What Are The Acute Treatments For Migraine
An isolated visual migraine, without headache, typically does not require any acute treatment, since the visual symptoms resolve on their own fairly quickly. The first few times someone experiences a visual migraine it usually causes a lot of anxiety. Once someone has become familiar with the symptoms of a visual migraine, new episodes no longer cause the same level of anxiety.
It can be helpful to try to rest during the episode. Some patients benefit from other strategies, including eating something, having caffeine, or taking an over-the-counter medication such as acetaminophen or ibuprofen .
Patients in whom the visual symptoms are accompanied by a severe headache often benefit from additional therapies. The goal of these medications is to try to cut short the headache before it becomes too severe. Some patients find naproxen , which is a stronger anti-inflammatory medication, to be helpful. Other patients try a class of medications known as triptans.
Triptans are specially designed to work on receptors on blood vessels and brain cells in order to halt a migraine at an early stage. Although there are a number of different triptans, made by several different pharmaceutical companies, each of these is approximately equally effective. Triptans are often taken orally, but also come as injections and nasal sprays. These medicines are generally not considered safe in patients with a history of strokes, heart attacks, or other vascular diseases.
How To Find Relief
There isnt one right way to treat a migraine. If your migraines are infrequent, you may be able to use over-the-counter medications to treat symptoms as they occur.
If your symptoms are chronic or severe, OTC treatments may not be helpful. Your doctor may be able to prescribe stronger medication to treat existing symptoms and help prevent future migraines.
When Should I See A Doctor
When migraines start to interfere with your daily activities or youve progressed from episodic migraines to more than 15 attacks per month, its time to get help. In the last couple of years, there are many treatments for both types of migraines and they can be life changing.
The trouble is that many people, especially those with chronic migraines, dont get the help they needone study found that fewer than 5% consulted with a doctor, got treated, and then followed through with treatments.
And while primary doctors can diagnose migraines, sometimes it makes more sense to go to a neurologist or even go to a dedicated headache doctor or center that can manage your care and treat all your symptoms. The problem, though, is that there are only 500 headache specialists for the 39 million people seeking relief.
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Treatment For Silent Migraine
Treating typical aura without headache can be difficult. Since many medications actually take longer to work than auras duration, some people dont take any as-needed medication. Others, however, may find that associated symptoms like nausea and sensitivity to light and sound will improve if treated.
There are not a lot of tested medications for silent migraine. Some medications have been tried, but there arent any good, large studies to guide them. There is nothing with an FDA approval in this indication, and the condition is managed on a case-by-case basis. Some smaller studies and case reports suggest the use of magnesium, aspirin and lamotrigine. For people with prolonged aura, there have been some treatment attempts with intranasal ketamine. These, however, are very small studies, and this is very much an off-label use.
How Are Migraines Treated
Migraines that are severe, frequent or accompanied by neurological symptoms are best treated preventively, usually with a combination of dietary modification, lifestyle changes, vitamins and daily prescription medications. Most of our best preventive medications are often used for other medical purposes as well; the majority are blood pressure drugs, antidepressants or epilepsy medications. Individual headache attacks are best treated early, often with one or more of the following types of medications: triptans, nonsteroidal anti-inflammatory drugs , anti-emetics , and sometimes narcotics or steroids.
Migraines typically last a few hours to a couple of days and respond well to specific treatments. However, in some patients, the migraine is particularly severe and long-lasting and may even become chronic, occurring continuously for weeks, months or even years. If improperly managed or left untreated, intermittent migraines may essentially transform into a chronic daily headache, with continuous and smoldering symptoms that periodically erupt into a “full-blown” migraine. This condition is extremely difficult to treat.
At the Johns Hopkins Headache Center, located at the Johns Hopkins Bayview Medical center, we have expert physical therapists, nutritionists and psychologists who work closely with our neurologists to help manage patients with frequent migraines. Biofeedback and relaxation techniques are available to complement our standard medical treatments.
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Phase 4: Migraine Postdrome
The final phase of a migraine attack is the postdrome, when many people feel drained, exhausted, or hungover. However, some people feel euphoria or a heightened feeling of well-being. The postdrome phase can last from 1 to 2 days. Other postdrome symptoms include depression, and trouble concentrating or understanding.1,4
How Long Can A Migraine Last
The Neverending Story
When you have a migraine, everyminute can seem like an eternity. It would be really great if your brain would wrap up the whole thing ASAP, but migraines can unfortunately last for much longer than they should have any right to do. We had experts explain why this is, plus if theres anything you can do to get rid of your migraines more quickly.
It could be that there are aberrations how in your brainstem communicates with your trigeminal nerve, an important pain messenger in your body, the Mayo Clinic says. Or maybe some of your brain chemicals that help regulate pain, like serotonin, are out of whack, again looping in that good ol trigeminal nerve to cause discomfort. Scientists still arent sure.
