Migraine Headaches: Test Your Medical IQ

People often refer to a migraine as if it's a really bad headache. While severe head pain with a migraine is common, migraine is actually a collection of neurological symptoms that can be incapacitating.

Migraine is the 3rd most common illness in the world, and nearly 30 million Americans suffer from migraine symptoms. Migraine most commonly occurs in adults between the ages of 25 and 55, and about 75% of those who have migraines are women.

The exact cause of migraines is unknown but it is believed to result from abnormal activity in the brain. Abnormal changes in certain substances naturally produced by the brain can result in inflammation, causing blood vessels in the brain to swell and press on nearby nerves, causing pain.

Genetics have also been linked to migraines. Certain genes can make some people more sensitive to migraine triggers.

Triggers do not cause migraines, but they make a migraine more likely to occur. Migraine triggers vary from person to person, and each trigger may not result in a migraine every time.

Common triggers of migraine include:

Symptoms of migraine may include:

• Throbbing headache that worsens over several hours and often affects just one side of the head
• Nausea, may be accompanied by vomiting
• Sensitivity to light and noise
• Aura – can happen before or during a migraine and usually lasts a few minutes to an hour (most often about 15 to 30 minutes)
• In most cases aura symptoms affect vision. A person may see flashing lights, bright spots, zig-zag lines, or have partial vision loss
• Other aura symptoms that do not involve vision may include hearing sounds or ringing in their ears, or numbness and tingling of the lips, lower face, and fingers of one hand

Early signs and symptoms of the first stage of migraine called "prodromal" symptoms can happen a few hours to a couple of days before the headache. Most people with migraines experience a prodrome, but they may not experience a prodrome before every migraine attack.

Symptoms that may occur during a migraine prodrome may include yawning, depression, irritability, food cravings, constipation, urge to urinate, sensitivity to light and sound, difficulty concentrating, fatigue, nausea, trouble sleeping, difficulty speaking or reading, muscle stiffness, or a stiff neck.

There are numerous types of migraines, including:

• Common migraine (about 80% of all migraines), which has no "aura."
• Classic migraines (also called migraine with aura) have an aura before the headache and are more severe than common migraines.
• Silent (or acephalgic) migraine occurs without head pain but with aura and other characteristics of migraine.
• Hemiplegic migraine symptoms may mimic a stroke, such as weakness on one side of the body, loss of sensation, or feeling ‘pins and needles.
• Retinal migraine causes temporary vision loss in one eye, and can last from minutes to months. This is often a sign of a more serious condition, and patients should see a doctor if this occurs.
• Chronic migraine lasts for more than 15 days per month.
• Status migrainosus is a constant migraine attack that lasts more than 72 hours.

Over-the-counter (OTC) medications used to treat migraines include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen.

Prescription medications used to relieve the pain of migraine include triptans and narcotic analgesics. Other medications used to treat migraine inclide beta-blockers, calcium channel blockers, ergot derivatives, and antidepressants. Botox injections may also be used to treat migraine.

Erenumab (Aimovig) is a new class of drug called a calcitonin gene-related peptide receptor (CGRP-R) antagonist approved in 2018 for use as a monthy injection used to prevent migraines.

There are numerous lifestyle changes that can help reduce the fequency and severity of migraine attacks.

• Avoid or limit known triggers
• Eating a healthy, balanced diet
• Do not skip meals
• Get regular exercise
• Limit alcohol and caffeine
• Maintain a regular sleep schedule
• Yoga can help with relaxation and pain mangement
• Stress management and relaxation techniques
• Biofeedback
• Acupuncture
• Counseling (especially if migraines may be related to depression or anxiety)

In general, migraines are not associated with strokes. A stroke occurs when a blood vessel in the brain is blocked, leaks, or bursts. Brain cells are starved of oxygen and they start to die. Stroke is a medical emergency. Know the signs of a stroke and act FAST:

• Facial drooping,
• Arm weakness,
• Speech difficulties,
• Time to call 9-1-1