The migraine is a particular form of headache (headache). It is manifested by seizures that can last from a few hours to a few days. The frequency of seizures varies widely from person to person, ranging from several seizures per week to one seizure a year or less.
Migraine differs from “ordinary” headache, especially in terms of duration, intensity and various other symptoms. Thus, a migraine attack often begins with pain felt on one side of the head or located near an eye . Pain is often perceived as pulsations in the skull, and is aggravated by light and sound (and sometimes odors). Migraine can also be accompanied by nausea and vomiting.
Surprisingly, in 10% to 30% of cases, migraine attacks are preceded by physiological manifestations that are grouped under the name of aura . Auras are essentially visual disturbances that can take the form of flashes of light, lines of bright colors or a temporary loss of vision. These symptoms disappear in less than an hour. Then comes the headache.
The migraine affects about 12% of adults, women are three times more affected than men. A recent study found that 26% of Canadian women were migraine sufferers , 38 with a high frequency of seizures. Migraine is also prevalent in children and adolescents (5% to 10%), in whom it is often underdiagnosed. According to Uptodate, in the general population, 17% of women and 6% of men suffer from migraine. In the 30-39 years, it would be 24% of women and 7% of men.
The frequency of migraine attacks varies greatly from one individual to another. Some people have a few a year, while others have 3 or 4 a month. In some cases, seizures can occur several times a week, but rarely every day.
The first attacks usually appear during childhood or young adulthood . Over the age of 40, migraines are more rare and they often disappear after 50 years.
The mechanisms of migraine
It’s unclear why some people have headaches , tension headaches (caused by nervous tension or anxiety) or migraines and why others simply do not, even if they are exposed to the same triggers .
From the 1960s to the 1990s, it was thought that migraines were primarily caused by vascular changes: a tightening of blood vessels (vasoconstriction) that surround the brain, followed by swelling (vasodilatation). However, subsequent research shows that the origin of migraine is much more complex. Indeed, it is a whole cascade of reactions in the nervous system that would cause this intense headache. A neurological mechanism has recently been discovered to explain why light exacerbates the pain of migraine while darkness calms it down.These chain reactions have effects not only on blood vessels, but also on inflammation , the neurotransmitters and other elements.
Without a thorough understanding of the mechanisms of migraine, we are still better aware of the triggers (see Risk Factors ) and the means to combat it.
|Do I have migraine or tension headache?
The tension headaches are headaches that result in a feeling of tightness in the forehead and temples . It’s not about migraines. People with point-and-point tension headaches remain largely uncomfortable with their headache. Moreover, they rarely consult a doctor for this reason. Point or chronic tension headache is often caused by nervous tension or anxiety. It does not cause nausea or vomiting.
Although the pain they cause is very intense, migraine attacks have no immediate health consequences. However, recent studies have shown that migraine particularly that with aura, is associated in the long term with an increased risk of cardiovascular disorders . The risk of myocardial infarction is thus multiplied by 2 in migraine patients. The mechanisms are not yet well understood. It is therefore important to adopt a healthy lifestyle to reduce cardiovascular risk: do not smoke, eat well and exercise regularly.
In addition, migraine can dramatically alter the quality of life of those who suffer from it. It is also an important cause of absenteeism at school and at work. Hence the importance of consulting a doctor to find an effective treatment.
The symptoms of migraine
In most cases, the migraine attack occurs without warning signs . In some people, however, the crisis is preceded by an aura or a few warning signs, which vary from person to person. One person may have crises without aura, and others with aura.
This phenomenon of neurological nature lasts 5 to 60 minutes, then the headache appears. So the person knows in advance that in a few minutes she will have a very bad headache. However, it also happens that the aura is not followed by migraine. The aura can manifest itself in different ways.
- The visual effects : flashing lights, bright colors of lines, double vision;
- A temporary loss of vision in one eye or both eyes;
- Numbness in the face, tongue or limb;
- More rarely, a significant weakness of one side of the body, which is similar to paralysis (in this case called migraine hemiplegic);
- Of speech difficulties .
Common precursor signs
They precede the headache from a few hours to 2 days. Here are the most common ones.
- Tiredness ;
- Stiffness in the neck;
- Emotions on the skin;
- Increased sensitivity to noise, light and odors.
The main symptoms of Headache
Here are the main symptoms of the migraine attack. In general, they last from 4 to 72 hours.
- A headache more intense and lasting than ordinary headaches;
- Localized pain, often concentrated on one side of the head;
- A throbbing pain, throbbing, pulsations ;
- Of nausea and vomiting (often);
- Disturbed vision (blurred vision, blackheads)
- Feeling cold or sweating ;
- An increased sensitivity to noise and light (photophobia), which often requires isolation in a quiet and dark room.
