. It prevents cellular calcium overload by reducing excessive transmembrane calcium influxes. It acts on the cells and open the calcium ion channel to release calcium ions from the calcium over loaded cells. Drugs like Paracetamol, Aspirin, Ibuprofen etc are used as analgesic drugs to relieve pain.
Lifestyle change can reduce the chance of migraine attack. Tension free job, relaxation excises, yoga, massaging, daily exercise, bath in cold water, relaxing with soft music, sufficient sleep etc can reduce to frequency of migraine attack considerably.
3. Nutritional supplements
Good food habits, vegetables, fruits, minerals, vitamins like B complex can reduce the frequency of migraine attack.
As many people think, migraine is not a disease unless it is caused by other problems in the body. So try to realize the condition and learn to cope up with the situation.