Although the cause of migraines may be hazy, this much is clear: They can be excruciating, causing a severe throbbing sensation in your head along with issues like nausea, vomiting, and an extreme sensitivity to light and sound. Some people also experience aura, which are sensory disturbances often having to do with your vision, so you might see mirages of wavy lines, flashes of light, and other weirdness.
While classic migraines cause intense pain, some may only crash into your life with symptoms such as visual changes or intense dizziness. Whether or not your migraines come with pain, common triggers include stress, caffeine, hormonal fluctuations, and the weather.
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Phase 2: Migraine Aura
Only about 1 out of 4 people with migraine have the second phase called aura. Aura refers to changes in the senses. Sight changes are by far the most common change. However, people with migraine also report changes to their sense of smell, hearing, and touch. Speech and movement may also be affected. Some people even have a combination of migraine auras during an attack.1
Whats The Best Treatment For Migraines
There are two types of treatmentthe type that prevent attacks, or at least lower the number and intensity ; and treatments that you take during an attack . Even when you do take preventative medication, you usually have to have something on hand during an attack to decrease the pain. There are also complementary treatments that include lifestyle changes that help keep triggers at bay.
Since 2018, new migraine meds that target CGRP have come onto the market that have sharply reduced the number of headaches people have every monthby as much as 75% in about half these patients. But because not everyone can take drugs there are also non-drug devices that can prevent attacks or help during one.
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Causes & Risk Factors
Migraine can be caused by a number of different biological mechanisms and environmental factors. The biology behind migraine is complex and not fully understood. It involves the activation of trigeminovascular pathways and central parts of the brain including the brain stem . The trigeminovascular system controls sensation in your face and jaw which is why trigeminal disorders cause head pain. The brain is thought to be in an altered state of excitability, which can also lead to disruptive symptoms like nausea, light sensitivity and aura .;
Neurotransmitters are chemical messengers that communicate between neurons. These play a very important role in brain function . When the brain is more sensitive, neurotransmitters can become overactive and trigger pain signals.;
Neurotransmitters also control things like hunger, wakefulness, anxiety and focus. This causes many of the prodromal symptoms , and also causes nausea, photophobia, and phonophobia during an attack. The difficulty in migraine treatment arises because there are often many different neurotransmitters active during an attack. Some patients may be more responsive to treatment that addresses their serotonin neurotransmitters, while others might find treatment more effective if it inhibits calcitonin gene-related peptides .;
Phase 3: Migraine Headache
If left untreated, the headache phase can last from 4 to 72 hours in adults. The head pain is usually felt on one side but the sides may change, or spread to both sides of the head. It is often described as pulsing or throbbing and often gets worse with physical activity. The amount of pain can be mild to severe and may change from one attack to the next.
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Recovery Or Postdrome Stage
This is the final stage of an attack, and it can take hours or days for a drained, fatigued or hangover type feeling to disappear. Symptoms can be similar to those of the first stage . Often, they mirror these symptoms. For example, if you lost your appetite at the beginning of the attack, you might be very hungry now. If you were tired, you might feel full of energy.
Being aware of the different stages of the migraine attack can be helpful. It can help you prepare for an attack, get a diagnosis and decide when to take acute treatment, such as painkillers or adapt your activities.
It is useful to have a rescue treatment plan for when attacks occur. This may include painkillers such as a triptan, a NSAID or paracetamol. It often also includes anti-sickness medication.
For other people, being aware of the stages and symptoms of a migraine attack can help their understanding. It may also help with the frustration and lack of understanding people often face around migraine, especially at work and in education.
Common Types Of Migraine In Children And Youth
Children can also suffer from chronic or episodic headaches, and it is important to recognize the symptoms
According to the National Headache Foundation,;20% of school-aged children from 5 to 17 are prone to headaches. Of that population, 15% will suffer from tension-type headaches, while the other 5% will be prone to migraine .
Headaches and migraine can happen to anyone, at any age, including young children. Not only that, but the intricacies and symptoms of the disorder are different in children than in adults; common migraine symptoms such as nausea, vomiting, and sensitivity to light and sound are not always prevalent in child sufferers. Children, in addition, cannot always vocalize or describe in detail what they are feeling, which makes diagnosis even more difficult. These patients may go undiagnosed for years, leading into adulthood, which can take a toll on their emotional and mental well being.
The American Migraine Foundation;outlines a few key differences between childrens migraine and those of adults:
- migraines in children are typically shorter in duration and occur less frequently
- the pain children experience tends to be more bilateral, such as across the forehead, rather than unilateral
- while common symptoms may not be reported, a lot can be deferred from a childs behavior, such as wanting to sleep or lay down in a dark, quiet room.
Common Migraine Without Aura
Classic Migraine With Aura
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How Is Migraine Diagnosed
Migraine is usually diagnosed by the typical symptoms. There is no test to confirm migraine. A doctor can usually be confident that you have migraine if you have typical symptoms and by an examination which does not reveal any abnormality. However, some people with migraine have non-typical headaches. Therefore, sometimes tests are done to rule out other causes of headaches. Also, with some uncommon or rare types of migraine such as ocular migraine, tests are sometimes done to rule out other causes of these symptoms. For example, temporary loss of vision can be due to various causes apart from ocular migraine.
