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What is Migraine?

Migraine is the second most common form of headache after tension headaches. Migraines are characterised by recurring unilateral attacks that can last from four to 72 hours. Women are three times as likely to suffer from migraine as men, a fact indicating that hormones may also play a role. According to Headache UK, more than 10 million people suffer regularly from migraine or other headache, which is the cause of 20% of workplace absenteeism. Migraines can start at any age; however, it most commonly develops in childhood, adolescence or young adulthood. The NHS Clinical Knowledge Summaries states that 90% of migraine sufferers have their first attack before the age of 40.

Migraines and their frequency, intensity, duration and symptoms are experienced differently; some people may only have moderate pain and discomfort, while for others the condition can be debilitating. Some people only get migraine attacks once every few years, yet others suffer an attack once a week.

Types of Migraine and Symptoms

There are two main types of migraine: migraine without aura (sometimes called common migraines) and migraine with aura (sometimes called classic migraine).

Migraine without Aura

Most people experience migraine without aura and an attack can last four hours to three days. The headaches associated with this type of migraine usually affect one side of the head with a throbbing or pulsating pain. The pain can be moderate to severe and usually gets worse with physical activity. Nausea, with or without vomiting, is also a common symptom. People who experience migraine without aura have increased sensitivity to light, sound or smell.

Migraine with Aura

Some people experience migraine with aura - warning signs that precede a migraine attack. These signals can be visual, such as seeing flashes of light, blind spots, blurred vision and seeing stars and zigzag patterns. They can also have physical manifestations including a tingling sensation in the neck, shoulder, arm or leg. Sensitivity to light, sound and smell, vertigo, loss of coordination, disorientation, difficulty speaking and in rare cases partial paralysis on one side of the body and loss of consciousness may also be experienced. Aura symptoms tend to begin 15 minutes to one hour before the onset of headache but some people can get auras with only a mild headache.

People who suffer from migraine, with our without aura, may also experience prodromal symptoms - feelings of premonition that indicate the onset of a migraine attack. These can occur several hours or even days before a migraine attack and include:

• Fatigue
• Mood changes - feelings of euphoria or irritability and depression
• Stiff neck
• Dizziness or drowsiness
• Lack of appetite or food cravings
• Diarrhoea or constipation
• Fluid retention
• Thirst
• Frequent urination

What causes Migraine?

Though there are theories about the causes of migraines, the exact mechanisms are still unknown. Most people suffering from migraine have a hereditary disposition; if one or both parents have migraine, the likelihood of a child having the condition is very high. Also, there seems to be a link between migraine and obesity. Most studies have attempted to explain migraines in terms of one particular causative factor and have failed to provide an explanation for the complexity of the symptoms and clinical observations. It's likely that a combination of factors result in a particular set of symptoms. These input factors include chronic inflammation in trigger points in muscles, emotional stimuli triggering the limbic system (part of the brain) to increase muscle contractions, and neurotransmitters like serotonin and others that affect the contraction/dilation of blood vessels and other tissues in the brain (vascular system input), causing them to become inflamed and swollen, resulting in a headache.

Serotonin (5-HT) is a neurotransmitter (message-sending) that controls mood and appetite, among other things. Serotonin is a vasoconstrictor (contraction and narrowing of blood vessels). It appears that just before a migraine attack, levels of serotonin increase rapidly, causing the constriction of the brain's blood vessels and a reduction in blood flow. This can result in aura symptoms. The constriction of blood vessels and reduced blood flow may provoke or irritate the trigeminovascular nerve and when a drop in serotonin level follows, the blood vessels dilate (widen) and resulting in inflammation around the blood vessels, which leads to a headache.

A theory is that the sum of the vascular system input plus the input from trigger points and emotional stimuli determines whether or not pain is a symptom, and if so, how intense the pain is. This could explain how some people can have trigger points or experience emotional duress without having headaches or migraines, while others get severe headaches. In the UK, migraines affect one in four women and one in 12 men, which suggests that hormones play a role. Fluctuations in estrogen (menstruation, pregnancy, menopause and use of oral contraceptives and hormone replacement therapy) lead to migraine in many women.

There are also many factors that may trigger migraine including:

• Diet - dieting, missed or irregular meals. Certain foods such as chocolate, alcohol, caffeine, monosodium glutamate, cheese, salt and aspartame are known migraine triggers
• Stress, anxiety or depression
• Lack of sleep
• Poor posture
• Environmental influences - bright or flickering lights, loud sounds, strong smells, cigarette smoke or changes in weather
• Intense exercise
• Medications - oral contraceptives, hormone replacement therapy, some sleeping pills

How is Migraine Diagnosed?

A medical history and physical examination (vision, coordination and reflexes) in most cases is sufficient to diagnose migraine. Atypical symptoms like sudden severe headache, fever, headache after an injury, rash, seizures, mental confusion and trouble speaking may need diagnostic tests, such as CT scan, MRI or a spinal tap to rule out underlying brain disorders or medical conditions.

What are the treatments for migraine?

Conventional migraine treatments

• Pain killers: Over-the-counter (OTC) analgesics, such as paracetamol or acetaminophen and aspirin are taken by people with moderate pain, but many don't find them effective for their migraine. Excessive and prolonged use of paracetamol can cause side effects that include stomach pain and bleeding, vomiting and liver damage, and even death due to liver failure, especially when taken with alcoholic drinks. Paracetamol is the most common cause of severe liver damage and liver failure today. Stronger, prescription medications called triptans are used by some people but these have more side effects than OTC painkillers
• NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen are also used to treat migraine. However, long-term use of NSAIDs can lead to unpleasant side effects such as digestive tract problems (ulcers, bleeding, heartburn, nausea and bloating); fluid retention and swelling; cardiovascular problems (heart attack, blood clots and stroke); and liver and kidney damage
• Anti-nausea medications: Because nausea often presents itself with migraine, anti-nausea medications are commonly prescribed
• Prevention medications: These are taken to prevent migraine and include:
  • Anti-depressants
  • Beta-blockers (cardiovascular drugs)
  • Anti-seizure medications
  • Serotonin agonists
  • Botox
• Side effects of these medications:
  According to "Physicians' Desk Reference lists" the following adverse reactions (side effects) to these drugs may include:
  • Manic reaction
  • Abnormal thinking
  • Hallucinations
  • Personality disorders
  • Amnesia
  • Agitation
  • Psychosis
  • Abnormal dreams
  • Emotional liability (or instability)
  • Hostility
  • Paranoid reactions
  • Confusion
  • Sleep disorders
  • Severe inner restlessness
  • Discontinuation (withdrawal) syndrome

Natural Alternatives for Migraine

• Dietary supplements: Anti-inflammatory and antioxidant nutrients, such as chondroitin, glucosamine, ginger root, methylsulfonylmethane (MSM), coenzyme Q10 and magnesium help to combat the associated chronic inflammation that often is involved as one of the causes of migraine and may reduce the frequency and severity of migraine attacks
• Medical Acupuncture: In combination with nutritional supplements, medical acupuncture is a very effective and side effect-free treatment. The reason for the effect of acupuncture may involve regulation of neurotransmitter levels, anti-inflammatory effect, production of endorphins and cortisone as well as a direct neuromodulatory effect in the relevant segments etc. According to a World Health Organization (WHO) consensus report, medical acupuncture of relevant trigger points is an effective treatment of migraine

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