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What are Migraines?
Migraine is a biologically based disorder. Its symptoms are the result of changes in the brain, not a weakness in character or an inappropriate reaction to stress. For many years, scientists believed migraines were linked to the dilation and constriction of blood vessels in the head. They now believe migraine is caused by inherited abnormalities in certain cells in the brain. People with migraine have an enduring predisposition to attacks triggered by a range of factors. Specific, abnormal genes have been identified for some forms of migraine.
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People who get migraine headaches appear to have special sensitivities to various triggers, such as bright lights, odors, stress, weather changes or certain foods and beverages.If you get a migraine, you may experience an aura 10 to 30 minutes before the attack. An aura may cause the sensation of seeing flashing lights or zigzag lines, or you may temporarily lose vision. Other classic symptoms include speech difficulty, weakness of an arm or leg, tingling of the face or hands and confusion. About 20 percent of migraine victims experience an aura prior to an attack. Even if you don’t have an aura, you may experience a variety of vague symptoms beforehand, including mental fuzziness, mood changes, fatigue and unusual retention of fluids.
The pain of a migraine is described as intense, throbbing or pounding and is felt in the forehead, temple, ear, and jaw, around the eye or over the entire head. It may include nausea and vomiting, and can last a few hours, a day, or even up to three or four days.
Migraines can strike as often as several times a week, or as rarely as once every few years. Some women experience migraines at predictable times–near the time that menstruation begins or every Saturday morning after a stressful workweek.
In addition migraine can take several other forms:
Hemiplegic migraine: Patients with hemiplegic migraine have temporary paralysis on one side of the body, a condition known as hemiplegia. Some people may experience vision problems and vertigo-a feeling that the world is spinning. These symptoms begin 10 to 90 minutes before the onset of headache pain.
Ophthalmoplegic migraine: In ophthalmoplegic migraine, the pain is around the eye and is associated with a droopy eyelid, double vision and other sight problems.
Basilar artery migraine: Basilar artery migraine involves a disturbance of a major brain artery. Preheadache symptoms include vertigo, double vision and poor muscular coordination. This type of migraine occurs primarily in adolescent and young adult women and is often associated with the menstrual cycle.
Status migrainosus: This is a rare and severe type of migraine that can last 72 hours or longer. The pain and nausea are so intense sufferers often must be hospitalized. The use of certain drugs can trigger status migrainosus. Neurologists report that many of their status migrainosus patients were depressed and anxious before they experienced headache attacks.
Headache-free migraine: This type is characterized by such migraine symptoms as visual problems, nausea, vomiting, constipation or diarrhea. Patients, however, do not experience head pain. Headache specialists have suggested that unexplained pain in a particular part of the body, fever and dizziness could also be possible types of headache-free migraine.
Because migraine headaches are believed to have a genetic component, it might help your doctor in making a diagnosis to review your family history even if you are not aware that a relative suffered from migraines, consider information you may know about, such as past illnesses and lifestyles. Keep in mind that the term “migraine” was not used much until the 1950s, and even then many migraines were not diagnosed or referred to as “migraines.”
Migraines may be induced by triggers, with some reporting it as an influence in a minority of cases and others the majority. Many things have been labeled as triggers, however the strength and significance of these relationships are uncertain. A trigger may be encountered up to 24 hours prior to the onset of symptoms.
Common triggers quoted are stress, hunger, and fatigue (these equally contribute to tension headaches). Migraines are more likely to occur around menstruation. Other hormonal influences, such as menarche, oral contraceptive use, pregnancy, perimenopause, and menopause, also play a role. These hormonal influences seem to play a greater role in migraine without aura. Migraines typically do not occur during the second and third trimesters or following menopause.
Reviews of dietary triggers have found that evidence mostly relies on self-reports and is not rigorous enough to prove or disprove any particular triggers. Regarding specific agents there does not appear to be evidence for an effect of tyramine on migraine, and while monosodium glutamate (MSG) is frequently reported as a dietary trigger, evidence does not consistently support this.
A review on potential triggers in the indoor and outdoor environment concluded the overall evidence was of poor quality, but nevertheless suggested people with migraines take some preventive measures related to indoor air quality and lighting.
Migraines are believed to be a neurovascular disorder with evidence supporting its mechanisms starting within the brain and then spreading to the blood vessels. Some researchers feel neuronal mechanisms play a greater role, while others feel blood vessels play the key role. Others feel both are likely important. High levels of the neurotransmitter serotonin, also known as 5-hydroxytryptamine, are believed to be involved.
