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Migraine

migraine


Migraine is a condition that causes episodes (attacks) of headaches. Other symptoms such as feeling sick (nausea) or vomiting are also common. Between migraine attacks, the symptoms go completely. Migraine is common. It most commonly first starts in childhood or as a young adult.

What are the types and symptoms of migraine?

There are two main types of migraine attack: migraine attack without aura (sometimes called common migraine) and migraine attack with aura (sometimes called classic migraine).

Migraine without aura

This is the most common type of migraine. Symptoms include the following: The headache is usually on one side of the head, typically at the front or side. Sometimes it is on both sides of the head. Sometimes it starts on one side, and then spreads all over the head. The pain is moderate or severe and is often described as throbbing or pulsating. It often begins in the morning, but may begin at any time of the day or night. Typically, it gradually gets worse and peaks after 2-12 hours, and then gradually eases off. However, it can last from 4 to 72 hours.

Other migraine symptoms that are common include: feeling sick (nausea), vomiting, you may not like bright lights or loud noises, and you may just want to lie in a dark room.

Migraine with aura

About 1 in 4 people with migraine have migraine with aura. The symptoms are the same as those described above (migraine without aura), but also include an aura (warning sign) before the headache begins. Visual aura is the most common type of aura. Examples include: a temporary loss of part of vision, flashes of light, objects may seem to rotate, shake, or boil. Numbness and pins and needles. Numbness usually starts in the hand, travels up the arm, then involves the face, lips, and tongue. The leg is sometimes involved. Problems with speech. Other types of aura include: an odd smell, food cravings, a feeling of wellbeing, and other odd sensations.

Phases of a typical migraine attack

A migraine attack can typically be divided into four phases:

  • A premonitory phase in which you may feel irritable, depressed, tired, have food cravings, or just know that a migraine is going to occur.
  • The aura phase (if it occurs).
  • The headache phase.
  • The resolution phase when the headache gradually fades. During this time you may feel tired, irritable, depressed, and may have difficulty concentrating.

Less common types of migraine

  • Menstrual migraine. The symptoms of each attack are the same as for common migraine or migraine with aura. However, the migraine attacks are associated with periods.
  • Abdominal migraine. This mainly occurs in children. Instead of headaches, the child has attacks of abdominal (tummy) pain which last several hours.
  • Ocular migraine. This is sometimes called retinal migraine, ophthalmic migraine or eye migraine. It causes temporary loss of all or part of the vision in one eye. This may be with or without a headache. Each attack usually occurs in the same eye. There are no abnormalities in the eye itself and vision returns to normal.
  • Hemiplegic migraine. This is rare. In addition to a severe headache, symptoms include weakness (like a temporary paralysis) of one side of the body.
  • Basilar-type migraine. This is rare. Symptoms typically include headache at the back of the head (rather than one-sided as in common migraine). They also tend to include strange aura symptoms such as temporary blindness, double vision, vertigo, ringing in the ears, jerky eye movements, trouble hearing, slurred speech, dizziness.

How is migraine diagnosed? Do I need any tests?

Migraine is usually diagnosed by the typical symptoms. There is no test to confirm migraine. Tension headaches are sometimes confused with migraine. These are the common headaches that most people have from time to time.

What causes migraine?

The cause is not clear. A theory that used to be popular was that blood vessels in parts of the brain go into spasm (become narrower) which accounted for the aura. The blood vessels were then thought to dilate (open wide) soon afterwards, which accounted for the headache.

It is now thought that some chemicals in the brain increase in activity and parts of the brain may then send out confusing signals which cause the symptoms.

What are triggers?

Most migraine attacks occur for no apparent reason. However, something may trigger migraine attacks in some people. Triggers can be all sorts of things. For example:

  • Diet. Dieting too fast, irregular meals, cheese, chocolate, red wines, citrus fruits, and foods containing tyramine (a food additive).
  • Environmental. Smoking and smoky rooms, glaring light, VDU screens or flickering TV sets, loud noises, strong smells.
  • Psychological. Depression, anxiety, anger, tiredness, stress, etc.
  • Medicines. For example, hormone replacement therapy (HRT), some sleeping tablets, and the contraceptive pill.
  • Other. Periods (menstruation), shift work, different sleep patterns, the menopause.

What are the treatment options for migraine?

Painkillers

Paracetamol or aspirin works well for many migraine attacks. (Note: children aged under 16 should not take aspirin for any condition.) Take a dose as early as possible after symptoms begin.

Anti-inflammatory painkillers

Anti-inflammatory painkillers probably work better than paracetamol. They include ibuprofen, diclofenac, and naproxen.

Dealing with nausea and sickness

Use soluble (dissolvable) painkillers. These are absorbed more quickly from your stomach and are likely to work better. You can take an antisickness medicine with painkillers.

Triptan medicines

A triptan medicine is an alternative if painkillers do not help. These include: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan. They are not painkillers. They work by interfering with a brain chemical called 5HT. An alteration in this chemical is thought to be involved in migraine. A triptan will often reduce or abort a migraine attack. Do not take a triptan too early in an attack of migraine. You should take the first dose when the headache (pain) is just beginning to develop, but not before this stage. Triptans probably work much less well if taken too early on in an attack.


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