Note. The headache is often followed by fatigue, difficulty concentrating and sometimes a feeling of euphoria.
|Attention to certain symptoms
It is recommended to see a doctor:
People at risk for Headache
- The women . Migraines affect almost 3 times more women than men. Two-thirds of women affected by this disease suffer more during their menstrual periods. Hormonal fluctuations, and especially the fall of the sex hormones at the end of the menstrual cycle, can help trigger the seizures.
- During a pregnancy , migraines tend to decrease in intensity from the second trimester;
- Migraine attacks are more important after puberty and they often disappear during menopause. On the other hand, in some women, migraines appear during menopause;
- People whose parents suffer or have suffered from migraines, especially in the case of migraine with aura (the risk is multiplied by 4);
- People who have inherited a gene deficiency, which predisposes to hemiplegic migraine . This familial form of hereditary migraine is rare. It is characterized by prolonged paralysis of only one part of the body.
The following factors are known to trigger migraine attacks . They vary from one person to another. Each person should learn to recognize the elements that cause his migraine, to avoid them as much as possible.
Triggers of non-food origin
Various personal and environmental factors have been identified as triggers by people with migraine headaches. Here are a few.
- The stress;
- Relax after a period of stress (migraine occurring at the beginning of the holidays, for example);
- Hunger, fasting or skipping meals;
- A change in sleep patterns (sleep later than usual, for example);
- A change in atmospheric pressure;
- Bright light or loud noises;
- Do too much or not enough exercise;
- Perfume, cigarette smoke or unusual odors;
- Various drugs, including painkillers used too frequently and oral contraceptives in some cases.
Triggers of food origin
About 15% to 20% of people with migraine headaches report that certain foods are the source of their seizures. The most frequently cited foods are:
- Alcohol, especially red wine and beer;
- Caffeine (or lack of caffeine)
- Aged cheeses;
- Fermented or pickled foods;
- Monosodium glutamate;
Of course, getting to know the foods that trigger migraine is a natural and logical way to reduce the frequency of seizures. On the other hand, this approach requires more effort and discipline, in particular because it is necessary to discover problematic foods. To do this, keeping a migraine diary is certainly a good starting point (see Prevention section). It may also be helpful to consult a nutrition specialist.
The prevention of migraine
|Basic preventive measures|
|The purpose of the preventive actions is:
Keep a journal of migraines
To prevent migraine in a natural way, the first step is to discover the element that triggers the seizures. To do this, it is recommended to keep a “migraine diary” where the circumstances surrounding the arrival of each migraine will be recorded. It will be necessary to note all the consumed food , the symptoms , its psychological situation (stress, relaxation after the stress, etc.), the external conditions (bright light, noises, etc.). Record any other information that seems relevant.
It can also be very helpful to note the small, though seemingly innocuous, symptoms that precede the migraine attack. Indeed, it is easier to fight migraine if you act at the onset of precursor symptoms.
By discovering the products or situations that trigger migraine, many people manage to reduce or virtually eliminate seizures.
Adapt your way of life
The newspaper will help make the necessary changes. For many migraine sufferers, it is very beneficial to reduce stress, not to skip meals, to exercise and to have enough sleep (at least 6 to 8 hours per night) and regular sleep ( get up and go to bed at the same time, both week and weekends).
Medical treatments for migraine
Drugs in prevention
The so-called “prophylactic” drugs do not cure migraine but they aim to reduce the intensity and frequency of seizures. They constitute a background treatment and usually need to be taken daily. The preventive effect can take from 2 to 3 months before manifesting itself.
These medications are usually only prescribed to people who suffer from migraines frequently (3 or more attacks per month) and whose activities are sufficiently disrupted to warrant medication. But there is no really established rule: the initiation of treatment is discussed on a case-by-case basis with the doctor. You should know that some drugs have side effects and that their long-term effectiveness is not guaranteed. However, for people with severe and frequent migraines, prophylactic medications can be a blessing.
The most commonly prescribed medications are:
- The beta-blockers , such as propranolol (Inderal) and timolol (Timol). Apart from migraines, these drugs are commonly used to treat hypertension and cardiovascular disorders. Other antihypertensives, such as lisinopril (Zestril), may also be effective. (cf Mayo) ;
- The calcium channel blockers , particularly flunarizine;
- The anticonvulsants (such as valproate, topiramate, gabapentin), but these can generate significant high-dose adverse events (nausea, vomiting, diarrhea …)
- The antidepressant tricyclic low dose (amitriptyline). Other antidepressants, such as venlaflaxine (Effexor), are also used. (cf Mayo);
- The vitamin B2 (riboflavin) to fill some gaps of brain cells in people with frequent migraines;
- The hormone replacement (estrogen gel) for reproductive age women whose migraines are related to hormonal fluctuations during the menstrual cycle.