Cortical spreading depression, or spreading depression according to Leão, is bursts of neuronal activity followed by a period of inactivity, which is seen in those with migraines with an aura. There are a number of explanations for its occurrence including activation of NMDA receptors leading to calcium entering the cell. After the burst of activity the blood flow to the cerebral cortex in the area affected is decreased for two to six hours. It is believed that when depolarization travels down the underside of the brain, nerves that sense pain in the head and neck are triggered.
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The exact mechanism of the head pain which occurs during a migraine is unknown. Some evidence supports a primary role for central nervous system structures (such as the brainstem and diencephalon) while other data support the role of peripheral activation (such as via the sensory nerves that surround blood vessels of the head and neck). The potential candidate vessels include dural arteries, pial arteries and extracranial arteries such as those of the scalp. The role of vasodilatation of the extracranial arteries, in particular, is believed to be significant
The diagnosis of a migraine is based on signs and symptoms. Neuroimaging tests are not necessary to diagnose migraine, but may be used to find other causes of headaches in those whose examination and history do not confirm a migraine diagnosis. It is believed that a substantial number of people with the condition remain undiagnosed.
The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the “5, 4, 3, 2, 1 criteria”:
*Five or more attacks—for migraine with aura, two attacks are sufficient for diagnosis.
*Four hours to three days in duration
*Two or more of the following:
*Unilateral (affecting half the head);
“Moderate or severe pain intensity”;
“Aggravation by or causing avoidance of routine physical activity”
*One or more of the following:
*Nausea and/or vomiting;
*Sensitivity to both light (photophobia) and sound (phonophobia)
If someone experiences two of the following: photophobia, nausea, or inability to work or study for a day, the diagnosis is more likely. In those with four out of five of the following: pulsating headache, duration of 4–72 hours, pain on one side of the head, nausea, or symptoms that interfere with the person’s life, the probability that this is a migraine is 92%. In those with fewer than three of these symptoms the probability is 17%
When checking family history these questions are to be asked:
- When growing up, do you recall a family member who was sick much of the time?
- If so, did he/she exhibit any of the following symptoms: head pain that interfered with daily activities, nausea or vomiting, sensitivity to light or sound, numbness or speech difficulty?
- To what did he or she attribute symptoms of their headache: menstrual cycle, over-work, fatigue, stress or something eaten or drunk?
- Be prepared to discuss with your health care professional both the symptoms of relatives’ headaches and their methods for coping.Diagnosing a headache relies on ruling out other problems, such as tumors or strokes. Experts agree that a detailed question-and-answer session with a patient can often produce enough information for a diagnosis. Some women have headaches that fall into an easily recognizable pattern, while others require further testing to determine if symptoms are due to secondary causes such as dental pain, hemorrhage or tumor.You may be asked:
- How often do you have headaches?
- Where is the pain?
- How long do the headaches last?
- When did you first develop headaches?
Your sleep habits and family and work situations may also be discussed.
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Main article: ICHD classification and diagnosis of migraine
Migraines were first comprehensively classified in 1988. The International Headache Society most recently updated their classification of headaches in 2004. According to this classification migraines are primary headaches along with tension-type headaches and cluster headaches, among others.
Migraines are divided into seven subclasses (some of which include further subdivisions):
*Migraine without aura, or “common migraine”, involves migraine headaches that are not accompanied by an aura
*Migraine with aura, or “classic migraine”, usually involves migraine headaches accompanied by an aura. Less commonly, an aura can occur without a headache, or with a nonmigraine headache. Two other varieties are familial hemiplegic migraine and sporadic hemiplegic migraine, in which a person has migraines with aura and with accompanying motor weakness. If a close relative has had the same condition, it is called “familial”, otherwise it is called “sporadic”. Another variety is basilar-type migraine, where a headache and aura are accompanied by difficulty speaking, world spinning, ringing in ears, or a number of other brainstem-related symptoms, but not motor weakness. This type was initially believed to be due to spasms of the basilar artery, the artery that supplies the brainstem.
*Childhood periodic syndromes that are commonly precursors of migraine include cyclical vomiting (occasional intense periods of vomiting), abdominal migraine (abdominal pain, usually accompanied by nausea), and benign paroxysmal vertigo of childhood (occasional attacks of vertigo).
*Retinal migraine involves migraine headaches accompanied by visual disturbances or even temporary blindness in one eye.
*Complications of migraine describe migraine headaches and/or auras that are unusually long or unusually frequent, or associated with a seizure or brain lesion.
*Probable migraine describes conditions that have some characteristics of migraines, but where there is not enough evidence to diagnose it as a migraine with certainty (in the presence of concurrent medication overuse).
*Chronic migraine is a complication of migraines, and is a headache that fulfills diagnostic criteria for migraine headache and occurs for a greater time interval. Specifically, greater or equal to 15 days/month for longer than 3 months.
