Medicinal Treatment For Migraine

What is Migraine?

A migraine headache can cause an intense pulsing sensation and throb in one area of the head. A migraine is normally accompanied by vomiting, nausea, and extreme sensitivity to sound and light. A migraine can cause significant pain to the patient for hours or even days. In some cases precede and the symptoms such as flashes of light, tingling in the arms or legs or blind spots can worsen with time and create more problems. Medications for a migraine can help in reducing the frequency and severity of the migraines. Self-help remedies and lifestyle changes can make a big difference in the providing relief to the patient.

Stages and Symptoms of Migraine

Migraine headaches generally start in childhood or adolescence. Migraines can progress through four stages:-

•    Prodrome.

•    Aura.

•    Attack.

•    Postdrome.

The patient generally does not experience all the stages.  The symptoms vary from stage to stage following are some of the symptoms

Prodrome

One or two days before a migraine the patient may notice subtle changes that may signify an oncoming migraine. Following are some of the symptoms the patient may experience in the Prodrome stage:-

•    Hyperactivity.

•    Depression.

•    Constipation.

•    Neck stiffness.

•    Irritability. 

•    Uncontrollable yawning.

•    Food cravings.

Aura

Aura can occur before or during migraine headaches. Auras are the symptoms of a nervous system that are usually visual disturbances. Most people experience migraine headaches without aura. Each of these symptoms gradually begins and, builds up over several minutes.

•    Flashes of light.

•    Touching sensations.

•    Movement.

•    Speech disturbances.

•    Visual phenomena.

•    Vision loss.

•    Pins and needles sensations in an arm or leg.

•    Speech or language problems.

Attack

When a migraine is untreated it usually lasts for around 71 hours. The frequency of a headache varies from person to person. During a migraine the patient can experience the following symptoms:-

•    Blurred vision.

•    Pain on one side or both the sides of the head.

•    Sensitivity to light.

•    Pain that has a pulsating.

•    Sensitivity to sounds.

•    Sensitivity to smell.

•    Nausea.

•    Vomiting.

•    Lightheadedness.

Postdrome

Postdrome phase of a headache can last up to 48 hours. Many of the symptoms of this phase appear initially during the prodrome or with the headache phase. Following are some of the symptoms:-

•    Alteration in the mood of the patient.

•    Sore muscles.

•    Food intolerance by the patient.

•    Fatigue

•    Impaired concentration.

•    Malaise.

•    Tenderness in the scalp.

•    Decreased energy requiring a period of rest.

Causes of Migraine

The causes of a migraine are still not understood but the genetic and environmental factor play an important role. A migraine can be caused by the changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway.

Treatment for Migraine

Migraines cannot be cured completely, but it can help the patient to manage their condition. A variety of medications is specifically designed to treat migraines. The type of medications recommended by the doctors depends on the severity of the headaches the patient is suffering from. Some drugs or medications are commonly used to treat conditions which help in relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:-

Pain-relieving medications: - Pain relieving medications is also known as an acute or abortive treatment. These drugs are taken by patients during migraine attacks and are designed to stop symptoms that have already begun. For more effective results. Pain-relieving medications include:-

•    Pain relievers.

•    Ergots.

•    Triptans.

•    Opioid medications.

•    Anti-nausea medications.

•    Glucocorticoids.

Preventive medications: - Preventive medications are taken on a regular basis which is often on a daily basis. These medicines are used to reduce the severity or frequency of migraines. Preventive medications can reduce the frequency, severity and length of migraines. These medicines can also increase the effectiveness of symptom-relieving medicines which are used during migraine attacks. Preventive medications include:-

•    Cardiovascular drugs.

•    Antidepressants.

•    Pain relievers.

•    OnabotulinumtoxinA (Botox).

•    Anti-seizure drugs.

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Headaches: Causes and Triggers

WHAT IS A HEADACHE?

A headache is an unpleasant pain experienced in any part of the head. It is the most common type of pain and people generally treat themselves simply with pain relievers or by having a rest. Its pain can be felt in the temples, forehead, scalp or at the back of the neck. The pain originates from tissues surrounding the brain. This layer of tissue, muscles that encase the skull, sinuses, eyes, ears, surface of the brain, spinal cord, can get inflamed or irritated thus causing headaches. Most people describe it as a “dull ache” or “sharp throbs” felt on part of the head or scalp.

Headaches can range from mild to moderate pain and can occur on both sides of the head, lasting from 30 minutes to weeks at a stretch.

WHAT ARE THE TYPES OF HEADACHES?

Headaches are classified in three major categories based upon the origin of the pain as -

•                Primary headaches:

Includes tension headaches, migraine and cluster headaches

•   Secondary headaches:

Caused by other medical problems, trauma or substance abuse

•         Cranial neuralgias, facial pain and others

Primary headache can affect the quality of living of a person. Some people experience dull headaches occasionally that resolve quickly while some others experience exhausting pains. These aches are not fatal but the symptoms coupled with them can imitate a stroke.

