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1.The aura 2.The headache phase 3.Post headache


The word "migraine" comes from words meaning "half the head", and sounds like "demi-cranium", because migraine headaches often hurt on only the left or right side of the head. However, many people with migraines always have pain on the whole head.

A migraine headache is caused by hormonal fluctuations which cause blood vessels in the head and neck to contract and then dilate. The first phase, or contraction phase, may last minutes, hours, or days. During this phase, symptoms can be spots in front of the eyes, difficulty concentrating, and cold fingertips and hands. This is called an "aura". Many people recognize this phase of their headaches; many others don't notice any symptoms at this time. Some people who think they don't have an "aura" can learn to recognize it.

When the blood vessels dilate, the headache pain starts. Apparently the hormones over-react. Instead of just going from a contracted state back to normal, the blood vessels dilate much wider than normal, causing pain. Other things also happen about the same time: swelling of the brain, release of certain chemicals, and perhaps muscle tension. These things add to the pain.

What is Migraine?

  • Migraine is one of the most common diseases of the nervous system. In developed countries migraine affects about 10-15% of people.
  • A migraine is a type of headache that usually happens in episodes or "attacks".
  • It may feel like it is throbbing or pulsating and may be located on one side of the head.
  • The pain may be accompanied by nausea, vomiting, and sensitivity to light or sound. It may be so severe that the patient has to lie down in a darkened room and wait for it to pass.
  • Some migraine sufferers have a warning 'aura', lasting up to 1 hour before the headache starts, which often causes problems with eyesight; for example, flashing lights, zig-zag lines and blank spots when trying to concentrate on something. Such attacks preceded by an aura are called ‘classical’ and account for about only 20% of migraines.
  • Migraines without aura are called ‘common’ and account for about 80% of migraine attacks.
  • Some people also suffer from other warning symptoms, such as numbness or tingling on one side of the face, around the mouth or down one arm.
  • There are also other types of migraine that are less common than the ones described above.

Causes of Migraine

  • Migraine can be triggered by many different things, including stress, exercise, certain foods, bright lights, flickering lights, loud noises, strong smells, lack of sleep or too much sleep.
  • In women, attacks may be triggered by hormonal changes, for example during menstruation (periods).
  • One theory of how migraine causes headache is that some of the nerves in the head that provide sensation from the face become overactive, causing blood vessels adjacent to the nerves to become slightly leaky and the lining of the brain in the vicinity to become mildly inflamed. As the linings of the brain are pain sensitive, headache occurs. After a while, the inflammation goes away and the headache resolves.

Typical Symptoms of Migraine

Prior to a migraine, sufferers often notice warning signals that an episode is on the way. About 40% of sufferers notice certain cravings or lethargy a day or two in advance. They are then able to take action to try to head off the attack. Other sufferers experience sensory symptoms – known as the ‘aura’ - usually in the hour preceding the headache.

The aura

  • Visual disturbances – wavy lines, flashing lights, blind spots (scotoma)
  • Dizziness
  • Numbness
  • Slurred or muddled speech
  • Nausea or vomiting
  • Diarrhoea

The headache phase

  • Thumping or throbbing headache
  • Pain on one side (may swap sides)
  • Pain in the sinuses or neck
  • Dehydration, thirst
  • Sensitivity to light (photophobia), noise (phonophobia) and smell (osmophobia)
  • Cold sensation
  • Pins and needles
  • Temporary numbness on the affected side
  • Inability to think clearly or perform normal activities
  • Loss of concentration
  • Lack of co-ordination

Post headache

  • A feeling of being ‘washed-out’
  • Fatigue
  • Poor concentration
  • Either lethargic or full of energy and revitalised

Acute (Symptomatic) Migraine Treatment

Many types of acute treatment are available for migraine. The choice of treatment will generally depend on the severity and frequency of the headaches, the degree of headache-related disability, associated symptoms, other illnesses, the patient’s medication history and any personal preferences.

Listed below are the most common acute medications for migraine. This list is not exhaustive and patients should always consult their physician to ensure that they receive the most appropriate treatment for their migraine.

  • Simple analgesics, combination analgesics and NSAIDs
  • Analgesics reduce the perception of pain by raising the pain threshold. They do not alter the cause of the pain, but simply mask the feeling of pain. Simple analgesics, such as aspirin or paracetamol (acetaminophen), can be effective in patients with mild-to-moderate and infrequent migraines. These agents are thought to be most effective when taken early in the onset of migraine. Overuse of these analgesics may lead to rebound headache.
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are also often prescribed for the acute treatment of mild-to-moderate migraine attacks.
  • When simple analgesics or NSAIDs fail to provide relief, doctors may choose to prescribe certain combination products. Caffeine and codeine, for example, are often combined with simple analgesics and/or NSAIDs.

Preventive (Prophylactic) Therapy

Prophylactic medications are taken daily to prevent or reduce the number of migraine attacks. Prophylactic therapy may be recommended:-

1.When acute therapy alone has failed to control the symptoms; 2.In patients who experience three or more attacks per month; and 3.In patients whose migraines are predictable.

Patients with infrequent, but severely incapacitating headaches may also be appropriate candidates for prophylactic therapy, particularly if the headaches are poorly controlled with symptomatic therapy.

Some of the more common types of medication used for preventive migraine treatment include antidepressants, anticonvulsants, beta-blockers, calcium channel blockers.

For Immediate Relief

Most of the treatments in this FAQ are used to prevent migraines from happening. This section describes things you can do when you're in pain, to reduce the pain.

  • Have a bath or shower.
  • Lie down to rest in a dark room.
  • Avoid bright or flashing light.
  • Put something cold on the back of your neck, such as a cold, wet cloth; or alternate hot and cold cloths where the pain is.
  • Put a cold compress on your forehead and your feet in a container of warm water.
  • Have a drink of water or natural juice, especially tomato juice.
  • Have some food, or a nutritious drink, if you haven't eaten for a while.
  • Massage your own face, head, neck and shoulders, or get someone else to do those and your back. Relax your muscles.
  • Press on two pressure points at the back of the neck. These points are about two inches apart, just below the base of the skull. Press for a minute or two. This releases endorphins that help against pain.
  • Massage or press on the fleshy area between thumb and forefinger.
  • Gently lean the head to left or right to stretch the neck muscles. Massage and relax any tense muscles.
  • Avoid sources of stress. Cancel activities so there's less to worry about.
  • Avoid exercise during a headache if it makes throbbing pain in the head and neck worse. On the other hand, generally exercise improves health, and it may help you relax during a headache.
  • Take some niacin (a form of vitamin B3). Taking enough niacin to cause a flush (blood rushing to the skin) can provide relief from headache pain, but this much niacin can also have side effects (flush, nausea, heartburn, liver damage, etc.) Niacinamide doesn't have such bad side effects, but isn't as much use against migraines, either. Smaller, safer amounts of niacin are also helpful. Niacin can trigger a migraine, though.
  • Take some vitamin C, vitamin B6, choline, tryptophan and niacin and/or magnesium.


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