What is a migraine?
A migraine is a recurring, moderate to severe headache. The pain, usually throbbing, occurs on one side of the head. Migraine is a biological disorder of the brain. While it is more common in women, it can affect anyone. It usually begins in childhood, adolescence or young adulthood.
What causes migraine?
The exact cause of migraine is unknown. It appears to be an inherited biochemical disorder in the brain. People with migraine may have a more sensitive nervous system response than others. During an attack,the changes in brain activity may cause blood vessels and nerves around the brain to become irritated and inflamed.
What are the symptoms?
Symptoms vary greatly among people with migraine but can include:
- Moderate to severe headache that lasts 4 to 72 hours, if untreated
- Throbbing pain, often on one side of the head
- Increased pain after exercise or movement
- Sensitivity to bright light, sound and / or odours
- Nausea and / or vomiting with the headache. One in five people with migraine have a warning before the headache. This is called an aura, which may cause flashing lights, temporary loss of sight or numbness on one side of the body. In some cases, people experience the aura without an accompanying headache.
How is migraine diagnosed?
No medical test can confirm that you have a migraine. You will need to provide details about your headaches and your other symptoms to your neurologist or primary care physician, who will perform a neurologic examination to check the functioning of your nervous system. Often, no further testing is needed. If your symptoms do not fit a typical pattern for migraine, your physician might order brain imaging or other tests.
What are the treatment options?
Although there is no cure, migraine is treatable with proper medical care and self-management that:
- Identifies and controls triggers that start a migraine
- Uses medications to treat migraine attacks acutely
- Uses medications and other treatments to help prevent attacks
- Encourages healthy behaviour and lifestyle changes
- Keeping a headache diary is a valuable tool for treating migraine. In it, you can note your pain level, symptoms, possible triggers and treatments.
Acute migraine treatments are used to stop an attack when it occurs and treat its symptoms.
Two types of acute treatments are available; drugs that specifically stop the migraine, called abortive treatments and nonspecific pain relievers. These will be prescribed by your doctor.
It is very important to take these medications as close to the start of the headache as possible.
Acute treatments do not work as well several hours into a headache. Most of these acute treatments are designed to be used infrequently. If you find that you are using acute therapies more than one to two times per week, you should talk to your neurologist about alternative approaches. Anti-nausea drugs are also frequently used to treat nausea that accompanies the migraine and they may have some effect on the headache itself.
Daily preventive medications are available for people with frequent, severe and debilitating migraines. They can also help if your treatment is not working or is causing side effects.
Contact your neurologist if your treatment is not working or if you are overusing acute medications to stop migraine attacks. Overuse of acute drugs can lead to more frequent headaches.
Cognitive and behavioural treatments
Ask your neurologist for more information regarding cognitive and behavioural treatments.
- Relaxation training
- Cognitive-behavioural therapy (also called stress-management training)
Living with migraine
The following practices and tips can help reduce the impact migraine has on your life. Know and avoid migraine triggers which vary from person to person. Some triggers are avoidable, but many are not. They can include:
Diet: missed meals, alcohol, foods with monosodium glutamate (MSG), too much caffeine or withdrawal from caffeine and preserved meats with nitrates and nitrites
Sleep: too much or too little sleep, sleeping late night or late dinner after 9:30 pm
Stress: relief from stress
Hormones: changes during the menstrual cycle
Environmental factors: weather changes, bright or glaring lights, strong odours and high altitude
Develop a partnership with your neurologist
- Work with your neurologist to develop a treatment plan and follow it
- Keep up your follow-up visits with your neurologist
- If your headaches are bad, talk to your neurologist about prevention
- Be actively involved in your treatment, including keeping a headache diary