The Botox , especially a bacterial toxin used to reduce wrinkles, may also help to relax the tense muscles of the head and neck. In October 2010, the Food and Drug Administration (FDA) approved the use of Botox injections for preventive treatment of migraine chronic. This indication concerns the rare cases where migraines occur at least 15 days a month. However, the therapeutic effect of Botox is low when compared to that of a placebo . Indeed, according to 2 studies conducted with 1,384 subjects (partially funded by the manufacturer of Botox) , a placebo treatmentshorten the duration of migraines by 6.2 days per month; Botox, 8.2 days.
It is important to discuss with your doctor the potential risks of Botox, which should be given every 3 months. The health authorities of Canada and France are studying the possibility of approving this therapeutic indication. Doctors can nevertheless use it off-label that is for “non-intended use”.
Treatments in case of crisis
There is no cure for migraine . Seizures should be treated with painkillers when they occur. All medications, whatever they are, will be more effective in relieving the pain if they are used as soon as the precursors of the migraine appear , or at the beginning of the headache if there are no signs precursors.
People who only experience a few migraine attacks a year may be able to take medications occasionally without worrying too much. The situation is different for those who suffer from frequent migraines. Indeed, many studies indicate that, on the one hand, the drugs can lose their effectiveness if one consumes a large quantity and, on the other hand, that they can even lead to an increase in the frequency of migraines. It is important to consult your doctor if you take a painkiller more than 10 to 15 days a month, because there is a risk of headache by drug abuse (headaches “rebound”). People who have frequent migraine attacks therefore have an interest in favoring a preventive approach to decrease their symptoms.
The acetylsalicylic acid (aspirin), the acetaminophen (Tylenol) and anti-inflammatory non-steroidal prescription (ibuprofen, Advil, Motrin, etc.) are often sufficient to break a mild migraine attack if the takes as soon as the first symptoms appear. Some preparations have been specifically designed to relieve migraines. This is the case of Liqui-Gels Advil (and Liqui-Gels Advil Extra-Fort), which contain a solubilized form of ibuprofen, with a slightly faster effect.
Warning. Consumed regularly, nonsteroidal anti-inflammatory drugs can irritate the stomach and cause ulcers. Ask the pharmacist or your doctor.
Some drugs contain a combination of painkiller molecules. This is the case of Tylenol Ultra-Efficace, which contains a mixture of acetaminophen (500 mg per tablet) and caffeine (65 mg).
If over-the-counter medications are not enough, doctors can offer a wide range of more powerful products , depending on the case and personal tolerance.
- Nonsteroidal anti-inflammatory drugs . The doctor may prescribe more powerful anti-inflammatory drugs, such as naproxen, diclofenac or ketorolac. However, these drugs are probably no more effective than ibuprofen, at equivalent doses;
- Triptans . This class of drugs is very effective in case of failure of conventional painkillers. Sumatriptan (Imitrex) was the first drug in this class. Since then, other triptans have appeared on the market: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt) and zolmitriptan (Zomig). These synthetic molecules mimic the action of serotonin and cause the constriction of blood vessels. Some are in the form of nasal sprays, others in the form of tablets to swallow or oral dissolution. Imitrex is also available as an auto-injectable device;
Triptans are generally well tolerated and effective even when the crisis has begun. In some people, however, they can cause nausea, dizziness, muscle weakness and, very rarely, cardiovascular problems. It is sometimes necessary to try several before finding one that is suitable;
- Ergotamine . Ergotamine combined or not with caffeine (Ergomar, Cafergot), in tablet form, is also prescribed to help reduce pain. It is less effective than triptans and can cause nausea and vomiting. There is also dihydroergotamine (Migranal), an ergotamine derivative that causes fewer side effects and is administered by nasal spray;
- Antinauseus . For migraine headaches with severe nausea, metoclopramide or prochlorperazine may help relieve this symptom. It is sometimes used in hospital, intravenously, to treat resistant migraines;
- Butalbital and other painkillers . For a stronger analgesic effect than those found over the counter, there is Fiorinal, which contains butalbital (a sedative), acetylsalicylic acid and caffeine. They tend to be left behind in favor of other more effective drugs.
|Opiates . Their use is not recommended because they have not been effective and they carry a risk of dependence.|
Advice in case of crisis
- Lie down in a dark and calm room;
- Put a cold compress on his forehead;
- Massage the scalp;
- Put pressure on his temples.