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Migraine is a painful condition that can be chronic and severe.
Symptoms may include:
Migraine attacks last from 4 hours to 3 days, however it can last longer in certain cases. Some patients may experience warning signs 24 hours or more before each attack also known as ‘Prodrome’. This can involve excessive yawning, tiredness, neck stiffness, brain fog or craving certain foods.
Causes:
Migraine attack is caused by a particular brain activity which we believe may be attributed to genes. When exposed to an environmental trigger such as stress, lack of sleep, oversleeping, skipping meals, hormonal changes then an attack becomes evident.
Headache is a symptom but migraine is a diagnosis. There is a spectrum of migraine conditions and keeping a migraine diary is useful for both the patient and clinician and offering the right diagnosis. This is important so as the most suitable treatments can be offered.
Two main types of migraine:
.
This is the commonest type of migraine.
We regard ‘aura’ as a warning for migraine. This can be in the form of visual disturbance (flashing lights, blind spots or other). In migraine without aura, there is no warning sign for the migraine.
Symptoms
Usually one sided headache of throbbing nature classically. It exacerbates with movement e.g. walking, climbing the stairs.
It is moderate to severe intensity which means patients are mostly unable to carry on routine activities.
Nausea and/or vomiting are experienced
Light, sound, movement and /or smell sensitivity has been described.
Treatment:
Acute/ abortive treatment to be taken at the beginning of each attack: Paracetamol 1g, Aspirin 900mg, Triptan and anti nausea medication. Using pain relief for more days per month, than advised by a clinician may lead to medication overuse headache. For triptans, this is no more than 8 days per month.
Preventive treatment: plethora of options such as CGRP antagonists such as Rimegepant, Atogepant, or other classes of medication such as Propranolol, Candesartan, Topiramate and more. These treatments aim to reduce the frequency and severity of those attacks. They must be taken daily at the minimum working dose or higher.
Lifestyle changes:this can involve sleep hygiene, dietary advice, exercise, hydration and supplementation.
This is the commonest type of migraine.
We regard ‘aura’ as a warning for migraine. This can be in the form of visual disturbance (flashing lights, blind spots or other). In migraine without aura, there is no warning sign for the migraine.
Symptoms
Usually one sided headache of throbbing nature classically. It exacerbates with movement e.g. walking, climbing the stairs.
It is moderate to severe intensity which means patients are mostly unable to carry on routine activities.
Nausea and/or vomiting are experienced
Light, sound, movement and /or smell sensitivity has been described.
Treatment:
Acute/ abortive treatment to be taken at the beginning of each attack: Paracetamol 1g, Aspirin 900mg, Triptan and anti nausea medication. Using pain relief for more days per month, than advised by a clinician may lead to medication overuse headache. For triptans, this is no more than 8 days per month.
Preventive treatment: plethora of options such as CGRP antagonists such as Rimegepant, Atogepant, or other classes of medication such as Propranolol, Candesartan, Topiramate and more. These treatments aim to reduce the frequency and severity of those attacks. They must be taken daily at the minimum working dose or higher.
Lifestyle changes:this can involve sleep hygiene, dietary advice, exercise, hydration and supplementation.
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