Migraine treatment made simple

Migraine is a severe headache followed by such symptoms as sensetivity to bright light, nausea and vomiting. Migraine is a common condition among youth, especially young women. Migraine cannot be cured, the treatment is aimed at relieving symptoms and preventing attacks.

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What are migraines?

Migraines are a type of neurological disorder characterized by a recurrent severe and intense pulsating type of pain in your head that is usually associated with accompanying symptoms like nausea and vomiting, double vision or seeing spots., known as aura. It usually affects one side and its intensity and time period is longer than a headache. Migraines can last for days and are usually intensified by physical activity.

How common is it?

In the general population for Western countries it varies from 4% to 9% in men and from 11% to 25% in women. It is considered that more than 30 million people suffer from migraines each year. Incidence rates for people under the age of 30 vary from 1.5 to 6 per 1000 person in men and from 3 to 24 per 1000 person in women.

Why do migraines occur?

Migraines are still being studied as in why they occur. In previous decades, it was thought that it was induced due to the distension of blood vessels inside the head provoking the pulsatil characteristic pain people suffer. Now, it is believed different factors such as genetic, vascular and neural take place for a migraine to occur.

How are migraines classified?

Migraines are classified into different types. The most common and known are migraine without aura, migraine with aura, chronic migraine, and chronic migraine associated with analgesic overuse to name a few.

Migraine without aura:

It is estimated that around 70-90% of people who suffer from migraines, experience this type. The pain usually lasts from 4 to 72 hours, it is one sided, worsens with physical activity and photo-sensitivity may be present. It is also known as “common migraine”. 

Migraine with aura:

10 to 30% of people that suffer from migraines, experience this type. They were previously known as classical migraine or complicated migraine. People who suffer from this type, have the same symptoms as in a migraine without aura, except neurological symptoms are added that usually last less than an hour. Auras are symptoms, commonly visual that “warn” the patient of a pending migraine. Included are:

Chronic migraines:

They are defined as the presence of 15 or more headaches in a month in a period of over three months in which 8 of these headaches must be diagnosed as a migraine to fulfill the criteria. It is not that common, affecting only 1% of the population, but the quality of life is severely affected and absent days from either work or school have high rates.

What can trigger a migraine?

There are many factors that can lead to a migraine. Migraine triggers can include:

• Food, such as red wine, and other alcoholic beverages, dairy products, spicy food and chocolate. Food additives may trigger attacks as well.

• Hormonal changes such as changes in estrogen levels. It is common for women to suffer episodes of migraine before or during the menstrual cycle. Contraceptives and menopause can either trigger them or actually diminish the times a woman experiences a migraine episode.

• Changes in your wake-sleep cycle: not getting enough or too much sleep will trigger an episode.

• Physical activity: Extreme physical activity including sexual activity can produce a migraine.

• Medications: Nitroglycerin and oral contraception pills can worsen an episode.

What are the phases of a migraine?

Migraines have phases, so if you feel your head pains are more related to migraine type, try to look for these symptoms so that you can avoid having one. The first phase known as prodrome will include symptoms such as depression, mood swings, constant yawning, and food cravings (mostly chocolate). The second phase may or may not include an aura. Auras are sensations that warn that a migraine will occur. Usually lasts from 20-60 minutes before the pain starts and are divided into:

1. Visual auras: These are the most common type and include double vision, photo-sensitivity and seeing flashy lights or dots.

2. Olfatory auras: People will experience an unusual and not familiar sense of smell. Different types of smell can even trigger a migraine.

Third phase is when the person is experiencing the head pain. Mostly pulsating, affects one side, and is worsened by physical activity. The fourth phase is called postrdomal. Most people who suffer from migraines feel tired, experience lack of energy, confusion, lack of focus and might be sleepy.

How long does it last?

Migraine is a chronic disease, but with the proper medication and life style changes, long periods of remission can occur. It is seen tan from 30 to 40 % of patients who suffered from migraines in an early age tend to stop having them while they age. 

How can you tell the difference between headaches and migraine?

Headaches are one of the most common types of pain and is one of the most major reasons why people seek professional help and miss work or school days. Sometimes, they don’t require a doctor’s attention; others may warn of a more serious illness. So knowing when to differentiate between a tension headache and a migraine is important. Here are some tips to help you recognize the differences.

Headaches may occur in your temples, forehead and the back of your neck. They are classified into cluster headaches, tension type, sinus and secondary headaches.

Cluster Headaches

Cluster headaches are daily chronic types of pain that will happen due to liberation of serotonin and histamine. Bright lights, altitude and physical activity may trigger them. Dehydration may cause this type of pain.

Tension headaches

These are the most common type of headaches since most people have experienced one throughout their lifetime. Mostly caused by stress, and lack of sleep, affects neck, eyes and forehead.

Sinus Headaches

These are caused by a sinus infection or is common in allergic patients that suffer rhinitis.

Secondary Headaches

They are due to an external cause such as an injury or another medical problem.  Hangovers, meningitis, medication overuse and due to concussions are some examples of what might cause a secondary headache.

What complications are associated with migraine?

Recent studies show that people who suffer from migraine with aura type have a two times fold risk of suffering a stroke. Migraines as well is associated with other neurological and psychiatric diseases such as depression, anxiety disorder, panic attacks and bipolar disorders.

