Migraine

Migraine is a neurological disorder that causes severe headaches. The headache is usually severe, throbbing and one-sided, additionally, it may be accompanied by nausea, vomiting and hypersensitivity to light.

Migraine symptoms

Migraine affects everyone differently. Many people experience it in stages. These stages may include:

Prodromal phase lasting hours or days before the headache, in which about 60% of migraine sufferers experience symptoms such as sensitivity to light, sound or smell, feeling tired, food cravings or loss of appetite, mood changes, increased thirst, bloating and constipation or diarrhoea
Aura phase, which symptoms are triggered by the nervous system and often affect vision. They usually start gradually over 5 to 20 minutes and last less than an hour. Auras can take many forms: visual disturbances (black spots, gloom, wavy lines, flashes of light, tunnel vision, sudden loss of vision), tingling or numbness on one side of the body, speech disturbances, a feeling of heaviness in the arms or legs, ringing in the ears, disturbances in sensory perception (sensation, smell, taste)
Migraine attack, where the headache often starts as a dull ache that becomes a throbbing pain. It usually intensifies with physical exertion. The pain may move from one side of the head to the other, be in the front of the head or feel like it is all over the head. About 80% of people experience nausea along with the headache, and about 50% vomit. You may also feel pale and sweaty or faint. Most migraines last about four hours, but severe migraines can last longer than three days. It is common to have two to four headaches a month. Some people have migraines every few days, while others once or twice a year
Postdromal phase, which can last up to one day after the headache stops. Symptoms include: feeling tired or fatigued, lowered mood, muscle pain or weakness, food cravings or loss of appetite

Causes of migraine

For many years, scientists believed that migraines were caused by changes in blood flow in the brain. Nowadays, most believe that this may contribute to the pain, but is not the cause. It is now thought that migraine probably starts with over-active nerve cells that send signals to the trigeminal nerve, causing pain in the head and face. This causes the body to release chemicals such as serotonin and calcitonin gene-related peptide (CGRP). CGRP causes swelling of blood vessels in the brain. The neurotransmitters then cause inflammation and pain.

Migraine risk factors

It is estimated that 8 million Poles suffer from migraines. Certain things can increase the likelihood of their occurrence:

Women are three times more likely to suffer from migraines than men
Most people start having migraines between the ages of 10 and 40. However, many women find that their migraines get better or go away after the age of 50
Four out of five migraine sufferers have a family history of migraines. If one parent has had these types of headaches, the child has a 50% chance of developing them. If both parents have them, the risk increases to 75%
Other illnesses like depression, anxiety, bipolar disorder, sleep disorders and epilepsy can increase the risk of migraines

Migraine triggers

Some common migraine triggers are

Many women find that headaches occur around menstruation, during pregnancy or during ovulation. Migraines can also be associated with menopause, hormonal birth control or hormone replacement therapy
Stress, especially chronic stress, affects the release of chemicals in the brain that can cause changes in blood vessels, which can lead to migraines
Certain foods and beverages, such as ripened cheeses, alcohol and food additives, particularly nitrates (cold cuts, sausages, smoked meats) and monosodium glutamate
Skipping meals
Caffeine, in too much or too small quantity, can cause headaches. Caffeine itself can be a treatment for acute migraines
Weather changes: storm fronts, changes in air pressure, strong winds or changes in altitude
Strong sensory stimuli: loud noises, bright lights and strong smells
Medications that dilate blood vessels
Physical activity and sex
Smoking or vaporising tobacco
Disturbed diurnal rhythm, equally too little or too much sleep can trigger migraines

Types of migraine

There are different types of migraine. The most common are migraine with aura (also known as classic migraine) and migraine without aura (or simple migraine).

Other types include

Menstrual migraine, which occurs when the headache is associated with menstruation. It usually starts 2 days before menstruation and lasts up to 3 days after. Other types of migraine can also occur at other times of the month, but menstrual migraines usually do not have an aura
Migraine without pain, this type is also called acephalic migraine. Aura symptoms occur without headache. In fact, the aura is usually the main warning sign of this type of migraine. Nausea and other migraine symptoms may be present. Migraine without pain is usually brief, lasting about 20-30 minutes
A vestibular migraine manifests as problems with balance, dizziness, where nausea and vomiting may occur, as well as a headache. This type usually occurs in people who have a history of motion sickness
Abdominal migraine causes abdominal pain, nausea and vomiting. It is common in children and can develop into a classic migraine over time
Haemiplegic migraine, is characterised by a brief period of paralysis or weakness on one side of the body. The following may occur: numbness, dizziness or changes in vision. These symptoms can also be signs of a stroke, so call 112 immediately for the above symptoms.
Ocular migraine, which is also known as retinal migraine. It causes a brief, partial or complete loss of vision in one eye and a dull pain behind the eye that can spread to the rest of the head. If any changes in vision occur, medical attention should be sought immediately, and an ophthalmologist should be consulted
Migraine with brainstem aura, dizziness, disorientation or loss of balance may occur before the headache. The pain may radiate to the back of the head. These symptoms usually start suddenly and may be accompanied by difficulty speaking, ringing in the ears and vomiting. This type of migraine is strongly associated with hormonal changes and mainly affects young adult women. Again, the emergency number 112 should be called immediately to rule out a stroke in a hospital setting
Status migraine, is a severe type of migraine that can last for more than 72 hours. The pain and nausea are so severe that a visit to a hospital may be necessary. Sometimes it can be caused by medication or medication withdrawal
Ophthalmoplegic migraine, which causes symptoms related to the eye, pain around the eye, including paralysis of the muscles around the eye. It is a medical emergency because symptoms can also be caused by pressure on the nerves behind the eye or by an aneurysm. Other symptoms include drooping eyelids, double vision or other changes in vision

