Migraine

While the origins of migraines are not entirely known, heredity and environmental factors appear to have a role.
Changes in the brainstem and its interactions with the trigeminal nerve, which is a primary pain route, may be implicated. Imbalances in brain chemicals, such as serotonin, which helps control pain in your neurological system, might also be to blame.
Researchers are investigating the effect of serotonin in migraines. Other neurotransmitters, such as calcitonin gene-related peptide (CGRP), can contribute to migraine discomfort.

Migraine triggers

• Hormonal changes in women. Many women get headaches when their estrogen levels fluctuate, such as before or during menstrual cycles, pregnancy, or menopause.
• Hormonal drugs, such as oral contraceptives, can potentially exacerbate migraines. However, some women report that using these drugs reduces the frequency of their migraines.
• Drinks. These include alcohol, particularly wine, and excessive caffeine, such as coffee.
• Stress. Stress at work or at home might trigger migraines.
• Sensory stimulation. Migraines can be triggered by bright or flashing lights, as well as loud sounds. Strong odors, such as perfume, paint thinner, and secondhand smoke, can cause headaches in some people.
• Sleep varies. Sleep deprivation or excessive sleep can cause migraines in certain persons.
• Physical strain. Intense physical exertion, especially sexual activity, may trigger migraines.
• The weather changes. A change in the weather or barometric pressure might trigger a migraine.
• Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can make migraines worse.
• Foods. Salty and processed meals, as well as aged cheeses, may cause migraines. Skipping meals may also be an option.
• Food additives. These include aspartame, a sweetener, and monosodium glutamate (MSG), a preservative present in many foods.

Migraines can advance through four stages: prodrome, aura, attack, and post-drome. They affect toddlers, teens, and adults alike. Not everyone with migraines progresses through all phases.

Prodrome
One or two days before a migraine, you may notice subtle changes that warn of an impending migraine, including:

Constipation

• Mood shifts from sadness to exhilaration.
• Food desires.
• Neck stiffness.
• Increased urination.
• Fluid retention.
• Frequent yawning.

Aura
For certain people, an aura may appear before or during a migraine. Auras are neurological symptoms that are reversible. They are generally visual, although other disruptions may occasionally occur. Each symptom normally appears gradually, grows over several minutes, and lasts up to 60 minutes.

Examples of migraine auras are:

• Visual phenomena include perceiving different forms, bright spots, or bursts of light.
• Vision loss.
• Pins and needles feelings in the arm or leg.
• Weakness or numbness on the face or one side of the body.
• Speaking can be difficult.

Attack
A migraine can persist anywhere from 4 to 72 hours if not addressed. Migraines occur at different frequencies depending on the individual. Migraines might occur seldom or many times each month.

During a migraine, you may have:

• Pain is commonly felt on one side of the head, but it can occur on both.
• Pain throbbing or pulsing.
• Sensitivity to light, sound, smell, and touch.
• Nausea and vomiting.

Post-drome
After a migraine episode, you may feel tired, bewildered, and exhausted for up to a day. Some folks say they feel elated. Sudden head movement may cause the discomfort to return temporarily.

Taking painkillers too often might result in severe medication-overuse headaches. Combinations of aspirin, acetaminophen (Tylenol, others), and coffee appear to pose the most risk. Overuse headaches can also occur if you use aspirin or ibuprofen (Advil, Motrin IB, etc.) for more than 14 days per month, or triptans, sumatriptan (Imitrex, Tosymra), or rizatriptan (Maxalt) for more than nine days per month.

Medication-overuse Headaches develop when drugs cease treating pain and start causing them. You subsequently take additional pain medicine, which perpetuates the cycle.

Migraines are frequently undetected and mistreated. If you get migraine symptoms on a regular basis, keep track of your attacks and how you handled them. Then, schedule an appointment with your doctor to address your headaches.

Even if you have a history of headaches, consult your doctor if the pattern changes or your headaches feel unusual.

See your healthcare provider immediately or go to the emergency room if you have any of the following signs and symptoms, which could indicate a more serious medical problem:

• An abrupt, severe headache like a thunderclap.
• Headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body, which could be a sign of a stroke.
• Headache after a head injury.
• A chronic headache that is worse after coughing, exertion, straining or a sudden movement.
• New headache pain after age 50.

There is medication available to help prevent frequent migraine attacks. If you suffer from frequent, prolonged, or severe headaches that do not respond to treatment, your doctor may recommend preventive medications.

