Many people experience this painful, pumping feeling in the head: a pulsating headache in one half of the head that can last from a few hours to three or more days.
If the pain does not hurt enough, the headache may also be accompanied by symptoms such as nausea, vomiting and sensitivity to light, sound or smell.
These recurrent headaches, which can range from moderate to severe, can be diagnosed as a medical condition called
migraine. And while a normal headache can disappear with a walk or physical activity, a migraine is usually made worse if the sufferer tries to be active and move.
What causes migraines?
To this day, the underlying causes of migraines are not known. However, they are believed to relate to a mix of environmental and genetic factors. Migraines run in families; in about two thirds of cases family members are affected. In more rare cases migraines occur due to a single gene defect.
Once it was even assumed that migraines are more common in highly intelligent people. But a migraine is no indication of intelligence. However, a number of psychological conditions are associated with migraines, including
depression,
anxiety and
bipolar disorder. Additionally, many biological events or triggers can cause migraine.
What happens in the brain when you have a migraine?
Migraines are believed to primarily be a neurovascular disorder. This means the condition is most likely related to blood vessels and blood nerves in the brain. Evidence supports a mechanism that starts within a part of the brain and then spreads via blood vessels and nerves.
Some studies suggest that blood vessels play the key role while yet another theories suggests more complex, abnormal processes in the brain are the principal cause of a migraines.
Who is most likely to suffer from migraines?
Migraines are two to three times more common in women than men. Young children usually don’t suffer from migraines. The condition usually develops during the teenage or middle-age years. Overall, migraine headaches are the second most common type of headache behind tension-type headaches.
Is it possible to treat migraines successfully?
There is no miracle cure to heal migraines. Chronic migraines, however, can be controlled through adequate self-care and proper medication. Additionally, it is common for symptoms to become less intense with age.
The treatment of migraines has made great strides over the years and can be divided into two categories:
- During acute migraine attacks, pain medication is given, such as paracetamol and non-steroid anti-inflammatories (NSAIDs). Such medication is given earliest possible after symptoms occur. Active substances will be activated in the blood stream directly.
- If a patient suffers from frequent or very severe migraine attacks, it is advised to take medication taken daily to prevent migraines. More than two attacks per month is considered to be a severe migraine.
Additionally, medicines for reducing nausea and vomiting can be prescribed, including anti-depressant and appetite-stimulating medications.
Migraine attacks that occur during menstruation are a special case. Patients usually are prescribed NSAID medication which should be taken two to three days before menstruation commences and until four to five days after menstruation stops.
How specifically do Bumrungrad's specialist doctors treat migraines?
Bumrungrad International Neuroscience Center has neurologists who have extensive experience in migraine headache treatment. Our specialists are well-equipped with the technology for investigation and treatment of migraine headaches.
As part of the new treatments Bumrungrad offers the once-a-month injection of calcitonin gene-related peptide, transcutaneous electrical nerve stimulator and a transcranial magnetic stimulator.
In general, however, Bumrungrad neurology specialist doctors consider three main aspects in treatment:
- Trigger avoidance
- Acute symptomatic control
- Prevention
Trigger avoidance
There are five different types of migraine triggers: emotional, physical, dietary, environmental and medical triggers.
Emotional triggers include
stress,
anxiety, tension, shock,
depression and excitement.
Physical triggers can be tiredness, poor-quality sleep, shift work, poor posture, neck or shoulder tension, jet lag, low blood sugar and, if someone is not used to it, strenuous exercise.
Dietary triggers include missed, delayed or irregular meals, dehydration, alcohol, caffeine products (such as coffee and tea), specific foods (such as chocolate and citrus fruits) and foods containing the substance tyramine which is found in cured meats, yeast extracts, pickled herrings, smoked fish (e.g. smoked salmon) and certain cheeses (such as cheddar, stilton and camembert).
It is also advisable to consume foods that have been stored at room temperature rather than being refrigerated or frozen, since the latter can lead to increased levels of tyramine.
Environmental triggers include bright lights, flickering screens, smoking or smoky rooms, loud noises, changes in climate (such as changes in humidity or very cold temperatures), strong smells and a stuffy atmosphere.
Medical triggers include certain types of sleeping tablets, contraceptive pills and
hormone replacement therapy (HRT) which is sometimes used to relieve symptoms associated with menopause and andropause.
Acute symptomatic control
Medications for acute symptomatic control are more effective if used earlier in an attack. The frequent use of such medications, however, may result in medication overuse headache, in which the headaches become even more severe and more frequent. Due to these concerns, Bumrungrad's specialist doctors carefully weigh up which medications to prescribe and in what dosage.
Recommended initial treatment for those with mild to moderate migraines usually consists of simple analgesics, such as NSAIDs or the combination of paracetamol, aspirin and caffeine.
Triptans, such as sumatriptan, are effective for both pain and nausea in up to 75 percent of migraine sufferers.
In the most severe cases, older medications such as ergotamine and dihydroergotamine are prescribed. These medicines, however, can cause vasospasm (narrowing of arteries) and are contraindicated in people with
coronary artery disease.
Prevention
Prevention is recommended in those who have migraine headaches more than two days a week and who cannot tolerate the medications used to treat acute attacks. Preventive treatment is also advised for patients with severe attacks that are not easily controlled.
The goal of preventive treatment is to reduce the frequency, intensity and duration of migraines while increasing the effectiveness of abortive therapy. Another reason for prevention is to avoid medication overuse headache.
Preventive treatment of migraines includes medications, nutritional supplements, lifestyle adjustments and, in rare cases, surgery. Recommended lifestyle changes consist of, for example, stopping tobacco use and limiting behaviors that interfere with sleep.
How long does treatment take?
The length of treatment depends on how severe and how often the patient suffers from migraine attacks. Generally, we recommend six months of prevention medications in cases of strong and often attacks. In milder cases, pain medication for each attack may be sufficient enough together with long-term trigger factors avoidance and lifestyle changes. Keep in mind though that it may take several weeks before migraine symptoms begin to improve after the first intake of prevention medications.
Avoiding specific triggers, such as stress or certain types of food, may help reduce the patient’s risk of experiencing migraines. It also helps to maintain a healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring to stay hydrated and limiting the intake of caffeine and alcohol.
Alternative therapies
In addition to the methods listed, alternative therapies can also be used. Acupuncture has shown to have a small effect in reducing the number of migraines. Patients must be aware though of sham acupuncture where needles are placed randomly or do not penetrate the skin.
Tentative evidence also supports the use of stress reduction techniques such as cognitive behavioral therapy, biofeedback and relaxation techniques.
Additionally, regular physical exercise may as well decrease the frequency and severity of migraines.
Among alternative medicines, there is tentative evidence that coenzyme Q10 may reduce migraine frequency. Furthermore, melatonin may be added for prevention and treatment of migraine. Study results though are non-conclusive. It is assumed that improved sleep and anti-inflammatory properties might have a direct impact on migraine easing.
There are even medical devices, such as biofeedback and neurostimulators, which are said to offer some advantages in migraine prevention.
A final recommendation
Aside from proper medical treatment, these common rules are recommended for easing and preventing migraines:
- Identify and avoid factors that trigger migraine headaches
- Get plenty of rest and have a healthy sleeping pattern
- Exercise regularly, without overexerting yourself
- Do not smoke, as smoking can lead to stroke
- Try avoiding caffeinated beverages such as coffee, tea, soda and energy drinks
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