The most common type of headache is said to be tension headache, which is mild or moderate pain and in some cases intense pain in the head, neck and behind the eyes and is caused by tight muscles in the shoulder, neck or jaw. There is little knowledge of the exact causes of tension headaches. They are usually felt as a band or across the forehead, lasting for several days. More often than not, tension headaches are related to stress, anxiety, depression, injury to the head or abnormal positioning of the head and neck. It starts at the back of the head and moves onwards to the front, and feels like squeezing.

SYMPTOMS OF TENSION HEADACHES:

•                           Pain originates in the upper neck or the back of the head
•                           Pressure felt at the temples or over the eyebrows
•                    Pain is bilateral i.e. it affects both sides of the head
•                  Pain is not associated with aura i.e. light or sound
•                    The pain is sporadic but can occur daily for some people

Migraine headaches are second most common type of headaches that fall under this type. Migraines can affect children and adults equally. Before puberty, boy and girls experience migraine in the same way but after puberty, more women than men experience these pains. These pains are intense and often are accompanied with various symptoms like nausea, seeing spots or flashing lights, sensitivity to light and sound, pain in the temples and even temporary vision loss.

Cluster headaches are a rare type of headaches most commonly affecting men in their 20s although women and children are likely to suffer from them too. It is a sharp and painful headache that shows up several times a day for months and then vanishes for a similar period. The pain lasts less than an hour and sometimes tends to occur at the same time every day.

SYMPTOMS OF CLUSTER HEADACHES:

           i.They begin quickly and without warning

         ii.The pain is deep and continuous

        iii.Pain may occur up to seven times a day but is of short durations

         iv. The pain begins around the eyes and the temples

          v. The pain is always one sided

    vi.These headaches are associated with redness of eyes and tear production, stuffy nose and sweating

Cluster headaches are more likely to be hereditary. Alcohol consumption can also cause this type of headache.

Secondary headaches are caused due to core problems in the neck and/or head. A broad spectrum of conditions can be the root cause of such headaches; ranging from infected teeth or sinus to life threatening conditions like bleeding in the brain or infections like encephalitis and meningitis. Treatment of such headaches means treatment of the cause.

Secondary headaches can be caused due to substance abuse, or due to its withdrawal. For example alcohol abuse causes throbbing headache the morning after. Dehydration also causes headache. Also lack of oxygen (or an excess of carbon mono oxide) in a poorly ventilated area may cause headache too.

Injury to the head may cause traumatic headaches which also fall into this category.

Neuralgia means nerve pain. Cranial neuralgia is the inflammation of one of the 12^th cranial nerve that controls the muscles and carries sensory signals to and from the head and neck. Trigeminal neuralgia is perhaps the most common of them, it affects the cranial nerve V (trigeminal nerve) which is the nerve that connects the face and causes severe facial pain when inflamed.

The pain consists of short throbs of electric shock-like sensations in the face – the area of the eyes, nose, lips, jaws, forehead or scalp and is triggered by touch. It is one sided and is often experienced by people of the age of 50 and above.

Sinus headaches cause pain in the front of the face and head. The pain is due to swelling of the sinus passage behind the cheeks, nose and eyes. The pain gets a little worse when the person bends forward or immediately after when they wake up in the morning. Some other types of headaches are caused by flu, fever or premenstrual.

A headache could also be a sign of something serious and these rare cases could be:

Bleeding in the area between the brain and the tissue that covers it (known as subarachnoid hemorrhage)

 High blood pressure

 Brain tumor

 Buildup of fluid inside the skull that results into brain swelling (hydrocephalus)

 Lack of oxygen during sleep (sleep apnea)

 Problems with the blood vessels such as arteriovenous malformation (AVM), aneurysm or stroke.

HOW CAN A HEADACHE BE DIAGNOSED?

A patient’s description of the headache and an examination by the doctor is sufficient to determine the type of headache. Some patients have more than one type of headache. Generally people don’t need an x-ray or an imaging test. A CT (or MRI) may be prescribed in certain circumstances if the symptoms are not self explanatory.

HOW CAN HEADACHES BE TREATED?

Some steps to be taken at home to manage headaches like migraines and tension headaches include -

For migraines

      Drink water to avoid dehydration

      Rest in a quiet and dark room

      Use relaxation techniques
      For tension headaches try pain killers but these should not be used too often.

Life style changes should be introduced to reduce occurrence of headaches. These can be:

•         Stop smoking
•        Reduce intake of alcohol
•         Decrease caffeine intake
•        A healthy sleep cycle
•        Dietary plan
•         Exercise

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