Dealing with migraine pain

For those who do not suffer from them, migraines are often considered to just be really bad headaches, but for the millions of people who endure the torture of migraines, they are so much worse. 

Although they are a form of headache, migraines usually come with a very intense throbbing or pulsing pain in one area of the head and are often disabling for the sufferer. Dr. Else Christoffersen of Cayman Doctors Ltd. explains that migraines are divided into two main categories – migraines without aura, also known as the common migraine, which accounts for 80 to 85 per cent of migraines, and migraines with aura, also known as classic migraines. 

The common migraine typically lasts between four and 72 hours and “can be so severe that all the patient can think about is finding a dark, quiet place to lie down,” says Christoffersen.  

Symptoms of the common migraine include unilateral location (one side of the head), pulsating quality, moderate to severe intensity, and/or physical activity making the pain worse. The patient may also suffer from nausea and/or vomiting or extreme sensitivity to light and/or sound.  

People who suffer from migraines with aura experience similar symptoms, but these are accompanied by flashes of light, having blind spots or getting tingling in an arm or a leg.  

Chronic migraines fall into either of these two categories, but the patient has migraine type headaches which occur 15 or days per month for three or more months in the absence of medication overuse and other diseases, says Christoffersen. 

About 5 per cent of children with headaches suffer from migraines. Both boys and girls get migraines, but after puberty it’s more common among girls, the doctor said. “Children may have symptoms other than headache, including stomach pain (abdominal migraines) or forceful and frequent vomiting (cyclic vomiting),” she says. 

“Having said this, there are a number of dilemmas in diagnosing migraines such as; the pain can be non-throbbing (40 per cent), it can be bilateral (43 per cent), neck pain is often present (70 per cent) and sinus pain and pressure, stuffiness, runny nose and weather association is often present (97 per cent of migraine attacks),” Christoffersen explains. 

 

Symptoms 

While the symptoms of migraine can differ from one person to the next, there are warning signs that show a migraine may be developing. 

One or two days before a migraine, subtle changes may signal an oncoming migraine, including constipation, depression, diarrhoea, food cravings, hyperactivity, irritability and neck stiffness. 

“About 10 to 15 per cent of patients with migraines will experience an aura which is usually visual but can be sensory, motor or verbal,” says Christoffersen. “These symptoms begin gradually, build up over several minutes and last for 10 to 30 minutes.” 

If left untreated, a migraine can last up to 72 hours and the frequency varies between patients. After the migraine pain has stopped, the patient typically feels “drained” or “washed out”, though some feel mildly euphoric.  

 

Causes 

It’s not entirely clear what causes migraines although studies have shown that the aura seen by migraine sufferers coincides with constriction of blood vessels in the brain, which may start in the occipital lobe where the visual cortex is located.  

“When the constriction of blood vessels inside the brain stops, the aura subsides and the blood vessels of the scalp dilate. The walls of the latter become permeable and some fluid leaks out. This leakage is recognised by pain receptors in the surrounding tissue and the body supplies the area with chemicals which cause inflammation.  

“With each heartbeat, blood passes the sensitive areas causing a throbbing pain,” says Christoffersen. 

Serotonin helps to control mood, pain sensation, sexual behaviour, sleep, as well as dilation and constriction of the blood vessels. Low serotonin levels in the brain can lead to constriction and dilation of the blood vessels which also trigger a migraine.  

 

Triggers 

A fluctuation in oestrogen may also trigger migraines. Women tend to have more symptoms immediately before or during their periods as well as in early pregnancy or at menopause. Hormonal medications, such as oral contraceptives and hormone replacement therapy, may aggravate or reduce migraines symptoms. 

Foods that can prompt migraines include aged cheeses; chocolate; aspartame; monosodium glutamate or MSG which is common in Asian cooking, alcohol, especially beer or red wine, or caffeine. 

Stress at work or home and sensory stimuli, including bright lights, sun, loud sounds, smells, such as perfume or unpleasant odours, including paint thinner and smoke, can also trigger migraines, says Christoffersen. 

“Other triggers include changes in sleep pattern (too much or not enough sleep and jet lag), physical exertion, including sexual activity and changes in the environment, including weather changes and/or barometric pressure can initiate migraines as can medications, including oral contraceptive, vasodilators such as nitro-glycerine, and Viagra type mediation,” she says.  

 

Risk factors 

A person’s family history, age, gender and hormonal changes can impact if and how badly they are affected by migraines. 

“Up to 90 per cent of patients with migraines have a first degree relative – mother, father or sibling – who also suffers with migraine,” says Christoffersen. 

“Most patients experience their first migraine during adolescence and, in general, migraines start before age 40. In childhood, migraine headaches affect more boys than girls, but by puberty more girls are affected. Women are three times more likely to have migraines than men,” she says. 

Migraine sufferers are advised to see a doctor immediately if they experience an abrupt, severe headache like a thunderclap; have a headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking; a headache after a head injury, especially if the headache gets worse; a chronic headache that is worse after coughing, exertion, straining or a sudden movement; or a new headache pain if they are older than 50. 

 

Treatments 

Medication can be taken to treat, relieve or prevent migraines. Pain-relieving medications can be taken during migraine attacks to stop symptoms that have already begun. There are also preventive medications which are taken regularly, often daily, to reduce the severity or frequency of migraines. 

One preventative treatment available for migraine sufferers is Botox, which was approved by the US Food and Drug Administration last year as a treatment of chronic migraine headaches in adults.  

The procedure involves getting about 30 injections in the muscles in the forehead, neck and sometimes the temporal area. The treatment typically needs to be repeated every 12 weeks.  

Botox, the trade name for botulinum toxin type A, blocks the release of a chemical messenger at the junction between nerves, temporarily stopping muscles from contracting, Christoffersen said.  

Two studies involving 1,384 adults in North America and Europe published in 2010 reported that patients treated with Botox experienced a major decrease in the frequency of headache days. 

“Exactly why Botox is effective in relieving headache is not clear but it may be direct effect on the neuro-muscular junction or via sensory nerves,” says Christoffersen. 

There are also alternative or home remedies that have been shown to ease migraines, including muscle relaxation exercises, meditation and yoga for at least 30 minutes each day, or simply relaxing by listening to music, gardening, taking a hot bath or reading. A good night’s sleep can also help.  

“Rest and relax, if possible, in a dark, quiet room when a headache is coming on, place an ice pack wrapped in a cloth on the back of the neck and apply gentle pressure to painful areas on the scalp,” says Christoffersen. 

She also advises keeping a headache diary to track what triggers the migraines and the most effective treatment.