How is migraine diagnosed?

The diagnosis of migraine is usually taken from the clinical medical history. You must have had at least 5 episodes of headache that last from 4 to 72 hours and presenting either a unilateral location, the pain must pulsating, the intensity of the pain goes from moderate to severe and is exacerbated by physical activity.

There isn’t a specific test that will tell you immediately what type of pain you have, but doctors may ask for different tests to exclude external causes. Blood tests, MRI or CAT scans are the most common tools to diagnose between a migraine and headache and choose the appropriate treatment.

How is migraine treated?

Being a chronic disease, it is important to prevent from having a migraine attack. Avoiding the triggers that exacerbate the disease is important.

Acute or abortive therapy:

Once you have the pain, analgesics or painkillers are used to fight the symptoms. Acetaminophen, NSAIDs  and narcotics are used for mild to moderate pain. For moderate to severe pains, triptans or opioid analgesics are used. It is important to remember that these type of medicines can only be used 2 to 3 times a week to prevent a “rebound” headache episode.

Triptans:(sumatriptan, eletriptan, rizatriptan, zolmitriptan, almotriptan and frovatriptan) Only one type can be used in 24 hours, it works best when the pain starts and can be tken every two hours. Only two doses in 24 hours is recommended. Some side effects you can experience are drowsiness, dry mouth or a warm sensation. Triptans are available in different forms, pills, nasal spray and in injection form.

Ergots: (Migergot, Cafergot) They are ergotamine medicine and caffeine combined. They should be taken just when the pain starts. Precautions should be taken because they tend to worsen the effects of nausea and vomiting that come with the migraine. Antiemetic drugs are recommended to be used with these type of medicines.

Dihydroergotamine (Migranal) comes from Ergots, but research has proved that it has less side effects and you will have less risk of suffering a medication overuse headache that is commonly found as a side effect with Ergots.

Opioids: (Codeine) These type of medicines are used when triptans or ergots are not well tolerated. Because of the risk of co-dependancy, they are used only if the other types of medicine don’t work.

Antiemetics: (chlorperazine, promethazine, metoclopramide, domperidone) These type of medicine are used to treat the nausea and vomiting symptoms that come with the headache. Usually, they are used in combination with dyphenhydramine to diminish the adverse effect of antiemetics. You maight feel restlesness and tend to fidget, pace back and forth and a sensation of uneasiness.

Preventive medication or prophylactic therapy:

These types of medicine are used to prevent you from having a migraine attack. They will be prescribed if the headaches affect your quality of life, if acute therapy fails, if the duration is longer than 24 hours and if the frequency of migraine episodes is higher than two episodes per month. Preventive medication are divided into three categories: Antihypertensives, antidepressants and antiepileptic drugs. 

Antihypertensives:

Beta-blockers: (Propanolol, metoprolol, etenolol, nadolol, timolol). They reduce the widening of the arteries and also the activity of cell in cortex that are involved with migraine pain. They are not recommended in older patients, thyroid disorders or patients that suffer from depression.

Angiotensin II blockers: (Candesartan) They are effective as prophylactic therapy. Its use is still being studied.

Calcium blocker channels:(Flunarizine) They make the neurons, cells that are related to cause the migraine less “excitable” preventing the migraine to occur. Used if Beta-blockers are contraindicated.

Antidepressants:

Tryciclic antidepressants such as amitriptyline and nortriptyline are recommended. They are also helpful if you suffer from migraine and have trouble sleeping.

Antiepileptic drugs:

Valproic acid and topiramate are the most common anticonvulsivant drugs used as prophylactic treatment. They may reduce the pain signals that come from the neurons associated with migraine attacks. As well as affecting the excitability of the neurons.

Women who are in fertile age should not use valproic acid if they have intentions of being pregnant or are breastfeeding. Topiramate should be avoided in patients who suffer from liver and kidney failure.

Other medications:

Botulinum toxin A (onabotulinumtoxinA; BOTOX. Every 12 weeks, Botox is injected in your forehead and neck. This treatment is more effective in adults and in people who suffer from chronic migraines.

When should I go to the doctor?

All counter medicines should be prescribed by a specialist. If you think you suffer from migraine, different studies should be made and then with your doctor discuss what best treatment suits you. Counseling and relaxation methods are also offered in specialized centers that treat migraine and other neurological diseases. It is important to remember that if you feel that after taking the medicines, your pain doesn’t disappear or fade, you must visit the emergency unity for proper attention by a specialist. 

What should I do if I’m pregnant and suffer from migraines? 

Women who are pregnant or breastfeeding should avoid migraine medication therapy. If you suffer from migraine and are pregnant always consult a specialist so that a suitable therapy can be started or changed. 

Sources:

• https://www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/drc-20360207
• https://www.nhs.uk/conditions/migraine/prevention/
• http://www.ihs-headache.org/ichd-guidelines
• https://www.medicalnewstoday.com/articles/148373.php
• https://emedicine.medscape.com/article/1142556-treatment#d14
• https://www.migraine.ie/types-of-migraine/migraine-without-aura/
• http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC3611683&blobtype=pdf
• http://www.pitt.edu/~elsst21/mcldi.html
• http://www.icd10data.com/ICD10CM/Codes/G00-G99/G40-G47/G43-/G43.909