A migraine is a headache that causes severe, debilitating, throbbing, one-sided pain in the head. Generally felt along with nausea, vomiting and fatigue, it can cause extreme sensitivity to sound and light, thereby leading to irritability, vision changes and other symptoms. A prolonged migraine attack can leave a person in bed for days together, disrupting daily activities. The headaches can worsen with bright lights, loud noises, strong odours and physical activity.
Some patients may experience a warning symptom called an ‘aura’ before or along with the headache. This could include blind spots, flashes of light or other disturbances, including a tingling sensation in an arm, leg or one side of the face, making it difficult to speak. Drugs could help make migraines less painful and even prevent some of them. A combination of self-help remedies, lifestyle changes and the right drugs could all help.
While there are several kinds of migraines, the two common ones are migraine with an aura (called classic migraine) and migraine without an aura (common migraine). An aura is merely a migraine phase before the pain in the head begins. Migraine prevalence is rising in India. In 2019, more than 213 million Indians were said to be afflicted with migraine. Of these, women comprised 60% of the cases.
The Migraine Phases
There are four migraine phases: prodrome, aura, headache and postdrome. The first phase (prodrome) can begin up to a day before one experiences a headache. The aura refers to a group of motor, sensory and/or speech symptoms, which act as a warning sign for an impending migraine headache. This phase may last for five minutes or an hour. Aura and headache may both be felt simultaneously.
The headache phase of a migraine could last anywhere between 4 and 72 hours. Typically, the postdrome stage can be felt for a few hours or up to two days. Its symptoms could feel much like an alcohol-induced hangover, resulting in the term ‘migraine hangover’. The four stages could take anywhere between 8 and 72 hours.
Symptoms of Migraine
The symptoms could vary depending on the specific stage. Since each migraine is different, a person may not necessarily experience symptoms in all the four migraine stages. Prodrome symptoms could include mood changes, trouble sleeping, difficulty in concentrating, nausea, fatigue, hunger, thirst and frequent urination.
Aura symptoms may include vision changes, muscle weakness, tinnitus (ringing in the ears), numbness and tingling, sensitivity to touch (almost like the person is being touched) and difficulty in speaking or concentrating.
Headache phase symptoms may affect one side of the head or both sides and slowly get more intense. It can happen along with other symptoms like nausea and vomiting as well as sound, light and odour sensitivity. Postdrome symptoms may comprise stiff neck, fatigue, light and sound sensitivity, difficulty in concentrating, nausea and dizziness.
Intensity and Frequency
The migraine could feel like a throbbing, pounding, pulsing or dull pain. Since each person will feel a migraine differently, the headache could range from mild to severe. Moreover, the head pain may begin from one side of the head and move to the other side. The pain may also be felt around the eyes and temple or, occasionally, around the face, jaw, neck or sinuses.
The frequency of migraine may vary between different people. Migraines can occur once a week or a year. However, most people will experience anywhere between two and four migraines each month. They usually tend to occur in the morning. Although most migraines can be unpredictable, occasionally one will have some idea of when a migraine may strike, such as just before menstruation or when a person is feeling stressed.
The Causes and Triggers
While studies indicate genetics may play a role in migraines, researchers don’t know the precise cause of these headaches. Triggers are factors that make the symptoms begin. Some common triggers for migraines include stress, specific medications, hormonal changes, sleep pattern changes, weather changes, overexertion or excess physical activity, consumption of caffeine, tobacco or other addictive substances, skipping a meal and exposure to loud noises, bright lights or strong odours.
The doctor can help a person identify his or her specific triggers. The doctor may also recommend you maintain a migraine diary to track the similarities between your migraine attacks. For example, certain chemicals and food preservatives could act as a trigger if your body is sensitive to these substances. Alongside other triggers, this sensitivity will make the occurrence of a migraine more likely. Some of the common food triggers are aged cheese, chocolates, beverages with alcohol, MSG, nitrates or other food additives, cured or processed foods (pepperoni and hot dogs) and pickled or fermented foods.
Some Risk Factors
Migraines could tend to run in families. In India, research indicates between 30% and 60% of common migraines may be because of hereditary causes. Children could be affected when one or both the parents suffer migraines. Be it children or adults, one could be affected by migraines at any age. More than men, women are likely to experience migraines. Other risk factors include anxiety, depression, epilepsy, sleep disorders or other underlying medical ailments and regular consumption of tobacco products.
Managing and Treating the Condition
Migraines have no cure. Nonetheless, the condition can be managed by avoiding migraine triggers and taking prescribed medications. Migraine medications fall into two categories: drugs to stop migraines and medicines to prevent them. The first type can be taken when the initial signs of a migraine arise. These medications will reduce or stop symptoms such as pain, sensitivity, nausea, etc.
Preventive medications will be prescribed by the neurologist if a person experiences severe symptoms that disrupt one’s normal routine or if there are frequent attacks. These drugs will minimise the frequency and severity of migraines. The medicines could be taken daily as prescribed by your neurologist.
OTC (over-the-counter) migraine medicines can be effective if one has mild to moderate symptoms. However, be cautious with OTC pain relievers as overuse could cause rebound headaches or a problem of dependency. If a person is taking OTC medications twice or thrice per week, inform the doctor about this. The doctor could prescribe more effective medications than the ones currently being taken.
When an attack occurs, rest in a quiet, dark and cool room; apply a warm or cold compress to the forehead or behind the neck; massage the scalp; apply pressure to the temple in a circular motion; and meditate to stay calm.
When Should One Visit the Doctor?
Visit the neurologist or hospital immediately if some signs or symptoms indicate a more serious issue. These will include an abrupt, severe headache that feels like thunder; headache accompanied by a stiff neck, fever, confusion, double vision, seizures, numbness or weakness in any part of your body, which may indicate a stroke; headache following an injury; and a chronic headache, which worsens when coughing, straining or making a sudden movement.
Although migraine pain can seem maddening, remember there are treatment options that will make them more manageable so your daily life is not disrupted often.