Migraine Symptoms and Effective Treatment Options

Migraines are more than just headaches; they're complex neurological conditions that affect millions of people worldwide. According to the World Health Organization, migraines are one of the top 10 most disabling medical illnesses [1]. This comprehensive guide delves into the causes of migraines, what happens in the brain during an attack, how to recognize a migraine, and the various types of migraines identified by researchers and clinicians.

What Causes Migraines?

The exact cause of migraines is not fully understood, but research has identified several factors that contribute to their occurrence:

1. Genetic Predisposition

Studies have shown that migraines tend to run in families, suggesting a genetic component. Researchers have identified several genes associated with migraine susceptibility, including CACNA1A, ATP1A2, and SCN1A [2]. These genes are involved in regulating brain excitability and neurotransmitter release, which may explain their role in migraine pathophysiology.

2. Neurotransmitter Imbalances

Serotonin, a neurotransmitter that regulates pain and mood, has been implicated in migraine pathogenesis. During a migraine attack, serotonin levels in the brain drop significantly [3]. This change in serotonin levels may trigger the release of neuropeptides, leading to inflammation and pain.

3. Cortical Spreading Depression (CSD)

CSD is a wave of neuronal and glial depolarization that spreads across the cerebral cortex. It's believed to be the underlying mechanism of migraine aura and may trigger the headache phase by activating the trigeminovascular system [4].

4. Trigeminovascular System Activation

The trigeminovascular system, which includes the trigeminal nerve and its associated blood vessels, plays a crucial role in migraine pain. Activation of this system leads to the release of inflammatory substances and dilation of blood vessels, causing the characteristic throbbing pain of migraines [5].

5. Environmental Triggers

Various environmental factors can trigger migraines in susceptible individuals. Common triggers include:

• Stress

• Hormonal changes (especially in women related to menstrual cycle)

• Certain foods and drinks (e.g., alcohol, caffeine, aged cheeses)

• Changes in sleep patterns

• Bright lights or loud noises

• Weather changes

• Strong scents

• Cold

• A high intake of stimulants such as coffee and energy drinks

A 2021 study published in the journal "Neurology" found that combinations of triggers, rather than single factors, were more likely to precipitate migraine attacks [6].

6.Health related issues

• Dental infections

• Poor vision

• Posture - neck and sholder pain

What Happens During a Migraine?

A migraine attack typically progresses through four distinct phases, although not everyone experiences all phases:

1. Prodrome Phase

This phase can begin hours or even days before the actual headache. Symptoms may include:

• Mood changes

• Food cravings

• Neck stiffness

• Increased thirst and urination

• Frequent yawning

2. Aura Phase

About 25-30% of migraine sufferers experience aura [7]. This phase usually occurs just before or during the headache phase and can include:

• Visual disturbances (e.g., seeing flashing lights or blind spots)

• Sensory changes (e.g., tingling or numbness)

• Speech or language problems

3. Headache Phase

This is the main phase of a migraine attack, characterized by:

• Moderate to severe head pain, often throbbing or pulsating

• Pain that's typically unilateral (on one side of the head)

• Increased sensitivity to light, sound, and sometimes smells

• Nausea and vomiting

During this phase, neuroimaging studies have shown increased activity in brain areas involved in pain processing, such as the brainstem and thalamus [8].

4. Postdrome Phase

After the headache subsides, many people experience a "migraine hangover" or postdrome phase, which can last up to 48 hours. Symptoms may include:

• Fatigue

• Difficulty concentrating

• Mild head pain

• Mood changes

Recognizing a Migraine

Distinguishing a migraine from other types of headaches is crucial for proper treatment. Here are key features that can help identify a migraine:

1. Pain Characteristics: Migraine pain is typically moderate to severe, often described as throbbing or pulsating. It's usually unilateral, although it can affect both sides of the head.

2. Duration: Untreated migraine attacks typically last 4-72 hours.

3. Associated Symptoms: Migraines are often accompanied by nausea, vomiting, and sensitivity to light (photophobia) and sound (phonophobia).

4. Impact on Daily Activities: Migraines tend to be disabling, interfering with normal daily activities.

5. Aura Symptoms: If present, aura symptoms can be a clear indicator of a migraine.

6. Trigger Identification: Many migraine sufferers can identify specific triggers that precipitate their attacks.

The International Headache Society provides detailed criteria for diagnosing migraines in their International Classification of Headache Disorders (ICHD-3) [9].