Remember, if you have migraine, you do not have symptoms between attacks. It is the episodic nature of the symptoms that is typical of migraine. A headache that does not go, or other symptoms that do not go, are not due to migraine.
Tension headaches;are sometimes confused with migraine. These are the common headaches that most people have from time to time.;See the separate leaflet called Tension Headache for more details.;Note: if you have migraine, you can also have tension headaches at different times to migraine attacks.
If you take painkillers too often for any kind of headache you may develop;medication-overuse headache;.;You can read more about this type of headache in the separate leaflet called;Migraine Medication, Treatment and Prevention.;;
Lifestyle And Home Remedies
Some people find relief from migraine symptoms using home remedies. These include:
- practicing relaxation techniques, such as progressive muscle relaxation, meditation, and yoga
- getting enough sleep each night
- resting in a dark, quiet room when symptoms start
- placing an ice pack on the back of the neck
- gently massaging painful areas of the scalp
- keeping a diary to help identify migraine triggers
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Understanding A Migraine Aura
About one-quarter of migraine sufferers experience an auraa visual, sensory, or speech disturbancebefore their migraine. You may see spots, lights, or zigzags, feel numbness or tingling in one arm, or have trouble speaking, notes the American Migraine Foundation. About a half-hour later, the traditional unilateral head pain known as a migraine typically hits.
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Symptoms Of Chronic Silent Migraine
The symptoms of a silent migraine;are almost identical to those of a standard migraine, with the exception of the headache pain. Sufferers report experiencing visual disturbances including flashing lights, halos, or spots of light, blurry or cloudy vision, or seeing dark areas in their field of vision.
Sensory symptoms include numbness and tingling in the extremities, feelings of weakness, vertigo or dizziness, confusion, speech disturbances or loss of hearing. These may also be accompanied by abdominal pain, nausea, and vomiting.
Many patients also go through four similar phases as a standard migraine attack, which are:
- Prodrome phase, during which patients typically feel confused, irritable, tired, or unusually thirsty. They may also experience diarrhea.
- Aura phase, which can last from a few hours to several days and bring disruptions of vision, language, and mobility.
- Pain phase, characterized by vomiting and nausea, sensitivity to light, touch, or sound. This is usually the period when the patient also experiences headache pain, but with silent migraines sufferers typically have everything else except that.
- Postdrome phase, when patients feel drained and exhausted and often experience depression.
Often, the symptoms can last for years at a time. One patient reported having daily aura for 2 years, while another experienced the effects of a migraine attack without the pain constantly for up to 12 years.
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Take A Medical History
Youll be asked to describe your headaches as your doctor asks you some questions, including:
Is your headache better when you lie down, or when you sit up?
Is your headache worse when you bend over, or when you strain for a bowel movement? Does your headache change on the weekends?
What makes your headache better and what makes them worse? And where does it hurt? Does it hurt anywhere else at other times?
Is it burning, or pounding, or throbbing?
When you have a headache, would you rather be in a sunny or dark room? What about a quiet room?
Theres also a set of criteria by the International Headache Society that doctors follow to make a diagnosis for migraines with or without auras. Patients must have two of the following four features when it comes to headache pain:
It must be moderately to severely intense
It tends to occur on one side
It has a throbbing or pulsating quality
It has to get worse with routine physical activity
And they have to have one of the following two criteria while theyre having an attack:
Not being able to tolerate light and noise
Nausea and/or vomiting
If you have auras, they must include:
Visual or sensory symptoms that only last as long as your migraine attack
They come on gradually
Theyre usually followed by a headache, but not always. In fact, you may not have a headache or you have such a mild one that the headache isnt very apparent
Finally, a patient has had to have at least five attacks in their lifetime.
Symptoms Of Silent Migraines
The visual symptoms of an aura include blind spots or temporary blindness, flashing lights, and seeing sparkles, zigzag lines, or colored spots. One MyMigraineTeam member wrote that her migraine symptoms appeared as red lights flashing all around my room the red flashing continued for a few minutes. Sometimes, it looks more like moving grayish flying shadows. Another wrote, My vision goes to nearly black with purple and green glowing lights that bubble back and forth like a 70s-era lava lamp.
Other neurological symptoms include dizziness, numbness, tingling, and a feeling of weakness on one side of the body. A MyMigraineTeam member described a physical aura where the outside of my right calf starts aching. Some might describe it as numbness, but I think its pain.
These symptoms can be severe. Last week, I went to the emergency room because the left side of my body became weak and numb. I had a very hard time forming sentences or speaking much at all, a MyMigraineTeam member said. I did not have a stroke, which is what I thought was going on. This morning, the same weakness started again. My face all the way down to my leg feels numb and weak.
How can you tell the difference between a silent migraine and a TIA? It can be difficult, but migraine aura symptoms tend to develop slowly and intensify over time, and TIA symptoms appear all at once.
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