Migraine

What is Migraine?

Migraine is a neurological disease causing repeatedly acute throbbing pain which is normally found on one side of the head. The attack of the disease can continue for hours or days. Other symptoms such as nausea, vomiting, and sensitivity to light, scent, touch, and sound are frequently found in several cases. The degrees of the migraine are varied from mild to severe.

Symptoms

There are four stages of migraine that can begin in any span of age, from childhood to adulthood.

1. Prodrome Stage: A warning stage that gives signs for coming of migraine which may include; mood changes, constipation, food cravings, neck stiffness, frequent yawning, or increased thirst and urination.
2. Aura: The stage containing visual and other disturbances shows reversible symptoms of nervous system. Beside vision loss or phenomena, other abnormal sense perceptions can be also found, such as hearing noises or music, uncontrollable movements, or pins and needles sensations in arm and legs. These symptoms may appear before or during migraines and last for 20 to 60 minutes.
3. Attack: Throbbing and pulsing pain on one side of the head is a common attack of migraines. Sensitivity to light, sound, scent, and touch are eventually found in patients of migraine as well, while nausea and vomiting tend to occur in numerous cases.
4. Postdrome:

Conditions of after migraine are diverse. Most of the patients are likely to get exhausted and confused for a day after the end of the attack. However, some are found exhilarated. There are reports show that sudden movement may bring back the pain.

It is important to see the doctor immediately if you have harsh headache especially when it comes after a head injury or with fever, stiff neck, confusion, or abnormal speaking. A chronic headache getting worse as you cough, exercise, strain or suddenly move are also the signs showing that immediate treatment is needed. Unfamiliar pain after the age of 50 is highly recommended for thoroughly check-up.

Causes

Causes of migraine are still unclear but genetic and environmental factors are likely to take parts of the disease. Several studies show that imbalances in brain chemical, serotonin, and neurotransmitters such as calcitonin gene-related peptide (CGRP) lead to the appearance of the disease. There are some triggers that raise up the risk of migraines include: foods and food addictive, stress, sleep changes, physical factors, sensory stimuli, drinks, medications, and hormonal changes in women. Women have 3 times tendency to have migraine more than men. Hormonal changes in women are the main triggers and these eventually happen during menstruation, pregnancy, and menopause. On the other hand, it is recorded that some hormonal medications help deceasing the frequency of migraine while migraine may get worsen in some taking the same medicines. Apart from the triggers above, those whose family member has migraine, the development of the disease is likely to increase.

Treatment

Purposes of the treatment are to discontinue the symptoms and to avoid the future attack. Therefore, treatments for migraine are categorized by their purpose as follow:

1. Pain-relieving medications are usually taken during migraine attacks to discontinue the symptoms.
2. Preventive medications are continually taken to decrease the harshness and frequency of migraines.

Medications 

The medications for migraines are used depending on the symptoms that need to be treated. There are choices of medications for pain relief and are used following the degree of the pain or the stage of migraine.

• Pain relievers such as aspirin or ibuprofen are broadly used in mild migraine pain. In long term, medication-overuse headache may occur.
• Triptans, prescription drugs, works directly to block the pain pathway in the brain. However, patients with stroke or heart attack are not recommended since it can cause serious side effects.
• Dihydroergotamines (D.H.E. 45, Migranal) is considered most effective medications if taken within 24 hours after the beginning of migraine symptoms. Some patients may have worse vomiting and nausea as side effects. Patients with coronary artery disease, high blood pressure, or kidney or liver disease should avoid Dihydroergotamines since they affect directly to coronary artery.
• Lasmiditan (Reyvow) is effective to migraine accompanied with pain, nausea, and sensitivity of light and sound. Since the medications cause dizziness, driving after taking medications should be avoided. It is advised not to take medications with alcoholic drinks and other drugs depressing the central of nervous system.
• Ubrogepant (Ubrelvy) is the first approval oral calcitonin gene-related peptide that can be used as a treatment of severe migraine with or without aura in adult. With some side effects including dry mouth, nausea and excessive sleepiness, the medication is effective to relieve symptoms of migraine including acute pain, aura, nausea, and sensitivity of light and sound within 2 hours after taking.
• Opioid medications are used only if none of the other medications is effective for it is highly addictive.
• Anti-nausea drugs are usually taken together with pain medications to relieve migraine with aura having nausea and vomiting.