Migraine

Description of the Disease

Migraine is a sudden pulsating type of headache without a clear cause, typically localized on one side of the head, often in the temple or forehead area. This headache is often accompanied by symptoms such as fatigue, nausea, vomiting, dizziness, and sensitivity to light and sound.

Women and Migraine

Migraine occurs more frequently among young women who have started menstruating (menarche). The attacks often recur before menstruation, presumably due to hormonal changes. Some women claim that the attacks completely disappear during menopause. Men experience migraines three times less often than women.

Frequency and Population Affected

There are cases where individuals do not even suspect they had a migraine attack, likely because it was the only one in their life. However, migraines occur more frequently in a larger population of sufferers. Typically, attacks happen 1-3 times per month, with each attack lasting from 4 to 72 hours.

Symptoms

A migraine attack is divided into 4 stages:

1) period before the onset of headache – mood, behavior changes. This includes increased irritability, restlessness, bad mood, decreased productivity (in rare cases, the opposite occurs – elevated mood, increased productivity). Sometimes there is a change in taste perception (craving for something salty, spicy, etc.). Some experience facial pallor, others have unexplained yawning.

2) migraine aura – the manifestation of neurological symptoms before or during the headache. Aura does not occur in everyone, so for some, migraine is called with aura, for others – migraine without aura. In very rare cases, there is only aura without headache. Aura symptoms appear within 5-20 minutes and last about 60 minutes. They include flickering in the eyes, black spots in the field of vision, light zigzags, geometric figures, sometimes – visual hallucinations, visual disturbances (more common in children). Sensory disturbances, tingling (in the hands, lips, tongue, face, etc.), speech disturbances, limb weakness are also characteristic.

3) headache – one-sided (60%) intensifying with physical activity, starting at any time of the day, although usually felt in the morning upon waking. Nausea, vomiting, fear of light and/or sound, attention and/or memory impairment may accompany the pain. Those affected usually take painkillers, draw the curtains in the room, lie down in bed, cover their head with a blanket, lie still afraid to move, and, exhausted by the pain, fall asleep, and when they wake up, the pain has decreased or disappeared.

4) recovery stage – the headache along with other symptoms weakens and disappears. Fatigue, weakness, increased irritability may be present.

Diagnosis

The necessary criteria for diagnosing migraine include:

Headache attacks last 4-72 hours. The headache presents with at least 2 of these features: occurring on one side of the head, pulsating in nature, moderate to severe intensity (interfering with or stopping daily activities), and worsening with activities such as climbing stairs or other similar physical exertion. Additionally, the headache is accompanied by at least one of the following: nausea and/or vomiting, or sensitivity to sound and/or light.

Treatment

Treatment divides into attack treatment and prophylactic treatment between attacks to reduce their intensity and frequency. Prophylactic treatment applies when attacks occur 1-2 times per month and significantly interfere with daily activities.

a) Treatment of Attacks:

• Relief for mild and moderate pain comes from analgesics such as aspirin or paracetamol, or their combinations with caffeine (Panadol Extra, Saridon) and codeine (Efferalgan codeine, Prodeine).
• To suppress nausea or vomiting, metoclopramide (Cerucal) and domperidone (Motilium) are suitable.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, indomethacin, diclofenac, ibuprofen, and ketorolac effectively relieve pain. However, they do not alleviate accompanying symptoms, leaving patients incapacitated after the pain subsides.
• The most effective drugs for treating an attack are triptans. Patients must take triptans at the onset of a headache attack; they are ineffective during aura. Triptans also alleviate other accompanying symptoms.
  • Restrictions: Triptans are not for patients with ischemic heart disease, arterial hypertension, pregnant women, and those under 18 years of age.
• Other known drugs include ergot alkaloids, but they have many side effects.

b) Prophylactic Treatment:

• Behavior modification and elimination of triggering factors for attacks are crucial. This includes maintaining a regular daily routine, ensuring quality sleep, engaging in regular exercise, and following a proper diet. Avoid foods containing tyramine, such as fermented cheese, and alcoholic beverages, especially red wine, which is rich in sulfites. Also, avoid smoking and learn to cope with stress.
• Medications prescribed for prophylactic treatment include:
  • Beta-adrenergic blockers (e.g., metoprolol)
  • Tricyclic antidepressants (e.g., amitriptyline)
  • Calcium channel blockers (e.g., verapamil, diltiazem)
  • Antiepileptic drugs (e.g., valproates, carbamazepine)
  • Magnesium preparations
  • Herbal remedies

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology