Migraine Headaches

How many times have you heard someone say,” I had a migraine”, or “My migraines are getting worse by the day” or even, “I wish there was a cure for these blasted migraine headaches”? As a rough guess all of us know at least one friend, parent, relative or cousin who suffers from migraine headaches, perhaps even more than one.

So what exactly are migraine headaches?

Migraine headaches are typical headaches that can last for anywhere between a couple of hours to a couple of days. People who suffer from migraine headaches experience pain in a characteristic pattern around the head. Some patients also have additional symptoms like vomiting, seeing strange visual patterns, changes in hearing and sensitivity to light and sound. Migraine episodes that have either or all of these additional symptoms are known as migraines with ‘aura’. In addition to migraines with and without aura, doctors have defined some other categories of migraine headaches as well. These are:

Episodic Migraine

If a person suffers from migraine headaches upto 14 instances per month, the migraines are said to be episodic migraines.

Chronic Migraine

If the number of migraine headache days is between 15-30, for  a duration of 3 months or more, physicians consider it to be chronic migraine. In addition to the increased number of days, at least 8 migraines should be without aura. Another criterion that doctors check is to see if the patient has had a history of migraine attacks without overusing any medication. The person should also not have any other major health problem that could cause headaches. If these checkpoints are ticked in the patient assessment, then this type of migraine is called as chronic migraine.

Pediatric Migraine

Children are not spared the headaches, either. Estimates suggest that about 3.5-5% of kids can suffer from migraine headaches. Diagnosis of migraine in children is not as easy as it is in adults. However, there are some signs and symptoms that can indicate migraine in children. Some children may have cyclical vomiting episodes. Kids might experience nausea followed by vomiting which can make them pale and lethargic. These symptoms can disappear between episodes. Some kids may suffer from bouts of Abdominal migraine. Abdominal migraine involves moderate-to-severe intensity pain in the stomach that can last for anywhere between 1-72 hours. Some kids may also vomit or report nausea during the stomach migraine attack. In addition to these stomach-related symptoms, another sign of childhood migraine is vertigo. If your child reports feeling giddy and there are no other obvious causes of giddiness, then it is likely that your kids may suffer from pediatric migraine. Usually, the giddiness goes away without medication.

What causes Migraine headaches?

The causes of migraine headaches are a hotly debated area. The jury is still out on whether there is one single cause of migraine headaches or not.  Typically, migraines is a disorder of altered vascular and or neuronal activity in brain  There is a large number of ‘triggers’ reported by migraine patients. Sometimes, some foods or some smells can set off a migraine attack. It is quite likely that multiple mechanisms related to the blood circulatory system and brain cells are involved in causing migraine headaches.

The earliest theory for the incidence of migraine headaches was proposed by Graham and Wolff in 1993. These doctors proposed that migraines start because of a sudden narrowing of blood vessels in one area of the brain. The lack of blood supply creates stress in a region of the brain which is responsible for the ‘aura’ phase of migraine. Eventually, these blood vessels expand a little more than normal to compensate for the narrowing. When that happens, the extra pressure on the blood vessels causes headache that lasts for a few hours.

Another theory for migraines is that the headaches can be caused by abnormal activity of brain cells.

A third theory is that migraine triggers cause a temporary abnormality in the activity of brain cells in the hind part of the brain. This pattern of abnormal brain cell activity then spreads to the rest of the brain as a wave. The abnormality is known as cortical depression, which essentially means that the nerve cells that are affected stop communicating properly with other nerves, for a short while. This wave of depression spreads to other areas of the brain and cause the pain and aura that are part of a migraine attack. When the brain cells regain their normal state, blood flow in the brain is also restored

Stages / Phases of Migraines

In order to understand migraine headaches, it is important to identify each stage of the episode. Take a look at this diagram, below. Each incident of a migraine headache is divided into four phases:

  1. Prodrome
  2. Aura
  3. Headache
  4. Postdrome

The Prodrome phase can begin 24 hours before the migraine episode starts. In contrast to the pain that follows, people can experience intense euphoria in this phase. Some people may also experience other emotional states like irritability and change in sensations. Sometimes people might experience local weakness in limbs as well.

In the Aura phase, migraine sufferers can experience heightened sensitivity to sound and light. Sometimes people visualise strange patterns or temporarily lose partial vision as well.

The Headache phase is usually the longest phase of a migraine episode. People report experience of pulsating or   throbbing headache that can last for 3-72 hours. Pain is typically experienced in the region of the head above the eyes but can also occur in other parts of the head as well. The sensations of pain might increase if a person leans forward.

In the Postdromal phase, people are likely to feel tired or sluggish owing to the intensity of the headache.Occasionally, people have reported feeling confused in this phase, as well.

The symptoms and features of a migraine attack vary from person-to-person and hence a subjective judgment of each person’s migraine is required. Characteristics of migraine episodes are likely to change over time as well. Ironically, it is like a personalised ‘signature’ headache!

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