Migraines are moderate or severe headaches that are accompanied by other features such as nausea, and sensitivity to lights, noises, and movement.
There are three main types of migraine:
- Migraine without aura;
- Migraine with aura;
- Chronic migraine (migraine on >15 days/month).
6 million people in the UK suffer from migraine.
Migraine without aura
- The most common form of migraine;
- Typically affects one side of the head only (front or side);
- It is described as throbbing or pulsating;
- Often moderate to severe in intensity;
- Most commonly starts in the morning, but can occur at any time of day or night;
- Frequently associated with symptoms of nausea, vomiting and aversion to bright lights or noise;
- Symptoms typically last 4-72 hours and are often improved by avoiding normal activities.
Migraine with aura
- Patients affected by similar symptoms, but get warning signs before the headache starts, called an aura;
- They typically last between 5-20 minutes before a headache, increasing with intensity over time;
- Visual auras are the most common form. Examples include temporary loss or distortion of vision, and zig-zag lines in vision;
- Other auras include pins and needles, speech and/or language disturbance, and motor problems.
- Often builds up from previous episodic migraines, but occasionally starts all at once as a new daily persistent headache;
- Regular painkillers usually do not work so well;
- Requires preventive treatment and close attention to triggers or exacerbating factors;
- It has major consequences for quality of life, school, work, and social activities.
The cause of migraine is not completely understood. The current theory is that the sensory areas of the brain are impaired resulting in excessive release of signalling molecules close to the blood vessels that supply the head and neck, causing pain, nausea and the other symptoms of migraine. Auras are caused by a wave of overactivity in the visual part of the brain.
Migraine often runs in families. It is more common in women, for reasons that are not entirely clear.
Most migraines occur without any reason; however, some patients may have specific triggers. These may include:
- Diet – caffeine, cheese, alcohol, and citrus fruits;
- Environment – smoking or second-hand smoke, loud noises, and specific smells;
- Medicines – hormone replacement therapy and the oral contraceptive pill;
- Psychological – depression, anxiety, and stress;
- Other – periods (menstruation), sleep deprivation, and the menopause.
There is no test to diagnose migraines. A diagnosis is made through listening to a patient and taking a thorough history and examination.
To help with diagnosis it can sometimes be useful to keep a headache diary, recording:
- Frequency of attacks;
- Activities at time of attack;
- Length of symptoms;
- Symptoms experienced;
- Anything that made the symptoms better or worse.
Migraine can be treated through a combination of medication and self-care. Lifestyle changes and avoiding triggers can help reduce the frequency and severity of attacks.
Medications to treat symptoms are dependent on the severity of attacks, associated symptoms, and other health conditions.
Acute treatment involves either simple painkillers (e.g. aspirin, paracetamol, ibuprofen) and/or a triptan (e.g. sumatriptan).
Clinicians may prescribe preventative medication for patients with a significant reduction in quality of life. First line medications recommended by NICE include propranolol, topiramate, and amitriptyline, though other medications are available (e.g. candesartan, calcium channel blockers, sodium valproate), and Botox is licensed for chronic migraine.
Medicinal cannabis can be considered when first line therapies have not achieved adequate symptom control.
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