What is a Migraine?

A migraine is a complex neurological condition that typically manifests as a severe, throbbing headache, often concentrated on one side of the head. It is more than just a headache; migraines can cause a variety of symptoms and significantly impact daily life. They are among the most common neurological disorders and can affect people of all ages, though they are most prevalent in adults.

Types of Migraines

Migraines are categorised into several types, with the most common being:

• Migraine with Aura: Previously known as "classic migraine," this type includes sensory disturbances called auras, such as visual flashes or zigzag patterns, numbness, or tingling, which typically occur before the headache starts.
• Migraine without Aura: The most common type, also known as "common migraine," where the headache occurs without any preceding sensory disturbances.
• Migraine Aura Without Headache: Also known as "silent migraine," where the aura symptoms occur without the accompanying headache.
• Chronic Migraine: A condition where a person experiences migraines on 15 or more days each month.

Symptoms of a Migraine

Migraines usually progress through four stages, though not everyone experiences all of them:

• Prodrome: This early stage occurs hours or even days before the migraine and includes subtle symptoms such as mood changes, food cravings, neck stiffness, and frequent yawning.
• Aura: For those who experience it, the aura stage can include visual disturbances, such as flashes of light, blind spots, or zigzag patterns, as well as other neurological symptoms like speech difficulties or pins and needles in the limbs.
• Headache: The headache phase is characterised by intense, throbbing pain, often on one side of the head. This can last from a few hours to up to 72 hours. Associated symptoms include nausea, vomiting, and sensitivity to light, sound, and smells.
• Postdrome: After the headache subsides, individuals may feel drained or fatigued, with lingering symptoms like moodiness, dizziness, and confusion.

Causes and Triggers

The exact cause of migraines is not fully understood, but they are believed to involve abnormal brain activity that affects nerve signals, chemicals, and blood vessels in the brain. Several factors can trigger migraines, including:

• Hormonal changes: Fluctuations in estrogen, especially in women during menstruation, pregnancy, or menopause.
• Stress: High levels of stress or sudden relaxation after stress can trigger migraines.
• Diet: Certain foods and drinks, such as alcohol, caffeine, chocolate, and processed meats, may trigger migraines in some individuals.
• Sleep patterns: Both too much and too little sleep can lead to migraines.
• Environmental factors: Bright lights, loud noises, and strong smells can all be migraine triggers.

Diagnosis

Diagnosing migraines involves a thorough review of the patient’s medical history, symptoms, and physical examination. There is no specific test for migraines, but doctors may use imaging tests like MRIs or CT Scans to rule out other causes of headaches.

Treatment Options

Treatment for migraines aims to alleviate symptoms and prevent future attacks. Options include:

• Acute Treatments: Medications taken at the onset of a migraine to relieve symptoms. These include over-the-counter pain relievers (like ibuprofen or aspirin), prescription triptans, anti-nausea drugs, and ergotamines.
• Preventive Treatments: These are taken regularly to reduce the frequency and severity of migraines. Options include beta-blockers, antidepressants, anticonvulsants, and Botox injections.
• Lifestyle Changes: Regular exercise, adequate sleep, a healthy diet, and stress management techniques can all help reduce the frequency of migraines.

Managing Migraines

Living with migraines requires ongoing management and awareness of triggers. Keeping a migraine diary to track symptoms, triggers, and treatments can be invaluable in managing the condition. Additionally, some individuals may benefit from alternative therapies such as acupuncture, biofeedback, or cognitive-behavioural therapy.