The Migraine Attack Or Acute Phase:
This is the most prolonged phase, lasting anywhere from four to 72 hours. This is the time to take your rescue meds to decrease the headache, preferably within the first hour . The signs of this phase include:
Head pain. About 60% of people feel a throbbing pain on one side of their head, and 15% of those people always get the pain on the same side. Forty percent feel pain on both sides. Sometimes your head doesnt feel like its throbbing, but you still feel pain. Its usually moderate to severe, but not every migraine comes with a headache . In fact, some people who also have auras just have the visual or sensory disturbances, and yes, that needs to be treated too.
Nausea or vomiting. Three-quarters of women and 65% of men report feeling queasy, and about 31% of women throw up compared to 28% of men.
Sensitivity to light and noise. Eighty-three percent of women and 76% of men cant tolerate too much light or feel as if the lights have suddenly become too bright. Noise is also unbearable: 70% of men and 78% of women feel as if sounds have become too loud.
Pain that gets worse when you move, even for routine activities like doing chores or walking up the stairs. In fact, about half of people with migraines report that they have trouble doing chores during a migraine.
A Migraine Attack Is Triggered
There is a lot of evidence that migraine attacks are triggered when the concentration of K+ in the ECF becomes too high. This corresponds to the situation where the dancer has dropped so many marbles around her feet that she ends up slipping on one of them. This increase in K+ in the ECF can happen for a number of reasons:
- If the Na+/K+-pumps are not being supplied with enough oxygen and/or blood sugar, K+ cannot be pumped out of the ECF fast enough and the concentration of K+ in the ECF will increase . This can happen if the arteries supplying this part of the brain are very contracted so that too little blood flow is coming through, starving the Na+/K+-pumps of the oxygen and blood sugar that is normally being delivered in sufficient amounts by the blood. If it is too long since youve eaten a meal, your blood sugar may also be so low that the Na+/K+-pumps are not getting the energy they need to remove K+ from the ECF at a fast enough rate.
- If the nerve cells have been firing at a very high frequency for a very long time, K+ in the ECF will increase . This can happen when you have been very stressed for a long time or have not had enough sleep.
- If too little K+ is being removed by the blood flow that normally helps sweep up some of the excess K+ in the ECF. This happens if the blood flow to that part of the brain is insufficient.
Is There An Anatomical Sequence In Migraine
The sequence of activation of different brain regions in migraine remains uncertain. At this stage it is not clear whether changes in cortical activity activate the brainstem, or vice versa. Alternatively, changes in these brain regions could occur in parallel, without an orderly sequence from one to the next. The typical occurrence of the migraine aura before migraine headache supports the hypothesis that cortical activation precedes brainstem activation. Consistent with this concept, important studies in experimental models demonstrate that it is possible for CSD to activate neurons in the trigeminal nucleus caudalis via trigeminal afferents . Conversely, it has been shown that brainstem activation can evoke changes in cortical blood flow, raising the possibility that a process beginning in the brainstem could secondarily evoke some of the cortical phenomena of migraine . But it is also possible that both brain regions are activated simultaneously, a concept that is supported by the observations that, in some patients, clinical symptoms may occur without any clearly defined sequence that indicates alteration in the function of one region leading to change in function of another. Regardless of the order of their activation, however, it is clear that both cortical and brainstem signaling mechanisms are involved in migraine and are appealing targets for new therapeutic approaches for migraine.
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When Should I Seek Immediate Help Or Contact My Healthcare Provider
- You are experiencing the worst headache of my life.
- You are having neurologic symptoms that youve never had before, including speaking difficulty, balance problems, vision problems, mental confusion, seizures or numbing/tingling sensations.
- Your headache comes on suddenly.
- You have a headache after experiencing a head injury.
Schedule a visit with your healthcare provider if:
- The number or severity of your headaches increase or your headache pattern changes.
- Your medications no longer seem to be working or youre experiencing new or different side effects.
What Causes Migraine Attacks
Migraine genes set the brain to be less able to process sensory inputs and make the brain vulnerable to attacks. But that is not the whole story.
Epigenetics, the interaction of genes with our behaviours and environment, is important too. The more the brain is challenged by these stimuli, the more pain neurochemicals are produced. Migraine threshold theory suggests that combinations of changes irritate the brain and trigger attacks once pain neurochemicals reach a certain level.
Change is the key word. The migraine brain is more sensitive to internal body changes, such as blood sugar levels, sleep routines, hormones or stress, and external environment factors light glare, strong visual patterns like stripes, stuffy air quality, and even weather.
Some things seem to be particularly likely to lead to attacks. Skipping meals leading to fluctuating blood glucose levels is one. Regular snacking may help. People with migraine are often sensitive to carbohydrates though, so low GI foods are preferable. Broken or extended sleep can aggravate attacks this is especially hard for teenagers, who wake early for school but then lie in at weekends.
