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Migraines 101: Symptoms, Causes and Treatments

Migraines 101: Symptoms, Causes and Treatments

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If you are one of the 1 billion people with migraines, you may know how uncomfortable a migraine attack can be. If you are not, how does it feel to be one of God’s favourites?! 

Keep reading to find out the answer to that 😉

Here's what a migraine feels like:

Most people describe it as a pulsating, pounding, dull ache that spreads across their forehead. You can feel the pain on one side of your head or both sides. Sometimes you can even feel it shift. 

What causes a migraine attack?

The direct causes of migraines have still not been identified. However, researchers believe that ‘abnormal’ brain activity affecting nerve signalling, blood vessels and chemicals are the root cause of migraines. Researchers have identified the following as significant triggers for migraines:

  • Severe heat
  • Dehydration
  • Bright lights
  • Unusual smells
  • Hormonal changes in women (oestrogen and progesterone fluctuations) during menstruation, pregnancy or menopause
  • Changes in sleep pattern

Hereditary history of migraines and being a female are some risk factors for developing migraine conditions.

causes of migraine attacks

How does a migraine attack arise?

Stages of migraine

Let’s learn about the process of how a migraine attack occurs and its respective symptoms.

  1. Prodrome Phase

This is the initial stage of a migraine. Usually occurring around 1-2 days before the migraine attack or any other headaches related to it, here are some prodrome symptoms:

  • Food cravings
  • Neck stiffness
  • Depression
  • Fatigue
  1. Attack Phase

It is during this phase that people have reported extremely uncomfortable sensations. The pain typically begins above your eyes and might spread over to one side of your head, your entire head or shift from side to side. Throbbing in the head may worsen if you exert yourself or move.

Other notable symptoms to look out for during the migraine attack phase include:

  • Increased sensitivity to light and sound
  • Nausea
  • Feeling faint

The symptoms of a migraine attack could last between several hours to two days, depending on the patient.

  1. Postdrome Phase

The migraine attack is followed by the postdrome phase. You may feel sick for up to a day. You may also experience:

  • Extreme tiredness
  • Pain in the head  that increases when you move too quickly or lean over
  • Confusion

You must gain sufficient rest after experiencing a migraine attack to recover effectively.

Now that we have broken down each stage of a migraine, did you also know there are different types of migraines, each with varied symptoms? Keep scrolling to find out more

Different types of migraines that exist

There are two common types of migraines: 

  • Migraine with aura
  • Migraine without aura

Along with the previously mentioned symptoms of a migraine, a person might experience either a migraine with an aura or a migraine without an aura.

Aura? What’s that?

It may sound like a pretty word but, it’s not a comfortable sensation. Aura is a condition that involves minor impairments to your vision, senses and speech for a period of time. Common signs involve blurry vision, coloured spots, neck stiffness, inability to hold your balance, difficulty speaking or forming words.

1. Migraine with aura (Brainstem Aura)

A person who experiences a migraine with brainstem aura would experience pain at the back of the head on both sides. They would face the following symptoms before the main migraine attack happens.

                                        Aura symptoms

  • An aura with visual problems
  • Numbness of body, face and tongue
  • Speech problems
  • Problems with moving

                                     Brainstem symptoms

  • Difficulty talking (unclear speech)
  • Vertigo (a spinning feeling)
  • Ringing in the ears
  • Eye problems in one eye (blind spots, flashes of light, temporary blindness, etc.)

2. Migraine without aura

Although, others may not experience an aura before their migraine attack or headaches. The following are some symptoms of a migraine without aura.

  • Migraine occurs only on one side of the head 
  • Throbbing/pulsating pain in the head
  • Pain gets more intense as you move (Eg: Walking)
  • Becoming sensitive to light
  • Becoming sensitive to sound
  • Nausea with or without vomiting

Treatment and tips for managing migraines

But wait! There’s some good news. Although migraine is not something that can be cured, you can still manage and control migraines from occurring through the following methods. As a result, it may lead to fewer attacks.

  • Adjustments to your lifestyle

You must ensure that you minimise or avoid any migraine triggers mentioned above. Along with this, managing your stress would also help you reduce the intensity of migraines.

