Migraines & Headaches

Over 100 types of headaches have been identified and proper diagnosis is necessary for optimal treatment and relief. By far the most common severe form of headache is migraine. Many people who suspect (or even are diagnosed with) sinus headaches may actually have migraines.

The typical migraine headache affects only one side of the head or face, tends to involve a pulsating or pounding type of pain, and lasts from four to 72 hours. Migraines may be accompanied by nausea, vomiting, sensitivity to light, and sound. Most people with migraines describe the pain as excruciating. Migraine patients experience specific symptoms during different phases of the headache, including symptoms that precede the actual headache and symptoms during the period after the headache has ended.

Causes

The exact causes of migraines and other severe headaches are known in part. Migraines and other forms of headaches are genetic, in that they tend to run in families. In fact, 90% of people with migraines have a family history of migraines. Migraines are thought to occur when changes occur in how the brain stem interacts with the trigeminal nerve, one of the body’s main “pain pathways”. Serotonin levels drop during migraine attacks. Migraines or other severe headaches may be brought on by certain triggers or environmental factors, including:

  • Foods including alcohol, chocolate, aspartame (an artificial sweetener), monosodium glutamate, and aged cheeses
  • Stress
  • Hormonal changes in women
  • Bright lights, glare, and even strong smells
  • Changes in sleep patterns
  • Weather changes, particularly changes in barometric pressure
  • Certain medications, including taking oral contraceptives and nitroglycerin (a vasodilator)

Terminology

People with migraines are called migraineurs. About 30% of people with migraines experience an aura immediately before the pain phase of the migraine, during which they may experience visual disturbances or sensory phenomena (such as tingling and pins-and-needles). Migraine without aura is sometimes called common migraine. Cephalgia is a general umbrella term for all types of headaches. Migraines and other types of severe headaches are frequently hemicranial, meaning they occur on one side of the head only. Retinal migraine causes extreme visual disturbances concurrently with the pain phase, even including temporary blindness in the eye on the painful side of the head. Chronic migraine is a migraine that occurs for 15 days per month or more for at least three months. A migraine that lasts more than 72 hours is called status migrainosus and is usually treated by hospitalisation and intravenous medicines.

Symptoms

There are four distinct phases of a migraine headache, each with its own unique symptoms. The prodome or period of hours or even a day or two before a headache may be accompanied by symptoms of:

  • Constipation, diarrhea
  • Depression
  • Food cravings
  • Hyperactivity
  • Irritability
  • Stiffness or mild pain in the neck

A minority of migraineurs experience an aura when they may have visual disturbances, tingling or pins-and-needles in the arm or leg, and, in some cases, problems with speech or language. This period occurs immediately before the pain phase. During this period, migraineurs may experience:

  • Intense, pulsating or pounding pain on one side of the head
  • Nausea
  • Vomiting
  • Sensitivity to light and sound
  • Sensitivity to smells
  • Diarrhea
  • Lightheadedness
  • Fainting or feeling like one might faint

When the pain phase ends, the patient may experience postdrome symptoms;

  • Weakness, fatigue
  • Feeling drained
  • Being “washed out” or depleted
  • In some individuals, a sense of euphoria

The symptoms of migraines and other severe headaches can vary a great deal by individual. Symptoms can help headache experts diagnose the specific type of headache. Patients suffering from painful headaches should keep a headache journal detailing dates and times of headaches, symptoms, and descriptions of the type and location of pain.

Treatment

Most people experience headaches over the course of their lifetime but only a small number of these people will ever experience headaches so severe or so frequent that they require medical intervention. However, for people with headaches that cause them to miss work or social events or to experience moderate to severe pain, medical treatment is advisable.

Headaches, including migraines, may be treated effectively with different types of drug therapy. Drug therapy may be given at the time symptoms are first noticed (acute abortive treatment). In patients with chronic headache, preventive treatment is often recommended in which the patient takes medication consistently to reduce the number of headaches that develop.

While there are over-the-counter medications for treating headache, people with severe or chronic headache should seek help from headache experts, such as the clinicians at the Neuro Spinal Hospital.

Prognosis

For many people, regular headaches are a lifelong disorder. While medications can be effective in treating a headache, most people suffering from persistent headaches will be asked to make lifestyle changes, including:

  • Dietary restrictions (avoiding trigger foods)
  • Fixed sleep/wake schedule
  • Getting adequate but not excessive amounts of sleep
  • Avoiding or minimising stress whenever possible
  • Avoiding situations known to bring on headaches (such as bright lights, glare)
  • Getting regular exercise
  • Avoiding birth control pills or hormone replacement therapy (to reduce estrogen levels)

Patients who receive medical care and adhere to physician advice and are able to make appropriate lifestyle modifications will often see their headaches greatly reduced or even eliminated.

Risk

The main risk factor for migraines and many other types of headaches is genetic.Women are more likely to have migraines than men, but certain other headaches (such as cluster headaches) are more common in men than women. Migraines can occur at any age, but it is most typical for a migraineur to have his or her first attack in adolescence. Migraines rarely start in older individuals (over the age of 40) and many women report migraines diminish with menopause.

Conclusion

There are many different types of headache, of which migraine is one of the most common. Migraines cause intense, pulsating pain on one side of the head and last from a few hours to three days. Migraines can be effectively treated, usually with drug therapy and lifestyle modifications. Other types of headaches may also be severe and an accurate diagnosis is required to get optimal treatment for best outcomes.