What Are Migraine Headaches?
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Migraine headaches are considered a primary neurological condition. They occur in regular episodes throughout the year that may involve:
- Extremely severe pain perceived as coming from within the skull
- Sensations of throbbing on one side of the head
- Nausea or vomiting
- Strong sensitivity to external environmental factors such as sound, light, or smells
These symptoms may last anywhere from a number of hours to a number of days.
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Most researchers and clinicians regard an episode of migraine as going through these four stages:
- Prodromal: This stage can occur several hours before the onset of pain. Many patients see this as a precursor to pain, and learn to expect it at the prodromal stage. It may involve signs and symptoms such as mood swings, lethargy, unusual food cravings, compulsive yawning, and an increased need for the restroom.
- Aura: This next stage may involve neurological events, known as auras, which precede an episode of pain. Auras may begin 20 to 60 minutes prior to actual migraine pain. They may manifest as seeing metallic lines, changes in sensation, motor deficits, or speech abnormalities. Auras are not common to all migraine sufferers, however.
- Attack: This stage involves pain and other symptoms such as light sensitivity. This may last up to 72 hours without treatment.
- Postdromal: This occurs after the episode of pain has ended. Patients may feel drained and fatigued at this stage. Some may experience mild euphoria.
Migraines are regarded as a primary condition in their own right, i.e. not occurring as a symptom of another disorder. However, some symptoms associated with migraine may in fact be signs of serious neurological events.
In rare cases, they may indicate the presence of a brain tumor, aneurysm, or meningitis. If these conditions are suspected, one should seek immediate medical assistance.
Signs of a serious event may include:
- Sudden-onset severe headache pain, especially if such pain is normally unusual for the person in question
- Aura symptoms, especially if this is not normally experienced
- Neurological events such as emotional or behavioral abnormalities, sudden falls, loss of balance, dizziness, speech disturbances, confusion, numbness, or tingling
- Headache pain severe enough to cause waking from sleep
- Passing or blacking out
- Stiffness in the neck
- Rash or fever accompanied by headache
- Severe pain that follows head trauma
Causes Of Migraine HeadachesBrain tissue itself does not normally feel pain. The pain of most headache types is related to chemical or mechanical damage to the tissues in close proximity to the brain, including the nerves, skull, sinuses, muscles, blood vessels, eyes, ears, and various membranes. The exact cause of migraine headaches is not completely defined. Early research into the subject led to conclusions that it is a vascular condition, or related to changes in the blood vessels of the brain’s surface. However, this was subsequently debunked. Current research tends to link mutations in certain genes to the increased probability of developing migraine headaches.
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This headache type is relatively common and may occur in conjunction with other illnesses. Migraine headaches may be difficult to diagnose, as their symptoms are also factors of other similar conditions. A physician may distinguish a case of migraine by asking detailed questions about pain episode onset, prior medical history, any family history of migraine, and other symptoms. Headaches are difficult to diagnose with techniques other than patient interview. A physician may use some standard rating scales to assess the degree of migraine headache-related pain.
Migraine headaches are commonly linked to factors that trigger, or increase the risk of, an episode. These may include:
- Psychological disorders, such as stress
- Sensitivity to chemicals such as food preservatives
- Caffeine intake
- Weather changes
- Sleep deprivation or changes to a normal sleep rhythm
- Failing to eat regularly
Treatments For Migraine Headaches
A pain clinic or specialist may offer many treatments to address the pain of migraine headaches. Patients with relatively mild to moderate pain may be advised to try conventional measures at home beforehand to assess their effect, if any. If these fail, a patient may discuss more treatments with their specialist or physician. For example, a patient might be advised to try over-the-counter painkillers to test their efficacy and make sure the next line in treatment is necessary.
A physician may advise their patient to track their symptoms in cases of migraine associated with severe chronic pain. Symptom tracking involves keeping a record of pain onset time, pain severity, the time from an episode onset to the maximum severity of pain, episode length, the presence of stages and their symptoms (e.g. aura), and unusual symptoms. This may contribute to the identification of triggers and to improved prophylaxis against the onset of pain episodes.
Symptom tracking may help with treatments such as biofeedback training. There is some evidence that this technique has some benefit in chronic pain conditions such as migraine headache. Biofeedback training educates patients in the use of biological metrics, such as electroencephalography, and how these change in response to pain and other symptoms. The patient uses this in conjunction with symptom tracking to apply relaxation techniques at an episode onset. The goal of this is to return the metrics to normal, and thus reduce pain and other symptoms. A patient may alleviate or even prevent an episode at its onset using biofeedback training.
Patients with chronic and severe headache pain may wish to consider direct nerve treatments, which inhibit pain signals from major nerves. These include nerve blocks, in which a physician or pain specialist inserts a needle through numbed skin to deliver pain-relieving medications such as lidocaine to a nerve. There are a number of nerve block types associated with effective migraine treatment, including those to the occipital nerve or sphenopalatine ganglion. A patient should discuss the risks, benefits, and treatment goals associated with these with their specialist or physician before considering this treatment.
ConclusionMigraine headaches are a widespread burden to health and life quality. Migraine headaches occur in regular episodes, in which a patient experiences severe headache pain, vomiting, nausea, and sensitivity to light or sound. The exact biochemical cause of migraine headaches is not completely understood. While most symptoms are related to simple migraine episodes, atypical symptoms may indicate a medical condition that should be addressed without delay.
Symptom tracking and biofeedback training may help to manage migraine episodes. Some patients also respond well to other treatments such as nerve blocks. A discussion with your physician or pain specialist may help you to arrive at the most effective treatment for your case of migraine headaches.
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