The diagnosis of abdominal migraines is controversial. Some evidence indicates that recurrent episodes of abdominal pain in the absence of a headache may be a type of migraine or are at least a precursor to migraines. These episodes of pain may or may not follow a migraine-like prodrome and typically last minutes to hours. They often occur in those with either a personal or family history of typical migraines. Other syndromes that are believed to be precursors include cyclical vomiting syndrome and benign paroxysmal vertigo of childhood.
Other conditions that can cause similar symptoms to a migraine headache include temporal arteritis, cluster headaches, acute glaucoma, meningitis and subarachnoid hemorrhage. Temporal arteritis typically occurs in people over 50 years old and presents with tenderness over the temple, cluster headaches presents with one-sided nose stuffiness, tears and severe pain around the orbits, acute glaucoma is associated with vision problems, meningitis with fevers, and subaracchnoid hemorrhage with a very fast onset. Tension headaches typically occur on both sides, are not pounding, and are less disabling.
Those with stable headaches which meet criteria for migraines should not receive neuroimaging to look for other intracranial disease. This requires that other concerning findings such as papilledema (swelling of the optic disc) are not present. People with migraines are not at an increased risk of having another cause for severe headaches.
Preventive migraine medications are considered effective if they reduce the frequency or severity of the migraine attacks by at least 50%. Guidelines are fairly consistent in rating topiramate, divalproex/sodium valproate, propranolol, and metoprolol as having the highest level of evidence for first-line use. Recommendations regarding effectiveness varied however for gabapentin. Timolol is also effective for migraine prevention and in reducing migraine attack frequency and severity, while frovatriptan is effective for prevention of menstrual migraine.
Amitriptyline and venlafaxine are probably also effective. Angiotensin inhibition by either an angiotensin-converting enzyme inhibitor or angiotensin II receptor antagonist may reduce attacks. Botox has been found to be useful in those with chronic migraines but not those with episodic ones
While acupuncture may be effective, “true” acupuncture is not more efficient than sham acupuncture, a practice where needles are placed randomly. Both have a possibility of being more effective than routine care, with fewer adverse effects than preventative medications. Chiropractic manipulation, physiotherapy, massage and relaxation might be as effective as propranolol or topiramate in the prevention of migraine headaches; however, the research had some problems with methodology. The evidence to support spinal manipulation is poor and insufficient to support its use. Of the alternative medicines, butterbur has the best evidence for its use.
Some Herbal Medicines for Migraine:
1. Betel leaves can be applied with beneficial results over the painful area to releave intense headache.
2. Seeds of bishop’s weed (ajwaine) are useful in the treatment of migraine. They should either be smoked or sniffed frequently to obtain relief.
3. A paste of clove and salt crysrals in the milk is a common household remedy for the headache.
4. Ginger oinment made by rubbing dry ginger with a little water on a grinding stone should be applied to the forehead.
5. Henna (mehndi) flowers cure headachs caused by the heat of the sun.Headache is relieved by a plaster made of henna flowers in vinegar and applied over the forehead.
One may try this Magic Drink to stop headache instantly:
All you need is lemon juice and salt. Not many people know of this remedy, but it can be used by anyone with a migraine. You need high-quality salt, like Himalayan salt. Himalayan salt contains about 84 healthy elements. Salt increases the levels of serotonin in the blood, which will save you from headaches.
Get fresh lemons and squeeze the juice out of the lemons and add about 2 teaspoons of salt to the juice. Stir this mixture and then add water.
When the water has been added you can drink it immediately. You must drink the whole thing in order for it to work, don’t sip on it. It may not taste too great, but it will definitely get rid of your migraine.
Devices and surgery:
Medical devices, such as biofeedback and neurostimulators, have some advantages in migraine prevention, mainly when common anti-migraine medications are contraindicated or in case of medication overuse. Biofeedback helps people be conscious of some physiological parameters so as to control them and try to relax and may be efficient for migraine treatment. Neurostimulation uses implantable neurostimulators similar to pacemakers for the treatment of intractable chronic migraines with encouraging results for severe cases. A transcutaneous electrical nerve stimulation device is approved in the United States for the prevention of migraines. Migraine surgery, which involves decompression of certain nerves around the head and neck, may be an option in certain people who do not improve with medications
Preventive treatments of migraines include medications, nutritional supplements, lifestyle alterations, and surgery. Prevention is recommended in those who have headaches more than two days a week, cannot tolerate the medications used to treat acute attacks, or those with severe attacks that are not easily controlled.
The goal is to reduce the frequency, painfulness, and/or duration of migraines, and to increase the effectiveness of abortive therapy. Another reason for prevention is to avoid medication overuse headache. This is a common problem and can result in chronic daily headache
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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.