MIGRAINE

Collected,Compiled,Edited and Presented by:-

JAGANNATHAN

 

A migraine is a severe headache that causes throbbing, pulsing  pain on one side of the head. The headache phase of a migraine usually lasts at least four hours, but it can also last for days. This headache gets worse with:

• Physical activity.
• Bright lights.
• Loud noises.
• Strong odors.

Migraines are disruptive. They can interfere with  daily routine and affect the ability to meet personal and social obligations.

TYPES

There are several types of migraines. The most common migraine categories are:

• Migraine with aura (classic migraine).
• Migraine without aura (common migraine).

• Migraines in children (abdominal migraine).
• Chronic migraine.
• Hemiplegic migraine.
• Menstrual migraine.
• Silent Migraine (Migraine without headache)
• Retinal migraine (ocular migraine).
• Status migrainosus.

SYMPTOMS

The symptoms of a migraine come in four phases. The most notable is a headache attack.

There are four phases or stages of a migraine:

1.     Prodrome: The first phase begins up to 24 hours before experiencing headache.

2.     Aura: An aura is a group of sensory, motor and/or speech symptoms that act as a warning sign of a migraine headache. The aura phase can last as long as 60 minutes or as little as five. Both the aura and the headache may occur at the same time.

3.     Headache: A migraine headache lasts between four hours to 72 hours.

4.     Postdrome: The postdrome stage usually lasts for a few hours up to 48 hours. Symptoms feel similar to an alcohol-induced hangover, which is why the postdrome phase is known as a migraine hangover.

It can take about eight to 72 hours to go through the four stages.

Migraine symptoms

Migraine symptoms vary based on the stage. Every migraine is different, and one won’t necessarily experience symptoms during all four stages of every migraine.

Prodrome symptoms

·         Mood changes.

·         Lack of concentration

·         Insomnia.

·         Fatigue.

·         Nausea.

·         Increased hunger and thirst.

·         Polyurea

Aura symptoms

• Muscle weakness.
• Vision changes.
• Tinnitus
• Sensitivity to touch
• Parasthesia
• Difficulty speaking or concentrating.

Headache attack symptoms

Headache gradually gets more intense. It can affect one side of the head or both. It can occur with other symptoms like:

• Nausea and vomiting.
• Light, sound and odor sensitivity.

Postdrome symptoms

• Fatigue.
• Stiff neck.
• Sensitivity to light and sound.
• Difficulty concentrating.
• Nausea.
• Dizziness.

Migraine headache pain may feel like the following:

• Throbbing.
• Pulsing.
• Pounding.
• Dull.

A migraine can feel different for each person. A migraine headache ranges from mild to severe. Headache can start on one side and shift to the opposite side. Thera may also be pain around the eyes or temple, and sometimes, around the face jaw and sinuses

MECHANISM OF PAIN IN MIGRAINE

The pain in migraines is primarily caused by the activation of nerve pathways in the brain and the subsequent release of inflammatory substances

1.     Neurovascular Changes: Migraines involve complex interactions between nerves and blood vessels. When a migraine occurs, certain blood vessels in the brain dilate, leading to increased blood flow. This dilation can activate pain receptors in the vessel walls.

2.     Inflammatory Mediators: During a migraine attack, the trigeminal nerve releases substances like calcitonin gene-related peptide (CGRP), substance P, and neurokinin A. These chemicals cause inflammation and increase pain sensitivity in the  meninges

3.     Cortical Spreading Depression (CSD): This phenomenon is a wave of electrical activity that spreads across the cortex. It’s believed to trigger migraine aura and may activate trigeminal nerves, leading to pain.

4.     Central Sensitization: During a migraine, the brain becomes more sensitive to stimuli. This central sensitization means that normal sensations can be perceived as painful, amplifying the overall experience of pain.

5.     Genetic Factors: Genetics can also play a role, as certain inherited traits may make individuals more prone to migraines and the mechanisms that cause pain.

FREQUENCY

The frequency of a migraine varies from person to person. One might have one migraine per year or one per week. On average, most people experience two to four per month. They’re most common in the morning. Most migraines are unpredictable, but sometimes, one can have an idea of when a migraine will happen, like before menstruation or after feeling stress.

CAUSES

We aren’t definite about the exact cause of migraines, but studies show genetics play a role.

When we have a headache, specific nerves of the vasculature  send pain signals to you’re the brain. This releases inflammatory substances into the head’s nerves and blood vessels. It’s unclear why the perivascular nerves do that.