Types of Migraines

Migraines are classified into several types based on their specific symptoms and patterns:

1. Migraine Without Aura

This is the most common type of migraine, characterized by the typical headache symptoms without the preceding aura phase.

2. Migraine With Aura

These migraines include visual, sensory, or other neurological symptoms that precede or accompany the headache phase.

3. Chronic Migraine

Defined as having headaches on 15 or more days per month, with at least 8 of those days meeting criteria for migraine, for more than 3 months [10].

4. Hemiplegic Migraine

A rare type of migraine with aura that includes motor weakness. It can be familial or sporadic and is associated with specific genetic mutations [11].

5. Vestibular Migraine

Characterized by episodes of vertigo and other balance disturbances along with migraine symptoms [12].

6. Retinal Migraine

Involves repeated attacks of visual disturbances in one eye, including scintillations, scotoma, or temporary blindness [13].

7. Abdominal Migraine

Primarily affects children and is characterized by episodes of abdominal pain accompanied by nausea and vomiting [14].

8. Menstrual Migraine

Occurs in association with the menstrual cycle, typically starting 2 days before to 3 days after the onset of menstruation [15].

Migraines are complex neurological disorders with a wide range of symptoms and presentations. Understanding the underlying causes, recognizing the signs, and identifying the specific type of migraine are crucial steps in managing this condition effectively. As research continues to uncover the intricate mechanisms behind migraines, new treatment options and preventive strategies are being developed to improve the lives of those affected by this debilitating condition.

If you experience recurrent headaches or suspect you may be suffering from migraines, it's important to consult with a healthcare professional for proper diagnosis and treatment. With the right approach, many people with migraines can significantly reduce the frequency and severity of their attacks and improve their overall quality of life.

Migraine Treatments

Click on this link to read more: Biohacking Lifestyle Migraine treatments.

Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with a healthcare professional for diagnosis and treatment of medical conditions.

References

1. World Health Organization. (2016). Headache disorders. Retrieved from [WHO website]

2. Russell, M. B., & Ducros, A. (2011). Sporadic and familial hemiplegic migraine: pathophysiological mechanisms, clinical characteristics, diagnosis, and management. The Lancet Neurology, 10(5), 457-470.

3. Hamel, E. (2007). Serotonin and migraine: biology and clinical implications. Cephalalgia, 27(11), 1293-1300.

4. Charles, A. C., & Baca, S. M. (2013). Cortical spreading depression and migraine. Nature Reviews Neurology, 9(11), 637-644.

5. Goadsby, P. J., Holland, P. R., Martins-Oliveira, M., Hoffmann, J., Schankin, C., & Akerman, S. (2017). Pathophysiology of migraine: a disorder of sensory processing. Physiological Reviews, 97(2), 553-622.

6. Park, J. W., Chu, M. K., Kim, J. M., Park, S. G., & Cho, S. J. (2021). Analysis of Trigger Factors in Episodic Migraineurs Using a Smartphone Headache Diary Applications. PLoS ONE, 16(2), e0246123.

7. Viana, M., Sances, G., Linde, M., Ghiotto, N., Guaschino, E., Allena, M., ... & Tassorelli, C. (2017). Clinical features of migraine aura: Results from a prospective diary-aided study. Cephalalgia, 37(10), 979-989.

8. Schulte, L. H., & May, A. (2016). The migraine generator revisited: continuous scanning of the migraine cycle over 30 days and three spontaneous attacks. Brain, 139(7), 1987-1993.

9. Headache Classification Committee of the International Headache Society (IHS). (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1-211.

10. Natoli, J. L., Manack, A., Dean, B., Butler, Q., Turkel, C. C., Stovner, L., & Lipton, R. B. (2010). Global prevalence of chronic migraine: a systematic review. Cephalalgia, 30(5), 599-609.

11. Pietrobon, D. (2007). Familial hemiplegic migraine. Neurotherapeutics, 4(2), 274-284.

12. Lempert, T., Olesen, J., Furman, J., Waterston, J., Seemungal, B., Carey, J., ... & Newman-Toker, D. (2012). Vestibular migraine: diagnostic criteria. Journal of Vestibular Research, 22(4), 167-172.

13. Grosberg, B. M., Solomon, S., & Lipton, R. B. (2005). Retinal migraine. Current pain and headache reports, 9(4), 268-271.

14. Napthali, K., Koloski, N., & Talley, N. J. (2016). Abdominal migraine. Cephalalgia, 36(10), 980-986.

15. MacGregor, E. A. (2010). Prevention and treatment of menstrual migraine. Drugs, 70(14), 1799-1818.