Any type of change can lead to attacks worsening a new job, moving house, travelling abroad. But so can stress reduction. Let-down or weekend migraine attacks are commonly described frustrating for people relaxing after a stressful time.
About the author Dr Katy Munro
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Whats The Difference Between A Headache And A Migraine
Headache is a neurological symptom, the underlying cause needs to be established. Migraine is a genetic, neurological condition often causing headache, but is also associated with many other symptoms including heightened sensitivity to light, sound, movement and smells, as well as dizziness, brain fog, abdominal pain, speech difficulties, visual disturbances, nausea, vomiting, fatigue and irritability. But this list is not exhaustive.
Migraine is a spectrum condition so some people have infrequent, mild attacks, while others have more severe, frequent episodes. Some suffer daily impact from the effects of migraine on their brain.
The Aura Or Second Phase:
Only about 20% of migraine patients have auras, usually anywhere from five to 60 minutes before the pain starts. Most patients have more than one type of auras, with 96% of people reporting having one type at a time. Sometimes an aura can feel like stroke and having auras can increase your risk of having one. If you do have an aura for the first time, let your provider know so you can get checked out to rule out the possibility. Signs of aura include:
Seeing things. About 99% have whats called a visual aura, seeing patterns like zigzags, curves, dots or shimmering. They typically start off to the side and then move to the center of your vision. Sometimes you can see shimmering colors. Other times you can get blind spots or tunnel vision.
Feeling things. A little more than half of migraine patients have whats called a sensory aura, which means they feel tingling or pins and needles in a hand or their face. Usually, people feel that on one side of their body. Sometimes your tongue feels numb, sometimes a leg.
Trouble speaking. Because your tongue feels numb, you may slur your words. Or feel like you cant get words out. This affects about a third of people.
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What Role Does Cortical Spreading Depression Play
Cortical spreading depression is the medical term for a slow wave of electrical activity that takes place in the neurons of the brain. Neurons are specialized brain cells that send signals to other types of cells.4,5
Cortical spreading depression may be the cause of migraine auras. In addition, these slow electrical waves can activate the nerves responsible for sensing pain in the covering surrounding the brain and also change the function of blood vessels, both of which can lead to migraine pain.4,5
Preventative Medication And Therapies
If you experience frequent migraines, your GP might discuss preventative medication options with you.
It is important to note that preventatives for migraines are not pain medication, but help to reduce the number of migraines. They take time to work, so the minimum time period required may be three to six months. Contact your GP or specialist for further information. All of these treatments have their advantages and disadvantages and some of the medications might not be suitable for everybody.
You might find that this medication reduces the frequency and severity of your attacks but does not stop them completely. You will need to continue your other migraine treatments when you experience an attack.
National Institute for Health and Care Excellence recommends that GPs and specialists should consider the following drugs and therapies if they think you might benefit from preventative treatment:
Beta blocking drugs
These drugs are traditionally used to treat angina and high blood pressure. It has been found that certain beta-blockers prevent migraine attacks. Beta-blockers are unsuitable for people with certain conditions.
This drug is typically prescribed for the treatment of epilepsy but has also been found to help reduce the frequency of migraines. Again, it is not suitable for everyone. In particular, women who are pregnant or thinking about getting pregnant should be advised of the associated side effects.
Botulinum toxin type A
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Treatment Options For Migraines
People with migraine can use a triptan drug to stop an attack. Triptans appear to work by inhibiting pain signaling in the brainstem. They should only be taken after consulting a physician.
Here are five other treatment options for migraines:
Consider what might have triggered the attack and avoid that trigger. Inquire with your doctor about treatment options for preventing or reducing attacks.
Although research is limited, complementary treatments may be beneficial for some. Acupuncture and aromatherapy are two examples of relaxation techniques .
The Role Of Triggers In Migraines
About 76% of people with migraines have triggerstypically factors in their life or the environmentthat set off their attack. Triggers may stimulate temporary changes in the chemicals and areas of the brain that get activated during an attack. And it usually takes two or three of them to set off a migraine.
The most common ones people cite are:
stress or something bad happening
specific foods and drinks
But you can have different triggers at different times of the months. For instance, you could have a glass of red wine most Friday nights and not have a migraine on Saturday, but if youre just about to get your period that glass of red wine could do you in. Or it could be that your brain was already in its preliminary migraine phase and you would have had an attack anyway.
Sometimes its a good idea to keep a migraine diary to find out what your triggers are and when they occur, especially if youre avoiding something enjoyable for fear of setting off a migraine and bring them up to a provider. It could be that preventative medications or even lifestyle changes will bring about the changes in the brain that may make these triggers less of a, well, headache.
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The Phases Of Migraine
Also known as preheadache or the premonitory phase, prodrome can mark the beginning of a migraine attack. This phase can last several hours or may even occur over several days.
