Migraine: Causes, Symptoms, Risk Factors and Diagnosis

A migraine is a type of headache that often affects one side of the head and can cause excruciating throbbing pain or a pulsating sensation. Severe light and sound sensitivity, nausea, and vomiting are frequently present. The pain from migraine attacks can be excruciating, interfering with everyday tasks for hours or even days at a time.

Some patients experience an aura, which is a warning symptom, either before or together with their headache. A person may have visual disturbances like blind spots or light flashes, as well as non-visual disturbances like tingling in one arm or leg, difficulty speaking, or tingling on one side of the face.

Certain migraines can be less unpleasant and prevented with the use of medications. Proper medication in conjunction with self-care and lifestyle changes can help.

Causes  Of Migraine

Although the precise causes of migraines are unknown, environmental factors and heredity appear to play a role.

Changes in the brainstem and its relationship to the trigeminal nerve, a major pain pathway, are among the potential explanations. Unbalances in brain chemistry, including serotonin, which helps the nervous system regulate pain, could also be the cause.

Researchers are looking into how serotonin plays a role in migraines. Migraine pain is mediated by other neurotransmitters, including calcitonin gene-related peptide (CGRP).

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Migraine Triggers

Numerous factors, including the following, may contribute to migraines:

• Hormonal variations in women: Oestrogen variations are linked to headaches that many women seem to feel before or during menstruation, during pregnancy, and menopause.
• OCP: One hormonal medication that can make migraines worse is oral contraceptives. Some women do, however, claim that using these medications lessens how frequently they get migraines.
• Drinks: They include consuming alcohol, especially wine, and caffeine in excess, such as from coffee.
• Stress: Stress at work or at home might trigger migraines.
• Sensorial experiences: Migraines can be brought on by bright, flashing lights as well as loud noises. Strong scents, such as paint thinner, perfume, secondhand smoke, and others, might cause migraines for certain people.
• Different people have different sleep patterns: Migraines may be brought on by excessive or inadequate sleep for certain people.
• Exertion on the body: Migraines can be brought on by sexual activity and other vigorous physical activities.
• The climate changes: A headache could potentially be brought on by a change in the weather or barometric pressure.
• Medicines: Both oral contraceptives and vasodilators such as nitroglycerin might exacerbate migraine attacks.
• Foods: Aged cheeses, processed foods, and salty foods can all contribute to migraines. Similarly, skipping meals could.
• Food additives: These include aspartame, a sweetener, and monosodium glutamate (MSG), a preservative found in many foods.

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Symptoms Of Migraine

Along with adults, children and teenagers can experience the prodrome, aura, attack, and post-drome phases of migraine progression. Not all migraineurs go through every phase.

Prodrome

One or two days before a migraine, you could notice minor changes that point to an approaching headache, like:

• Diarrhoea.
• Mood swings, from happiness to melancholy.
• Craving food.
• Stiffness around the neck.
• Increased urge to urinate..
• Yawning.

Aura

Some people may experience an aura before or during a migraine attack. Auras are examples of reversible neurological symptoms. They are usually visual, though they may also involve other disruptions. Each symptom usually begins slowly, builds over a few minutes, and can linger for up to an hour.

Migraine-related auras include:

• Visual phenomena include bursts of light, bright spots, and various forms observed.
• Loss of vision.
• Needle and pin pain in the arm or leg.
• weakness or numbness in the face or on one side of the body.
• Difficulty speaking.

Attack

A migraine that is left untreated can persist anywhere from 42 to 72 hours. Everybody experiences migraines at varying intervals. A migraine may occur once a month or more frequently.

A migraine may result in the following symptoms:

• Though it usually affects one side of the head, it can also affect the other.
• Pain that vibrates or pulses.
• intermittent sensitivity to light, sound, smell, and touch.
• nausea in addition to vomiting.

Post-drome

After a migraine attack, you could feel worn out, confused, and depleted for up to a day. A handful say they experience ecstasy. A quick head movement could bring on the discomfort again for a short while.

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Risk Factors Of Migraine

Numerous factors can elevate your susceptibility to migraines, including:

• History within the family: If any members of your family have migraines, you are more likely to acquire them yourself.
• Age: Adolescents are usually the first to encounter them, however, they can begin at any age. In your 30s, migraine frequency and intensity typically reach their peak, after which they gradually decrease over the following decades.
• Sex: Women experience migraine headaches three times as frequently as men do.
• Hormone changes: Women who experience migraines may experience their first headaches either before or after the onset of their menstrual cycle. Migraine relief frequently occurs after menopause.

