Migraines

What is a Migraine?

A migraine is a neurological disorder of the brain. It occurs when the brain becomes over excited by certain neurochemical changes.

About 15% of the general population is affected by migraines at certain point in their life.

A migraine is typically a unilateral headache that can last for several hours to several days. The pain may be mild to severe and may have a pulsing or throbbing feeling. You may become very sensitive to lights, smell and sounds. Some can have nausea and vomiting.

One third of patients with migraine can present with an aura, which is a transient visual, sensory, language or motor disturbance which can be considered as an alarm sign that a headache will soon occur. Sometimes aura can present without an associated headache.

The visual auras include zigzagging lines or spots, flashes of light, blind spots, shimmering spots or stars. These can happen on one or both eyes. Auras of the sensory-motor system include transient numbness or weakness, and in severe cases can cause a severe paralysis. Speech difficulty and memory loss have also been described.

A retinal migraine is a rare condition that can occur with and without a headache. Unlike a migraine aura, this typically affects only one eye. Usually patient complains of repeated bouts of transient visual loss in one eye that usually lasts less than one hour. This visual loss can involve parts of a visual field or the entire field. Other associated symptoms include light sensitivity and nausea. After each episode, normal vision should return. The cause is unknown, spasms of the retinal vessels during a retinal migraine attack have been documented. Since this is a rare condition, visual loss in one eye is not usually related to a migraine; therefore, if you experience visual loss, you should see an eye specialist to rule out other more serious conditions.

Common triggers of migraines include:

• Stress
• Hormone Changes
• Weather Changes
• Neck Pain
• Alcohol
• Heat
• Diet
• Physical Exertion

Treatment

Treatment of migraines consist of three main aspects: lifestyle modification including trigger avoidance; acute symptomatic control and pharmacologic prevention.

Acute symptomatic control include the use of common analgesics like ibuprofen and acetaminophen, which can relief the headache. If you have nausea, the use of an antiemetic can help. Specific agents like triptans and ergotamines have been used frequently for headaches that do not improve with common analgesics.

Chronic analgesics use must be avoided for fear of rebound headaches. Frequent migraines are treated with preventive methods.

Preventive therapies for migraines include pharmacological and non-pharmacological agents.

There are several groups of medications that can be used. One is the antihypertensive group, commonly prescribed are propranolol or verapamil. Antidepressants are also effective for migraine prophylaxis. Seizure medications, like topiramate and valproic acid have been used very widely. The target of preventive therapy is to reduce the frequency and severity of migraines by 50%.

For people who are suffering from chronic or long standing migraines; meaning, 15 or more headache days a month, and with each headache lasting longer than 4 hours, and if they have tried several type of migraine preventive therapy without success, they can be evaluated for Botox injections.

Other alternative options for migraines include acupuncture, transcutaneous electrical nerve stimulation and migraine surgery.

Migraine surgery is an option reserved for certain people who have not improved with medications. It mainly consists of decompression of certain nerves around the head and neck.