• Preventive medication therapy aims to reduce migraine frequency, severity, and duration, which may include blood pressure-lowering medications. These include beta-blockers (propranolol, metoprolol) and calcium channel blockers (verapamil).
• Antidepressants. The tricyclic antidepressant amitriptyline can help prevent migraines. Because of amitriptyline's side effects, such as drowsiness, other antidepressants may be recommended instead.
• Anticonvulsants. Valproate and topiramate can be used to treat rare migraine attacks, but they are not recommended for pregnant women or women who are trying to conceive.
• Botox injections, administered every 12 weeks, can help some adults avoid migraines.
• Calcitonin gene-related peptide (CGRP) monoclonal antibodies are new drugs approved by the United States Food and Drug Administration (FDA) to treat migraines. They are administered monthly or quarterly via injection.
• Atogepant and rimegepant. These medications also help prevent migraines and can be used in conjunction with migraine treatment when necessary.

Numerous medications have been developed to treat migraines. There are two major groups of migraine medications:

• Pain relief medicines. These medications, often known as acute or abortive therapy, are used to relieve migraine symptoms.
• Preventive medicines. These medications are used regularly, sometimes even daily, to minimize the intensity or frequency of migraines.

Your treatment options are determined by the frequency and intensity of your headaches if you have nausea and vomiting, how disabling your headaches are, and any other medical issues you may have.

Migraine pain relief medications work best when used at the earliest warning of an impending migraine, or as soon as migraine symptoms appear. It can be treated with the following medications:

• Pain remedies. Aspirin and ibuprofen are common over-the-counter or prescription pain medications. When used for an extended period, they might produce drug overuse headaches, ulcers, and bleeding in the gastrointestinal tract.
• Migraine treatment drugs including caffeine, aspirin, and acetaminophen (Excedrin Migraine) may be effective, but only for mild migraine discomfort.
• Triptans. Prescription medications such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) are used to treat migraines because they block pain pathways in the brain. Many migraine symptoms can be relieved by using medications, injections, or nasal sprays. They may not be suitable for people who are prone to strokes or heart attacks.
• Dihydroergotamine (Migranal; Trudhesa). This medicine, available as a nasal spray or injection, works best when administered early after the onset of migraine symptoms for headaches that last more than 24 hours. Side effects may include increasing migraine-related vomiting and nausea.
• People with coronary artery disease, high blood pressure, renal or liver problems should avoid dihydroergotamine.
• Lasmeditan (Reyvow). This newer oral tablet is licensed for the treatment of migraines, both with and without aura. In clinical studies, lasmiditan greatly reduced headache pain. Lasmiditan can have a sedative effect and induce dizziness, thus those taking it should avoid driving or using machinery for at least eight hours.
• Oral calcitonin gene-related peptide antagonists, also known as gepants. Ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) are oral gepants that have been authorized for migraine therapy in adults. In pharmacological studies, this class of medications was found to be more effective than placebo at relieving pain two hours later. They were also beneficial in alleviating migraine symptoms including nausea and sensitivity to light and sound. Common adverse effects include dry mouth, nausea, and excessive tiredness. Ubrogepant and rimegepant should not be used in conjunction with powerful CYP3A4 inhibitors, such as cancer treatments.
• Intranasal zavegepant (Zavzpret). The Food and Drug Administration recently authorized this nasal spray for the treatment of migraines. Zavegepant is a gepant and the only migraine medication available as a nasal spray. It provides migraine pain relief within 15 minutes to 2 hours of taking a single dosage. The medication remains effective for up to 48 hours. It can also help with migraine-related symptoms including nausea and sensitivity to light and sound. Zavegepant's common side effects include a change in taste, nose congestion, and throat irritation.
• Opioid medicines. Narcotic opioid drugs may be beneficial for patients who are unable to tolerate other migraine treatments. Because they may be extremely addictive, they are often used only when no other therapies are successful.
• Antinausea medications. These might be useful if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea medications include chlorpromazine, metoclopramide (Gimoti, Reglan), and prochlorperazine (Compro, Compazine). These are typically given in conjunction with pain medicines.

Some of these medications are not safe to take during pregnancy. If you're pregnant or trying to get pregnant, don't use any of these medications without first talking with your health care provider.

Another method of preventing migraine attacks is transcranial magnetic stimulation (TMS).

Transcranial magnetic stimulation (TMS) is a type of non-invasive therapy that helps prevent or reduce severe migraine symptoms.

A 2017 Trusted Source review of research shows that TMS is an effective and safe treatment for migraines, especially chronic migraines. It can be an alternative to prescription drugs and other treatments, especially when other methods have failed to reduce the number or severity of migraine attacks.

In addition, migraine can also be treated with Transcranial direct current stimulation (tDCS).