  • Keep a journal

Maintaining a journal to list the instances you face migraine symptoms and attacks will help identify your triggers. This will allow you to avoid events and circumstances that trigger these symptoms.

  • Apply a cold compress on your forehead

This method slows down the nerve signals involved with migraine pain and generates a soothing, cool feeling that can help reduce the severe headache.

  • OTC pain or migraine medications

These medications include Nonsteroidal anti-inflammatory drugs (NSAIDs), Paracetamol, etc. These would reduce the intensity of migraine headaches and attacks. It is advisable to consult a doctor and receive a prescription before taking these medications.

  • Stay hydrated

Often when we are out in an environment with severe heat, we may forget to keep ourselves hydrated. Dehydration is a main trigger of migraine attacks. Therefore, ensuring an adequate intake of fluids will rule out the possibility of dizziness and headaches associated with dehydration.

Did any of the above symptoms and triggers sound familiar to you?  Feel like you’ve experienced them? If you have, it is possible that the ‘really bad headache’  you experienced was actually a migraine attack. Consulting a doctor about these symptoms may help diagnosis and treatment of your ailment. .

Consult a GP via the oDoc app to receive expert medical advice on reducing the highly uncomfortable symptoms of migraines and improving your well-being.

Sources

  1. Everything You Want To Know About Migraine, Healthline (2021)
  2. Migraine with brainstem aura, Genetic and Rare Diseases Information Center (2022)
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Management Of Common Headache Disorders In Adults

Management Of Common Headache Disorders In Adults

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    Written by Dr. Namal Lasantha Ulluvisheva

Headache is a common medical condition worldwide. Physicians need to evaluate adult patients with acute headaches to determine whether the condition is benign (harmless) or if it indicates the features of life-threatening neurological or other systemic illness.

Approximately half of the adult population is affected by a headache disorder. Physicians are faced with many challenges in differentiating primary headaches (tension-type, migraine, cluster headache) from secondary headaches (those caused by infection or vascular disease). Hence, a thorough history, physical examination, and understanding of the typical features of primary headaches can reduce the patient’s cost of unnecessary investigation and intervention like neuroimaging, lumbar puncture, or other laboratory studies.

But if you experience frequent headaches, you might have a chronic headache. Unlike a specific headache type, chronic headaches include subtypes. The constant nature of this headache makes it one of the most disabling headache conditions. However, aggressive initial treatment and steady long-term management could help alleviate the pain.

Causes of chronic headaches

The causes of many chronic headaches are not well-understood. Primary chronic daily headaches don’t have an identifiable cause.

Conditions that might cause non-primary chronic daily headaches include:

  • Inflammation or vascular disorders in the brain, including stroke
  • Infections, such as meningitis
  • High Intracranial pressure
  • Brain tumour
  • Traumatic brain injury

Common Chronic Headache types are,

  • Migraine
  • Tension-type headache
  • Cluster Headache
  • New daily persistent headache
  • Medication overuse headache
  • Sinusitis associated headache
headache types

Cluster Headache – relatively rare

Severe or very severe unilateral orbital, supraorbital  or temporal pain may last 15 to 180 minutes (if untreated).

Headache is accompanied by at least one of the following

  • Conjunctival  injection, lacrimation, nasal congestion or rhinorrhea, eyelid edema,
  • Forehead and facial sweating, miosis or ptosis, restlessness or agitation

Tension-type headache – These headaches tend to:

  • Affect both sides of your head
  • Pain – Mild to moderate intensity
  • Pain that feels pressing or tightening but not pulsating

Migraine – This type typically occurs in people with a history of episodic migraines. 

Chronic migraines tend to:

  • Affect one side or both sides of your head
  • Have a pulsating, throbbing sensation
  • Cause moderate to severe pain

And they might have at least one of the following:

  • Nausea, vomiting or both
  • Sensitivity to light and sound(Photophobia & Phonophobia)

New daily persistent headache – These headaches come on suddenly, usually in people without a headache history. They become constant within three days of the onset of the first symptoms. 