Diagnosis  Of Migraine

Tests to rule out uncommon, intricate, or suddenly severe conditions could include the following to rule out other potential causes of your discomfort:

• MRI scan: Using radio waves and a strong magnetic field, an MRI scan produces incredibly detailed images of the blood vessels and brain. MRI pictures can be used to diagnose tumours, strokes, cerebral haemorrhages, infections, and other neurological conditions affecting the brain and nervous system.
• CT scan: A computerised tomography (CT) scan produces accurate cross-sectional images of the brain by using a series of X-rays. This facilitates the detection of brain injury, infections, tumours, haemorrhages, and other possible medical conditions that may be the cause of headaches.

Treatment  Of Migraine

Curing migraines and preventing further attacks are the main objectives of treatment.

To treat migraines, numerous medications have been created. Migraine treatment involves two primary categories of drugs:

• Medicines that reduce pain: Sometimes called acute or abortive treatment, these drugs are administered during migraine episodes to stop the symptoms.
• Medications as a preventative measure: To reduce migraine frequency or intensity, these drugs are taken often, sometimes even daily.

Your treatment options will depend on several factors, including the frequency and severity of your headaches, whether they are very debilitating, whether you experience nausea or vomiting when they occur, and any underlying medical conditions you may have.

Painkillers designed to treat migraine discomfort work best at alleviating pain when used as soon as symptoms start to occur. The following drugs can be used as a kind of treatment:

• Pain relievers: Ibuprofen or aspirin can be found in Advil, Motrin IB, and other over-the-counter or prescription pain relievers. Long-term use of these may cause bleeding and ulcers in the stomach, as well as headaches associated with prescription overuse.
• Excedrin One such medication that may be helpful for migraines is migraine, which is a combination of caffeine, aspirin, and acetaminophen; however, it is typically only used for mild migraine symptoms.
• Triptans: Prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan are used to treat migraines because they block the brain's pain pathways. As tablets, injections, or nasal sprays, they help reduce a variety of migraine symptoms. It may not be safe for those who are susceptible to a heart attack or stroke.
• Trudhesa, Migranal: Dihydroergotamine. This medication is available as an injectable or nasal spray; it is best taken as soon as the migraine symptoms appear, especially for migraines that frequently last more than twenty-four hours. Possible side effects of migraines include increased nausea and vomiting.Those with high blood pressure, coronary artery disease, kidney disease, or liver illness should not use dihydroergotamine.
• The Lasmiditan of Reyvow: With this more current oral pill, headaches with or without aura are approved for treatment. In clinical trials, Lasmiditan significantly lessened headache pain. Since lasmiditan may have a sedative effect and produce dizziness, it is advised that those who take it refrain from driving or using machinery for at least eight hours after taking it.
• Calcitonin gene-related peptide antagonists, or gepants, are taken orally. Umbegepant (Ubrelvy) and rimegepant (Nurtec ODT) are two oral drugs that have been approved for the treatment of adult migraine cases. 

These drugs decreased pain more than placebos did in clinical trials two hours after consumption. 

The light and sound sensitivity as well as the nausea brought on by migraines were successfully treated by them. Prolonged fatigue, nausea, and dry mouth are common side responses. When taking strong CYP3A4 inhibitor drugs, like many cancer treatment drugs, together with ubergepant or rimegepant is not advised.

• Intermittent Zavegepant (Zavzpret): The Food and Drug Administration recently approved this nasal spray for the treatment of migraines. The only migraine drug that comes in a nasal spray form is Zavegepant. Migraine pain treatment usually takes effect 15 minutes to 2 hours after taking a single dosage. The drug remains effective for up to 48 hours. It can also aid in the relief of other migraine symptoms, such as nausea and sensitivity to light and sound. Zavegepant commonly causes nasal congestion, throat discomfort, and pain. It also regularly causes changes in taste.
• Medications that contain opioids: For those who are unable to use other medications, narcotic opioids may help relieve migraine episodes. Because of their high potential for addiction, they are frequently only utilised in circumstances where no other treatments are effective.
• Drugs that reduce nausea: These can be useful if you have nausea and vomiting in addition to your migraine with aura. Anti-nausea drugs include prochlorperazine, metoclopramide, and chlorpromazine. Usually, they are administered with analgesics.

Certain medications are not safe to use while expecting. If you are trying to get pregnant or are already pregnant, do not use any of these drugs without first talking to a healthcare provider.

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Complications Migraine

Abuse of pharmaceuticals can result in excruciating headaches from the overuse of painkillers. The most dangerous combinations seem to be aspirin, acetaminophen, and coffee. In addition, overuse headaches may occur if you use aspirin or ibuprofen for more than 14 days in a month, or triptans, sumatriptan, or rizatriptan for more than nine days.

Abuse of prescription drugs Headaches occur when medications stop relieving pain and instead cause headaches. When you take additional painkillers, this causes your system to become rewired.

If you suffer from migraines or have a family history of the condition, a neurologist, who specialises in treating headaches, will likely diagnose migraines based on your medical history, symptoms, and the findings of a physical and neurological examination.

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