TRIGGERS

A trigger is something that causes symptoms to start. Some of the most common migraine triggers include:

• Stress.
• Hormonal changes.
• Certain medications.
• Changes in sleep.
• Weather condition changes.
• Too much physical activity (overexertion).
• Addictive substances like caffeine or tobacco.
• Missing a meal.
• Exposure to bright lights, loud noises or strong odo

RISK FACTORS

A migraine can affect anyone at any age, from children to adults. Women are more likely than men to experience a migraine.

Other risk factors that may make one more likely to experience a migraine include:

• Biological family history of migraines.
• Underlying medical condition                             
• Depression,                                                                                          Anxiety,                                                                                                                
• Sleep disorders and                                                                                                      Epilepsy.
• Regular use of tobacco products.

DIAGNOSIB

1.History                                                                                                                            2.Physical Examination                                                                                                                  3.Neurological Examination

HISTORY

 Symptoms experienced

Description of the feeling and location of the headache

Sevearity of the  symptoms

Duration of the symptoms and

Aggrevating and relieving factors of the pain 

Blood tests Imaging tests (such as a CT scan or an MRI) to make sure there aren’t any other causes forthe headache.

 An electroencephalogram (EEG) may help to rule out other conditions.

MANAGEMENT

There isn’t a cure for migraines. But WE can help TO manage migraine symptoms through the following:

• Taking medications.
• Avoiding migraine triggers.
• Using alternative migraine reme

DRUGS FOR MIGRAINE

There are two types of medications available:

• Medications to stop migraines: These medications are takenat the first sign of a migraine. They stop or reduce migraine symptoms like pain, nausea, sensitivity and more.
• Medications to prevent migraines: Preventive medications are prescribed if one experiences severe symptoms that interfere with the routine or have frequent migraines. These drugs reduce how often and how severe migraines affects.

Common DRUGS  that stop migraines include:

• Triptans (5-hydroxytryptamine).
• Ditans (Lasmiditan).
• Gepants (Rimegepant and Ubrogepant).
• Dihydroergotamine
• Antiemetic medications (Metoclopramide).

Common preventive migraine medications include:

• Antiseizure medications (Valproic acid, Topiramate).
• Beta-blockers (Atenolol, Propranolol, Nadolol).
• Calcium channel blockers (Verapamil).
• Monoclonal antibodies
• Tricyclic antidepressants (Amitriptyline, Nortriptyline, Doxepin).
• Serotonin and norepinephrine reuptake inhibitors (Venlafaxine, Duloxetine).

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COMMON ANALGESICS

Common analgesics  are effective in mild to moderate migraine symptoms. The main ingredients in common analgesics  are Ibuprofen, Aspirin, Acetaminophen, Naproxen and Caffeine.

One has to be cautious when taking over-the-counter pain relievers. Sometimes, overusing them can cause analgesic-rebound headaches or a dependency pro

TRIGGER AVOIDANCE

Once we identify a trigger, we can take steps to avoid it. This isn’t always possible, but awareness of our triggers is helpful to identify them and treat a migraine when it starts.

For example, if stress is a trigger, one may want to speak with a mental health professional to help you manage your stress. If you get migraine symptoms when you miss a meal, set an alarm on your phone to remind you to eat meals on a regular schedule.

Alternative migraine remedies

People  may want to try alternative therapies to help them to  manage migraines. These include:

• Taking vitamins, minerals or herbs like riboflavin (vitamin B2), magnesium, feverfew, butterbur or co-enzyme Q10.
• Relaxation techniques like yoga.
• Acupuncture.
• Biofeedback.
• Botulinum toxin type A injections (Botox®).

 Deal with a migraine as it happens

There are certain things we can do to help us feel better when a migraine attack happens, including:

• Resting in a dark, quiet, cool room.
• Applying a cold or warm compress on the forehead or behind the  neck.
• Massaging ther scalp.
• Applying pressure on the temples in a circular motion.
• Keeping oneself in a calm state (meditating).

Prevention

You can’t prevent all migraines. But we can take preventive migraine medications as directed to reduce how often and how severe migraine symptoms affect . We can also learn more about ther triggers and avoid them.

Outlook

Migraines are different for each person.                                                                     They’re temporary but recurring throughout your life.                                                          There’s also no available cure..                                                                                               It may take time to find a treatment option that’s right for us.                                       Let us wait hopefully for better outcome in future                                              

JAGANNATHAN