What is migraine?
Migraine is a recurrent headache associated with increased
sensitivity in the brain to sound and light, sometimes with nausea
and vomiting. Some patients experience aura, a visual disturbance
on one side of their visual field, or abnormal sensation on one
side of their body for typically 20-60 minutes before the headache.
Migraine is more common in women and may be affected by the
menstrual cycle: migraine tends to be better in pregnancy and after
the menopause.
The precise cause of migraine is not known, but the tendency
often runs in families and genes for some types of severe migraine
(familial hemiplegic migraine) are now known. It is thought that in
the first stage of migraine there is activation of nerve centres
within the brain that control the sensations we receive from the
blood vessels around the brain. These nerve centres then release
inflammatory proteins causing inflammation and dilation of the
blood vessels which increases the pain further and soon a vicious
circle builds up with activation of the pain sensitive structures
in the brain and dilation and inflammation of blood vessels causing
the patients to become sensitive to light, sound, movement for up
to several days. Some patients can detect the first stage of this
process as the 'premonitory phase' several hours before the
headache starts with symptoms such as neck ache, yawning and food
cravings reflecting the early stages of activation of brain centres
leading up to the attack.
What do you do to treat it?
The first stage is always to look for triggering factors such as
irregular sleep, meals, exercise, but foods such as cheese and
chocolate are rarely the cause. Migraines just with the menstrual
cycles can sometimes be treated with hormonal treatments such as
changing the contraceptive pill.
If the migraines are happening infrequently then treatment taken
just as the pain starts may be sufficient, starting with a
Non-steroidal anti-inflammatory drugs combined with an
anti-sickness drug such as domperidone. If this is insufficient
then migraine specific medication known as triptans can be
used. If the patient vomits within 1-2 hours of taking
medication then it may not be absorbed and injectiable medication
or suppositories may be needed.
If migraines are occurring frequently then preventative
treatment on a daily basis for a several months may be necessary.
Patients should avoid taking pain-killers such as paracetamol and
codeine based drugs frequently as these may make the headache worse
(medication overuse headache). Preventative treatments include
amitriptyline, beta-blockers, topiramate and valproate: the option
depends on many factors and should be discussed with your doctor.
If these treatments do not work and the patient is suffering
headaches most days then treatments such as occipital nerve
injection and botulinum toxin injections can be done as outpatient
procedures