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A migraine is a headache disorder that typically affects one side of the head and sometimes neck. It is characterised by recurrent headaches, with each bout about lasting between two and 72 hours. The headaches have moderate to severe intensity and may be accompanied by other symptoms like vomiting, increased sensitivity to light, sound and smell.
The headaches in migraines are believed to be caused by neurovascular structures in the brain. Some theories propose that the disorder begins in the brain tissue and then spreads to the bold vessels. Some other researches suggest that migraines are caused by neurons in the brain. The specific cause of migraines is still unknown, but the discussion revolves around the fact that it may be caused by blood vessels and neurons.
One explanation proposes that the excitability in the cerebral cortex is increased, and that causes an abnormal control of pain in neurons in the brainstem. These neurons are a part of the trigeminal nucleus, which is the largest of the cranial nerves. It extends through the pons, medulla, and midbrain and goes further into the upper part of the spinal cord. The wide distribution of this cranial nerve could explain why migraine headaches feel the way they do.
Another factor that has been linked to the way migraines develop is the levels of serotonin in the body. Serotonin is popularly known as the “feel good” hormone and is responsible for several positive and happy feelings we experience as human beings. It is also linked to modulating pain, memory, reward, learning and several other processes in the body. The theory is that low levels of serotonin lead to the development and prevalence of migraine headaches.
Some other theories have linked migraines to a phenomenon called “cortical spreading depression”. What happens in this is a burst of neuronal activity, and that is followed by a period of lack of activity. This “burst” and “inactivity” is seen in people who experience migraines. The theory is that after the activity, the blood flow to the cerebral cortex is affected for a couple of hours. This then triggers the nerves that sense pain in the head and neck
Except for the fact that pain in migraines is of varying durations and that they occur on one side of the brain, not much else is known about it. Here too, there are theories to try and explain how the pain is experienced. Some suspect structures in the central nervous system, such as the brainstem and diencephalon, while others suspect structures the peripheral nervous system (sensory nerves around blood vessels in the head and neck).
There are four phases to a migraine headache. They all differ in duration and prevalence. Some people experience all the phases in varying durations while others only experience some of them. The stages are:
The prodrome stage: This stage is experienced by 6 out of every ten people who suffer migraines. Its onset can last for anywhere between two hours to two days, and it is followed by the aura phase. The prodrome stage is characterised by a series of experiences, including altered mood, depression or euphoria, fatigue, food craving, diarrhoea, sensitivity to smells and even muscle stiffness.
The aura: The aura can occur before or during the migraine headache, and it is a neurological problem that appears gradually, over several minutes. It generally subsides within an hour and presents symptoms that are visual (in 90% of cases) and motor. With the visual disturbances in the aura phase, the individual may see bright lights, zig-zag lines, or a complete loss of sight in a part of the visual field.
The pain (headache) phase: The headache is usually on one side of the head, and it begins mildly and becomes more severe the longer it lasts. The pain is usually throbbing or pulsing and aggravated with physical activity. In about 4 out of every ten migraine cases, the headache is experienced on both sides of the head and neck (bilateral). This bilateral pain is most common in individuals who don’t experience the aura phase.
The postdrome: The postdrome is the period after the headache. The symptoms include feelings of general weakness, confusion, and even soreness in the area of the head where the migraine occurred.
The causes of migraines are numerous. It has been linked to some genetic factors, and so people whose parents suffer migraines are more likely to get them.
Migraines can also be triggered by several factors, including:
Migraines are ranked as the third most common diseases in the world, and it is estimated that about 1 in 7 people get migraines worldwide. Furthermore, about 2 in 100 people suffer from chronic migraines.
One of the major risk factors of migraines is genetics. Individuals with a family history of migraines are several times more likely to suffer the condition than others. Other risk factors include:
The typical symptom associated with migraines is recurrent headaches that have varying durations. They also include autonomic symptoms. All the stages of migraines described earlier are also symptoms that individuals with the condition experience. Sometimes, not all the stages are experienced. About 15% to 30% of cases, an aura (see above for more information) is associated with the migraine.
Migraine headaches last for different durations and have been known to last from between two hours to 72 hours. A migraine headache that lasts longer than 72 hours in one occurrence is known as status migrainosus.
In addition to headaches, other symptoms of migraines are increased sensitivity to light, sound and smell.
There are also conditions associated with migraines. These have been observed in individuals who present with migraines, and they include Depression, Bipolar disorder, anxiety, and obsessive-compulsive disorder. Additionally, these disorders are up to five times more common in people who have migraines without aura. They are three to ten times more common in people that have migraines with aura.
Migraines can be diagnosed based on their presentation alone. For this, history and assessment of symptoms are enough. These symptoms include the stages of the migraine, and well as headaches that fit the stages. The diagnosis of migraines also includes ruling out other similar conditions.
There is no cure for migraines, and so, the treatment is focused on relieving the symptoms of the condition and preventing future attacks. For symptom relief, several medications are usually prescribed, including pain relievers, triptan drugs, and ergotamine drugs. There are also drugs prescribed to prevent the reoccurrence of migraines in individuals who experience it frequently.
Other things that can be done for symptom relief include
Treating migraines also involves making lifestyle changes. For example, reducing the levels of stress experienced can help reduce the pain and the frequency of occurrence. Stress management strategies like exercise, relaxation techniques, monitoring vital signs can also help keep a lid on the impact of migraine.
Aminoff, Roger P. Simon, David A. Greenberg, Michael J. (2009). Clinical neurology (7 ed.). New York, N.Y: Lange Medical Books/McGraw-Hill. pp. 85–88. ISBN 9780071664332.
Vos, T; Flaxman, AD; Naghavi, M; Lozano, R; Michaud, C; Ezzati, M; Shibuya, K; Salomon, JA; et al. (Dec 15, 2012). “Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010”. Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607
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