Migraine is the intense throbbing or pulsing sensation in one or both parts of the head and is accompanied by uneasiness and extreme sensitivity to light, sound and smell. In some occurrences, migraine is preceded or accompanied by sensory warning symptoms or aura such as flashing of lights, blind spots or tingling of arm or leg. Migraine attacks can last for hours to days.
Types of Migraine
The 2 main types of migraine include:
- Migraine without aura (Common migraine) . As the name implies, it is the most common type of migraine, characterized by a throbbing pain on one side of the head. If untreated, it may last from 4 to 72 hours. This type of migraine has the risk of worsening with frequent use of symptomatic medication. It does not begin with an aura.
- Migraine with aura (Classic/Complicated migraine) . Some migraines begin with an aura up to 30 minutes before the migraine attack. Aura refers to neurological disturbances people ?see? before migraine. Aura can be in a form of flashing lights, zig-zag patterns or objects appearing distorted. Migraine with aura can occur without a headache or tension type headache. Other symptoms include nausea, loss of appetite and sensitivity to light or sound.
Other types of migraine include:
- Migraine with brainstem aura (basilar migraine). This type of migraine causes loss of balance or dizziness before the headache. It may also cause slurred speech, poor muscle coordination, ringing in the ears and even loss of consciousness prior to headache. Headache suddenly comes and if felt on both sides at the back of the head.
- Abdominal migraine mostly affects children. It may cause nausea, vomiting or dizziness without headache which persists for one to 72 hours.
- Menstrual migraine. As the name suggests, it affects women as an effect of hormone fluctuation prior to menstrual cycle.
- Chronic migraine or transformed migraine. This type of migraine occurs up to 15 days or more each month in at least 3 consecutive months. It mostly affects one side of the head which include a throbbing and pulsating sensation on the area affected by the headache which may worsen due to physical activity such as walking or cleaning.
- Retinal or ocular migraine. This type of migraine may cause visual disturbances such as vision loss or blindness preceding a migraine headache. This condition is rare. Other symptoms include nausea and sensitivity to sound and a headache that worsens with physical activity.
- Hemiplegic migraine is a rare type of migraine which causes temporary paralysis on one side of the body which may last for several days prior to or during a headache. Other symptoms resemble stroke, such as disturbances in speech and vision.
- Status migraine or status migrainosus is a serious and rare type of migraine that can last up to 72 hours. This type of migraine can be so severe and prolonged that hospital treatment is needed to relieve nausea or vomiting and prevent dehydration. Along with headache, symptoms include vision changes (aura) and difficulty in thinking and sleeping.
There are 4 phases of migraine:
- Prodrome phase occurs hours or days before migraine attack.
Sensitivity tlight, sound and smell
- Aura phase occurs before or during migraine. Aura is a symptom of the nervous system that affects the visual sense (e.g. sudden appearance of flashing lights), sensory or touch, movement, and speech production.
- Attack/Pain phase migraine attack that last from 4-72 hours, may experience migraine several times a month or less often.
Pain on one side or both sides of the head
Nausea (feeling sick), vomiting
Sensitivity tlight, sound and smell
Lightheadedness, sometimes followed by fainting
- Postdrome phase effects of migraine pain may persist after the main headache attack has ended. May feel tired/weak or hungover.
Cognitive (nervous system) difficulties
When to See a Doctor
If the headache is sudden and severe
If the headache is accompanied by a stiff neck, fever, difficulty in speaking, mental confusion, loss of consciousness or weakness.
Your headache follows a head injury.
Home remedies or over-the-counter treatments do not help. Headache gets worse rather than better.
A new kind of headache if you are older than 50.
Commonly Prescribed Drugs
There are 2 types of migraine treatments:
- Abortive or acute medications can stop migraine once it starts and is useful for patients who have nausea/vomiting related migraine.
- Pain relievers such as NSAIDs (e.g. paracetamol and ibuprofen), aspirin and caffeine help relieve mild migraines. Side effects: Gastrointestinal disturbances includes bleeding, peptic ulcer and dyspepsia. Headache, nausea, dizziness, visual disturbances. Hypertension. Renal failure, fluid retention. Central nervous system and blood disorders.
- Triptans or Serotonin receptor agonist (sumatriptan, zolmitriptan) constricts blood vessels and blocks pain pathways in the brain. Precaution: Not recommended for people at risk of stroke and heart attacks. Side effects: Nausea, dizziness, drowsiness, muscle weakness, vomiting, uneasy feeling (heat, pain, tingling, tightness or heaviness) in any part of the body.
- Ergots (ergotamine) and caffeine in combination are most effective for migraine lasting more than 48 hours. Side effects: Nausea, vomiting, medication-overuse headaches.
- Preventive or prophylactic medications are for patients with migraine that are recurring on an everyday basis. These medications are to be taken regularly to lessen frequent migraine attacks.
- Hypertensive drugs such as beta-blockers (propranolol, timolol, metoprolol), calcium channel blockers (flunarizine, verapamil, diltiazem) Side effects: Dizziness, headache, fatigue, GI upset, bradycardia. Drug interactions: Beta-adrenergic blocking agents, other cardiovascular drugs (cardiac glycosides, calcium channel blockers), alcohol, hypnotic drugs.
- Anti-seizure drugs (gabapentin, divalproex sodium/sodium valproate, topiramate) Side effects: Sleepiness, dizziness, fatigue, visual disturbances, nausea, vomiting, headache, viral infection, diarrhea, abdominal pain, thinking disorder. Drug interactions: Other anti-seizure drugs, antidepressants, phenytoin, alcohol, carbamazepine, warfarin, aspirin.
- Antidepressants (sertraline, paroxetine, fluoxetine) Precaution: Patients w/ renal or hepatic impairment. Cognitive and motor interferences, low sodium concentration in blood, bipolar depression and risk of suicide. Side effects: Headache, vomiting, abdominal pain, disturbance in blood pressure, sexual dysfunction in males, diarrhea, dry mouth, hot flushes.