Migraine frequency

Doctors divide migraines into three levels of frequency

Episodic migraine means that a migraine occurs every so often, up to 1-2 times a week or less frequently
High-frequency episodic migraine is a condition where there are 8 to 14 days with a headache per month, with not all pain necessarily being typical of migraine
Chronic migraine means that headaches occur for more than 15 days per month, and eight of these days have typical migraine characteristics, such as moderate to severe intensity, pain on one side of the head, throbbing in nature, where discomfort is worse with activity (walking), nausea or vomiting occurs, and hypersensitivity to light and sound occurs

What should you do if you are suffering from a headache?

When to call the emergency number 112 to summon an ambulance:

The first episode of a severe and sudden headache should rule out a stroke or aneurysm
In case of headache with neck stiffness fever, vomiting
If there is visual disturbance, numbness, paralysis or weakness of half the body, difficulty in speaking, or other new neurological symptoms, a stroke should be absolutely ruled out in the hospital ward

When is it advisable to see a doctor?

If the headache recurs
If the frequency of headaches changes
When headaches make work or personal life difficult
If the nature of the pain has changed, the patient may be suffering from more than one type of headache at the same time

How to prepare for a visit

It is worth keeping a diary to monitor: frequency, symptoms and any headache triggers noted
Write down the frequency with which the pains have occurred in the last 3 months
Ask other family members about the occurrence of headaches
Prepare a thorough list of all medications and supplements currently being taken, as well as medications that have been used previously to treat headaches
Bring previous medical records, along with additional tests such as an EEG or CT scan of the brain

Treatment

Over-the-counter medications containing non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol or caffeine can help in the treatment of episodic migraine; combination medications containing several substances are most effective. Unfortunately, over-the-counter painkillers can also exacerbate the headache. If they are used too often, headache recurrence or addiction can occur. Over-the-counter medicines should not be used for more than two days a week
Over-the-counter medications, which can be used in oral form, suppositories or injections
The gold standard treatment for migraines is triptans. This is a group of drugs that interrupt a migraine attack, but are not without side effects. Also, this group of drugs should not be abused. Until now, triptans were only available by prescription; as of 2023, the first triptan (almotriptan) can be purchased without a prescription. Tryptan abuse can also lead to drug-induced headache
CGRP receptor antagonists are a new group of antimigraine drugs showing high efficacy and few side effects. The only preparation available in Poland is rimegepant; the biggest problem is still the high price of the drug
Prophylactic medication, if other treatments do not work, the headaches are severe or there are at least four migraine days per month, prophylactic treatment can be considered. Prophylactic medication is taken regularly to make the headaches less severe or less frequent. This is a very diverse group of medications including: antiepileptics, some antidepressants, antihypertensive medications (beta-blockers and sartans), and modern biologic medications acting via the CGRP receptor (erenumab , fremanezumab and galcanezumab)
Botulinum toxin therapy is an established treatment for chronic migraine.
Electrostimulation devices for trigeminal nerve stimulation such as the Cefaly or Paingone Qalm are also available, these devices have two programmes prophylactic and ad hoc for pain. Another stimulator, the gammaCore, sends a mild electrical signal to the fibres of the vagus nerve in the neck to relieve pain and prevent migraines

Home remedies that can relieve migraines

Resting with eyes closed in a dark, quiet room
Placing a cool compress or ice pack on the forehead
Drinking plenty of fluids

Try the following steps to prevent migraines

Identify and avoid triggers.
Keep a diary of your symptoms to find out what is causing them
Control stress. Relaxation techniques such as meditation, yoga and mindful breathing can help
Eating regularly
Drinking plenty of fluids
Getting plenty of rest
Taking regular moderate exercise
If migraines occur around the time of your period or if lifestyle changes do not help, ask your doctor about preventive medication