Understanding Migraines: Causes, Symptoms, and Management

Migraines are intense headaches characterised by strong throbbing or pulsating pain, often coupled with nausea, vomiting, and heightened sensitivity to light and sound.

Migraines are not typically considered dangerous, but they can be so debilitating that those affected may need to withdraw to a dark, quiet space until the symptoms ease.

The exact cause of migraines is unclear. Neurological, environmental, and hereditary factors are believed to play a role. Adult women are three times more likely to experience migraines compared to adult men.

Phases and symptoms of migraine

Migraines often follow a complex timeline, typically progressing through phases like prodrome, aura, headache, and postdrome. However, the duration and nature of these phases can vary significantly from person to person.

1. Prodrome

• May occur a day or two before the migraine starts.
• Symptoms: Mood changes, food cravings, inability to concentrate, fatigue and muscle stiffness, frequent yawning, smell, sound, or light sensitivity, changes in sleep patterns, nausea.
• Individuals prone to migraines should look out for symptoms during the prodrome phase to help prevent migraine episodes.

2. Aura

• Approximately one-third of individuals who have migraines encounter the aura phase.
• Typically develops gradually over a minimum of 5 minutes and can persist for up to 60 minutes.
• Symptoms: Seeing bursts of light, brilliant spots, wavy lines, or black dots; having “pins and needles” sensation; numbness or weakness in one side of the body or the face, speech changes, tinnitus.
• Individuals who are aware that a migraine will occur after an aura can determine when to take medicine that may lessen or stop migraine discomfort.

3. Headache

• Lasts for up to 72 hours or more if left untreated. Usually, it begins gradually and progresses into pulsing and throbbing on one or both sides of the head.
• Symptoms: Icepick in the head, sensitivity to light, smell, and sound, neck pain and stiffness, depression or anxiety, insomnia, nausea and vomiting, dizziness, and light-headedness and fainting.

4. Postdrome

• Causes individuals to experience symptoms lasting up to a day. Also known as “hungover migraine.”
• Symptoms: Fatigue, feelings of euphoria or mild depression, difficulty concentrating, body aches.

How Can Migraines Be Managed Effectively?

While migraines cannot always be prevented, they can be managed through a combination of trigger management, lifestyle adjustments, and medical treatment.

Identify and Avoid Triggers

Managing migraines effectively include identifying and avoid potential triggers such as:

• Stress and fatigue
• Hormonal changes
• Lack of sleep or changes in sleep patterns
• Alcohol and caffeine
• Sensory stimuli such as loud sounds, strong smells or bright lights
• Environmental factors such as weather changes
• Certain foods and additives
• Skipped meals

Lifestyle Tips to Reduce Migraine Attacks

You can manage migraines more effectively by making simple lifestyle adjustments, especially by recognising how daily routines and hormonal changes may influence symptoms:

• Take regular breaks and manage stress: Migraines are often linked to stress, which can be influenced by both work and daily responsibilities. Avoid overworking, stay positive, and engage in relaxing activities. Taking regular breaks throughout the day can help prevent migraines or reduce symptoms if one is already developing.
  
  
• Maintain a balanced and consistent diet: While diet alone may not eliminate migraines, eating regular, balanced meals can help reduce their frequency. Some individuals may notice symptoms triggered by certain foods such as chocolate, aged cheeses, or processed foods. Staying hydrated, limiting caffeine, and keeping a food diary can help identify personal triggers.
  
  
• Get enough sleep and maintain a routine: Aim for 7 to 8 hours of sleep each night by keeping a consistent sleep schedule. Hormonal fluctuations, particularly during menstruation, can affect sleep patterns and migraine frequency, so maintaining a regular routine may help reduce episodes.
  
  
• Stay physically active at a comfortable pace: Light to moderate aerobic exercises such as walking, cycling, or swimming may help reduce stress and improve overall well-being. Start gradually, as sudden or intense exercise may trigger migraines in some individuals.
  
  
• Keep a migraine diary: Recording details about headaches, daily habits, and potential hormonal patterns can help identify triggers. This information can support your doctor in developing a personalised treatment plan.

When Is Medical Treatment Needed?

Migraines are treatable. Medical treatment includes:

• Acute treatment - medications taken at the onset of an attack to relieve symptoms during an attack, which includes aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, ergots, and antiemetics.
  
  
• Preventive treatment - medications taken daily to reduce the frequency and severity of future migraine episodes, which includes antiseizure medications, beta-blockers, antidepressants, and calcium channel blockers.

Consult a doctor if:

• Migraines occur frequently
• Pain is severe or worsening
• Symptoms interfere with daily activities

When to see a doctor for migraine

A migraine typically lasts 4 to 72 hours if untreated. If it persists beyond 72 hours, consult a doctor for further evaluation and management.

Warning signs that a migraine may be more serious include:

• Severe pain unrelieved by over-the-counter medication or lasting more than three days.
• Migraines starting after age 50.
• Changes in headache pattern or severity.
• Headaches that worsen with coughing or movement.
• Personality or cognitive changes.
• Accompanying symptoms like fever, stiff neck, confusion, memory loss, neurological issues (e.g., seizures, slurred speech, weakness, numbness, vision changes).
• Headache following trauma.
• Headaches disrupting daily activities or waking you at night.
• Headaches in individuals with cancer or weakened immune systems.

Potential complications of migraine

The intensity of a migraine attack may cause concern about potential long-term damage. While brain scans of migraine sufferers sometimes show white matter lesions, a systematic review on migraines and brain structure changes indicates that these lesions generally do not link to neurological issues or increase the risk of cognitive decline.

Status migrainosus is a severe, debilitating migraine attack that prolongs over 72 hours. It is more prevalent in females and can happen in individuals who experience migraines, whether with or without aura.

Migrainous infarction is a rare type of stroke characterised by a migraine episode occurring in a person with migraine with aura, where one or more aura symptoms last for over an hour. Imaging test reveals an infarction in a pertinent brain region.

Persistent aura without infarction is described as aura symptoms lasting for a week or longer without any signs of infarction on neuroimaging and a migraine aura-triggered seizure refers to a seizure that occurs because of a migraine attack with aura.

In extremely rare cases, complications like swelling of the brain (cerebral oedema) or complications from medication overuse headaches can pose serious risks. Migraines can significantly impact quality of life and may lead to severe symptoms, but death directly caused by migraines is exceedingly rare.

Make an appointment at Gleneagles Hospitals

Treatment options are available to manage migraines and improve your quality of life. If you or someone you know experiences migraines, it is crucial to take action to manage and alleviate symptoms effectively.

A dedicated and expert team of neurologists at Gleneagles Hospital is available for consultation to provide the best care and assistance. Get in touch with us to book an appointment today if you have any concerns or questions regarding migraines.