IT IS COMMON for patients to say, “I have a migraine,” but what really is a migraine?
Migraines are typically associated with a moderate to severe headache that is episodic and comes with a variety of symptoms including nausea and sensitivity to light. Stages of a migraine can vary greatly. Many patients (up to 60%) experience a prodromal period, where hours or even days before the onset of headache symptoms, they may notice tiredness; sensitivity to light, sound, or smell; changes in appetite; mood swings; and changes in bowel function.
Many patients also experience an aura, which results from a chemical imbalance and inflammation of the nervous system. Auras may start five to 20 minutes prior to a migraine and usually resolve within an hour. Auras may be visual, consisting of wavy lines or black dots that move typically from central to peripheral vision. They may also cause partial or complete loss of vision and tingling in the extremities or weakness in limbs. These symptoms can mimic a stroke; therefore, it is important not to dismiss these signs if you have them and to seek immediate medical attention.
The headache itself, with or without aura, often starts dull and can grow worse over time. It may be unilateral or on both sides of the head. Nausea, vomiting, and light sensitivity also often accompany the throbbing pain. A migraine can also mimicasinusheadache,asmanypatients report sinus pressure and congestion. The headache phase typically last two to four hours, but many patients experience pain for longer. After the migraine has passed, they may still feel weak and tired. What actually causes a migraine? Up until recently, it was thought that migraines resulted from changes in blood flow in the brain, triggered by various environmental or internal triggers. Blood flow changes are associated with the pain in a migraine, but the current thinking is that a migraine starts when overactive nerve cells (activated by triggers) send impulses to the trigeminal nerve. This nerve is located on the face in front of the ear and has three branches that control sensation and pain to the head and face. Activation of this nerve causes a release in chemicals like serotonin and calcitonin gene-related peptide (CGRP). CGRP causes the blood vessels in the lining of the brain to swell, resulting in further inflammation and pain.
What are risk factors for migraines? Women are three times more likely than men to have migraines. Age of onset is typically between 10 and 45. After menopause, migraines typically, but not always, get better. Family history is another risk factor. In fact, four out of five people with a history of migraines also have a close family member(s) with migraines. Depression and bipolar disorder also increase the risk of migraines. Migraine triggers can vary and include:
• Hormonal fluctuations, including use of birth control and hormone-replacement therapies.
• Stress and lack of sleep.
• Certain foods such as those containing MSG, alcohol, NutraSweet, or caffeine.
Skipping meals can also be a trigger.
• Weather changes (e.g., dropping barometer).
• Smells, such as perfumes, food, or environmental odors.
• Certain medications, such as caffeine-containing products.
• Tobacco products.
Migraines can vary greatly. Some patients experience vertigo, others have sinus symptoms. Oftentimes they occur prior to a woman’s menstrual cycle. Most concerningly, some patients experience visual loss or weakness in an extremity, mimicking a stroke.
There is no cure for migraines, and the best treatment is to avoid triggers if possible. The mainstay of treatment is anti-inflammatory medication, such as ibuprofen, Naprosyn, etc., especially if taken early in the headache onset. Triptan medications, such as Imitrex, work by stabilizing the release of inflammatory chemicals in the brain to prevent progression of a headache and again work best when taken early in the migraine course. CGRP receptor antagonists, such as Rimegepant, can block the release of inflammation signals, which can prevent migraines. Botox and even magnetic stimulation therapy can also be used. The best course for patients is to avoid triggers,stayhydrated,andmanagestress.
Dr. Lisa Graves-Austin is a board-certified Internal Medicine physician who focuses on preventative care while also managing conditions such as diabetes, migraines, PCOS treatment and menopausal treatment, and hormone replacement. She is conveniently located in Perrysburg, has over 20 years of experience, and is welcoming new patients. ✲
