Everything You Need to Know About Migraine

What is migraine?

Migraine is a complex condition with a wide variety of symptoms. For many people, the main feature is a painful headache. Other symptoms include disturbed vision, sensitivity to light, sound and smells, feeling sick and vomiting. Migraine attacks can be very frightening and may result in you having to lie still for several hours.

The symptoms will vary from person to person and individuals may have different symptoms during different attacks. Your attacks may differ in length and frequency. Migraine attacks usually last from 4 to 72 hours and most people are free from symptoms between attacks. Migraine can have an enormous impact on your work, family and social lives.

There are several types of migraine, including:

migraine with aura – where there are specific warning signs just before the migraine begins, such as seeing flashing lights
migraine without aura – the most common type, where the migraine occurs without the specific warning signs
migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache doesn't develop

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Some people have migraines frequently, up to several times a week. Other people only have a migraine occasionally. It's possible for years to pass between migraine attacks.

Causes of Migraines

The exact cause of migraines is unknown, but they're thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain.

It's not clear what causes this change in brain activity, but it's possible that your genes make you more likely to experience migraines as a result of a specific trigger.

Migraine triggers

Many possible migraine triggers have been suggested, including hormonal, emotional, physical, dietary, environmental and medicinal factors.

These triggers are very individual but it may help to keep a diary to see if you can identify a consistent trigger. It can also sometimes be difficult to tell if something is really a trigger or if what you're experiencing is an early symptom of a migraine attack.

Hormonal changes

Some women experience migraines around the time of their period, possibly because of changes in the levels of hormones such as oestrogen around this time.

These type of migraines usually occur between two days before the start of your period to three days after. Some women only experience migraines around this time, which is known as pure menstrual migraine. However, most women experience them at other times too and this is called menstrual related migraine.

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Many women find their migraines improve after the menopause, although the menopause can trigger migraines or make them worse in some women.

Emotional triggers:

stress
anxiety
tension
shock
depression
excitement

Physical triggers:

tiredness
poor quality sleep
shift work
poor posture
neck or shoulder tension
jet lag
low blood sugar (hypoglycaemia)
strenuous exercise, if you're not used to it

Dietary triggers:

missed, delayed or irregular meals
dehydration
alcohol
the food additive tyramine
caffeine products, such as tea and coffee
specific foods such as chocolate, citrus fruit and cheese

Environmental triggers:

bright lights
flickering screens, such as a television or computer screen
smoking (or smoky rooms)
loud noises
changes in climate, such as changes in humidity or very cold temperatures
strong smells
a stuffy atmosphere

Medication:

some types of sleeping tablets
the combined contraceptive pill
hormone replacement therapy (HRT), which is sometimes used to relieve symptoms associated with the menopause

Risk factors

Several factors make you more prone to having migraines, including:

Family history. If you have a family member with migraines, then you have a good chance of developing them too.
Age. Migraines can begin at any age, though the first often occurs during adolescence. Migraines tend to peak during your 30s, and gradually become less severe and less frequent in the following decades.
Sex. Women are three times more likely to have migraines. Headaches tend to affect boys more than girls during childhood, but by the time of puberty and beyond, more girls are affected.
Hormonal changes. If you are a woman who has migraines, you may find that your headaches begin just before or shortly after onset of menstruation.They may also change during pregnancy or menopause. Migraines generally improve after menopause.Some women report that migraine attacks begin during pregnancy, or their attacks worsen. For many, the attacks improved or didn't occur during later stages in the pregnancy. Migraines often return during the postpartum period.

Prevention

Until recently, experts recommended avoiding common migraine triggers. Some triggers can't be avoided, and avoidance isn't always effective. But some of these lifestyle changes and coping strategies may help you reduce the number and severity of your migraines:

Transcutaneous supraorbital nerve stimulation (t-SNS). This device (Cefaly), similar to a headband with attached electrodes, was recently approved by the Food and Drug Administration as a preventive therapy for migraines. In research, those that used the device experienced fewer migraines.
Learn to cope. Recent research shows that a strategy called learning to cope (LTC) may help prevent migraines. In this practice, you are gradually exposed to headache triggers to help desensitize you to them. LTC may also be combined with cognitive behavioral therapy. More research is needed to better understand the effectiveness of LTC.
Create a consistent daily schedule. Establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.
Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches. Regular exercise can also help you lose weight or maintain a healthy body weight, and obesity is thought to be a factor in migraines.
Reduce the effects of estrogen. If you are a woman who has migraines and estrogen seems to trigger or make your headaches worse, you may want to avoid or reduce the medications you take that contain estrogen.

These medications include birth control pills and hormone replacement therapy. Talk with your doctor about the appropriate alternatives or dosages for you.

Treating migraines

There's no cure for migraines, but a number of treatments are available to help reduce the symptoms.

These include:

painkillers – including over-the-counter medications such as paracetamol and ibuprofen
triptans – medications that can help reverse the changes in the brain that may cause migraines
anti-emetics – medications often used to reduce nausea and vomiting

During an attack, many people find that sleeping or lying in a darkened room can also help.

Summary

Migraines can severely affect your quality of life and stop you carrying out your normal daily activities. Some people find they need to stay in bed for days at a time.

However, a number of effective treatments are available to reduce the symptoms and prevent further attacks.

Migraine attacks can sometimes get worse over time, but they tend to gradually improve over many years for most people.

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