Most people with migraine will experience prodrome, but not necessarily before every migraine attack. If a person with migraine is experiencing prodrome, his or her care team can study their symptoms and patterns to guide a treatment plan that may lessen the severity of the oncoming headache. During this phase, taking medication, minimizing/avoiding other trigger factors , and practicing mindfulness meditation, relaxation therapy, or other biobehavioral techniques, can even prevent headache in some cases. Prodrome symptoms vary from person to person but can include changes in mood, from feelings of depression or irritability to difficulty focusing. Other symptoms may include fatigue, sensitivity to light and sound, insomnia, nausea, constipation or diarrhea, and muscle stiffness, especially in the neck and shoulders. Symptoms that are especially unique to the prodrome phase of migraine include yawning, cravings for certain foods, and frequent urination.
Reviewed for accuracy by the American Migraine Foundations subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. to read about our editorial board members.
The Brain Before A Migraine Attack
The entire brain with all its neurons and ECF is covered by a membrane . Running on the outside of this membrane are the arteries that supply the brain with oxygen and blood sugar. The nerve cells in the brain cannot feel pain, but the arteries have pain-sensing nerve endings in them, so-called pain receptors.
In the normal case illustrated in the picture above, the concentration of K+ is very large inside the nerve cells, but very low outside in the ECF. For Na+ it is the other way around.
When a nerve cell sends a signal , some of the K+ inside leaks out of the cell into the ECF, and some of the Na+ outside leaks into the cell. In our dancer example, this is similar to how the dancer from time to time drops a marble on the floor.
The normal inside/outside concentrations are kept stable by microscopic Na+/K+ pumps in the nerve cells walls. These pumps are all the time pumping K+ out of the ECF and into the cells, and Na+ in the other direction. In our dancefloor example, these pumps are like the dancer continually picking up the marbles that she drops.
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What Symptoms Must You Have To Be Diagnosed With A Migraine
Migraine with aura . This is a headache, plus:
- Visual symptoms or vision loss.
- Sensory symptoms .
Migraine without aura . A common migraine is a headache and:
- The attacks included pain on one side of your head.
- Youve had at least five attacks, each lasting between four and 72 hours.
Plus, youve experienced at least one of the following:
- Nausea and/or vomiting.
- Lights bother you and/or you avoid light.
- Sounds bother you and/or you avoid sounds.
What Happens In The Brain During A Migraine
Until the 20th century it was a mystery what caused migraine and what happened in the body during an attack. However, in recent years scientists have discovered many of the mechanisms that are involved when migraine attacks start and develop. This article will describe the most important of these mechanisms.
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What Are The Symptoms Of A Migraine
A migraine attack happens in stages and lasts from a few hours to several days. The symptoms vary depending on the stage:Prodrome: This early stage can include a host of symptoms: fatigue, uncontrollable yawning, insomnia, nausea, gastrointestinal upset, neck stiffness, food cravings, tinnitus, and sensitivity to light and sound. Anxiety and depression are also common. The prodrome is the best time to treat a migraine attack, but it can be hard to pinpoint since many of the symptoms can be caused by other issues.
Aura: Roughly a quarter of migraineurs experience aura. It can start with spots in the visual field, which gradually spreadusually on one side. People describe seeing shimmering lights, geometric patterns, and zigzag lines. Aura can be particularly alarmingespecially if youre in publicbecause it blocks your vision. Some people also experience sensory phenomena like a tingling hand or arm. This phase lasts from five minutes to an hour and usually precedes the headache, but the two can happen simultaneously.Headache: A migraine headache is typically a throbbing pain on one side of the head, which sometimes spreads to other areas. The headache can also be accompanied by nausea, vomiting, insomnia, anxiety, and sensitivity to light, sound, and smell. This phase lasts from four to 72 hours. While this is the most well-known symptom, some people dont experience the headache phase at all, or not with every attack.
Migraine Treatment And Home Remedies
There’s no cure for migraine headaches. But many drugs can treat or even prevent them. Common migraine treatments include:
You may ease migraine symptoms by:
- Resting with your eyes closed in a dark, quiet room
- Putting a cool compress or ice pack on your forehead
- Drinking plenty of liquids
Complementary and alternative treatments
Some people get relief with therapies they use in addition to or instead of traditional medical treatment. These are called complementary or alternative treatments. For migraine, they include:
- Biofeedback. This helps you take note of stressful situations that could trigger symptoms. If the headache begins slowly, biofeedback can stop the attack before it becomes full-blown.
- Cognitive behavioral therapy . A specialist can teach you how actions and thoughts affect how you sense pain.
- Supplements. Research has found that some vitamins, minerals, and herbs can prevent or treat migraines. These include riboflavin, coenzyme Q10, and melatonin. Butterbur may head off migraines, but it can also affect your liver enzymes.
- Body work. Physical treatments like chiropractic, massage, acupressure, acupuncture, and craniosacral therapy might ease headache symptoms.
Talk to your doctor before trying any complementary or alternative treatments.
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