  • Often affect both sides of your head.
  • Cause pain that feels like pressing or tightening, but not pulsating
  • Cause mild to moderate pain
  • It might have features of chronic migraine or chronic tension-type headache.

Medication overuse headache – This type of headache usually develops in people who have an episodic type headache disorder, usually migraine or tension-type, and are taking too much medication for their pain. If you’re frequently taking pain medications, even over-the-counter (generally more than two days a week), you will be at risk of developing rebound headaches.

Risk factors

Factors associated with developing frequent headaches include:

  • Female sex
  • Anxiety
  • Depression
  • Sleep disturbances
  • Obesity
  • Snoring
  • Overuse of caffeine
  • Overuse of analgesic medication
  • Other chronic pain conditions

Diagnosis

Your doctor will evaluate the symptoms and examine you for signs of underlying medical conditions such as infection, neurological problems, etc. If the cause of your headaches remains uncertain, your doctor might order imaging tests, such as a CT or MRI scan of the brain, to look for an underlying medical condition.

Prevention

Taking care of yourself might help ease chronic daily headaches.

Avoid headache triggers.

  •  Keeping a headache diary can help you determine what triggers your headaches to avoid the triggers.
  • Include details about every headache, such as when it started, what you were doing at the time and how long it lasted.

Avoid medication overuse. 

  • Taking over-the-counter medications more than twice a week can increase the severity and frequency of your headaches.
  • Consult your doctor about how to wean off the medication because there can be severe side effects if taken improperly.

Get adequate sleep. 

  • The average adult needs 7-8 hours of sleep a night, and it’s best to go to bed and wake up simultaneously every day. 
  • Talk to your doctor if you have sleep disturbances, such as snoring.

Don’t skip meals. 

  • Eat healthy meals at the same time daily. Avoid food or drinks, such as those containing caffeine that triggers headaches. 
  • Try to lose weight if you are obese or overweight.

Do regular exercise.

  • Regular aerobic physical activity can improve your physical and mental well-being and reduce stress. 

Reduce stress.

  • Stress is a common trigger of chronic headaches, so get organised, simplify your schedule, plan ahead and stay positive.
  • Try stress-reduction techniques, such as yoga, tai chi or meditation.
preventing headache

When to see a doctor

Occasional headaches are common and usually require no medical attention. However, consult your doctor if:

  • You  have two or more headaches a week
  • You are required to take a pain reliever frequently
  • You need more than the recommended dose of over-the-counter pain remedies to relieve your headaches
  • The pattern of pain and headaches intensity has worsened
  • Headaches interrupt your daily routines

Seek prompt medical care if your headache:

  • Is sudden and causes severe pain
  • Accompanies a fever, neck stiffness, confusion, seizure, double vision, any limb weakness/numbness or difficulty speaking
  • Follows a head injury
  • Gets worse despite rest and pain medication

Treatment

Treatment for an underlying condition is the definitive management of chronic headaches. If the doctor cannot find such an etiological condition, treatment will be focused on symptom relief and prevention of pain.

Prevention strategies may vary depending on your headache type and whether medication overuse contributes to your headaches. If you take pain relievers more than three days a week, the first step might be to wean off these drugs with your doctor’s instructions.

After a detailed evaluation of the symptoms and signs, your doctor may recommend various medications depending on your clinical profile.

Coping and support

Chronic headaches can interfere with your day-to-day activities, relationships and quality of life. 

  • Have self-control – Commit yourself to living a full, satisfying life and discuss with your doctor to develop a treatment plan for you while doing things that lift your spirits.
  • Reach out to support groups. You might find it helpful to talk to other people who have chronic headaches.
  • Consider counselling. A counsellor/psychologist will support you, and they help to manage your stress. Additionally, there is evidence that cognitive-behavioural therapy can reduce headache frequency and severity.

In these difficult times, it is vital we look after ourselves and our loved ones. If you or anyone you know is suffering from any of the above-mentioned symptoms you can speak to an on-demand doctor on oDoc from the comfort of your home. 

Dr Namal Lasantha Ulluvisheva

General Physician

SLMC 19165

Sri Lanka Navy – Ministry of Defence 

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