It is a common disorder that can affect up to one in five women and a man of 15.
Some migraines are preceded or accompanied by sensory warning symptoms or signs ( auras ), such as flashes of light, vision points blacks or tingling in the legs or arms. Together with migraines often have nausea, vomiting, and extreme sensitivity to light and noise.
Those who suffer from it tend to have attacks triggered by a number of different factors, including the stress , the ‘ anxiety , hormonal changes, flashing lights, or even lack of food or sleep, and rather common foods. In women it is often linked in some way to the menstrual cycle.
For many years it was considered that it was linked to the dilation and constriction of cerebral blood vessels, while now it is more oriented to investigate genetic causes.
For migraine there is no cure, but medications can help reduce the frequency and intensity of attacks. If a certain type of treatment has not worked in the past, it is worthwhile to consult your doctor and seek a different set. The appropriate drugs, combined with home remedies and lifestyle changes can really make a difference.
Many of the causes of migraine are still unknown, but it appears that both genetic factors and environmental ones have an important role.
It might in some way be related to temporary alteration in brain activity, which affects the neurotransmitters in the brain and blood vessels. In particular it is believed that it can be linked to most of the cerebral cortex excitability and an abnormal control of pain neurons in the trigeminal nucleus of the brainstem.
It is unclear what causes this change in brain activity, but it is possible that specific genes make it more likely the occurrence of migraines as a result of situations, events, and substances that can act as triggers.
Even if you do not know the exact mechanism of the headaches, you know that the triggers are many, among the most common are:
- Female hormonal changes . It seems that changes in estrogen levels are capable of causing headaches in many women who have been diagnosed with migraine. Women with migraine often claim immediately preceding suffer from headaches before or during menstruation , when there is a sudden decrease in estrogen. Others, however, have a greater tendency to develop migraines during pregnancy or menopause .
- Stress . Stress in the family or in the workplace can cause migraines.
- Sensory stimuli . Migraine headaches can be caused by bright lights and sun glare, but also by very loud noises. Unusual smells and unpleasant odors, such as the paint thinner and smoke, can have the same effect.
- Changes in sleep-wake cycle . The insufficient or excessive sleep can trigger migraine attacks in some patients; even jet lag can have the same effect.
- Physical factors . Intense physical exertion, including the ‘ sexual activity , may provoke migraines.
- Changes of time . A change in the weather or atmospheric pressure may facilitate the onset of migraine.
- Drugs . Certain medications can worsen migraines.
- Fame . Migraine can also occur when you skip meals or eat too fast.
- Dehydration .
- Celiac . There seems to be some connection between gluten and headache, although at the moment has not yet been fully clarified. Some patients seem to benefit from a gluten-free diet.
- Food . Some types of migraines seem caused by certain foods, although the topic is debated; among the most harmful are
- alcohol, especially beer and red wine,
- aged cheeses,
- the chocolate,
- caffeine (some more than anything else would be the caffeine withdrawal),
- monosodium glutamate (a food additive)
- salty foods and industrially processed.
On many of these trigger factors, there is insufficient evidence in the literature, but basically you can see that all sources of stress for the organism could trigger the attack; In this regard it is believed particularly useful subdivision proposal from ‘ English NHS :
- poor sleep quality
- shift work
- poor posture
- voltage neck or shoulder
- low blood sugar (hypoglycemia)
- intense exercise in the absence of proper training
- late meal or skipped meal
- Foods containing tyramine
- caffeinated beverages, such as tea and coffee
- specific foods like chocolate, citrus fruits and cheese
- bright lights
- flickering visions, as may occur in television or PC
- smoke (or local smoke filled)
- loud noises
- climate change, such as changes in humidity or very low temperatures
- strong odors
Symptoms of Migraine
The headache usually occurs for the first time in childhood or during youth and characteristic symptom (though not always) is a strong pain with the following characteristics:
- pain, moderate to severe variable intensity, which can be limited to one side of the head or can affect both sides;
- sore pulse type head;
- pain that worsens with physical activity;
- pain that interferes with normal daily activities.
They can also appear;
- nausea with or without vomiting,
- sensitivity to light and noise,
- sweating more or less intense,
- worsening of the ability to concentrate,
- feeling hot or cold,
- abdominal pain,
This form of headache has different characteristics depending on the patient, most people suffering from migraine without aura, formerly called common migraine . Some people, on the contrary, suffer from migraine with aura, previously called classic migraines . The aura includes several phenomena including changes of vision and sensory disorders: if you suffer from migraines with aura may see bright flashes and feeling tingling in the arms or legs.
Whether you have the aura that is not have, it is possible that for several hours or a day before the attack of migraine started to experience some warning signs including:
- elation or intense energy,
- craving for sweets or other specific foods,
- increased thirst and frequency of urination,
- muscle stiffness that primarily affects the neck,
- constipation or diarrhea,
- hypersensitive to smells or noises,
- irritability or depression .
These symptoms (defined prodromal or warning) occur in 6 out of 10 people, from two hours to two days before the start of the pain or the aura.
The aura is a set of neurological symptoms that precede the migraine attack; It is characterized by sensations and extremely unpleasant and unwelcome Excited of variable duration between 5 and 20 minutes (even if you know cases of long aura up to an hour). During these times you still feel no pain, migraine attack occurs only after the end of the aura, not necessarily. It may actually not feeling any pain but would still others listed disorders.
The most common symptoms include;
- visual disturbances,
- loss of strength,
- altered sensitivity to a hand, often as pins and needles, which then “back” on the arm to involve the face, lips, or tongue,
- annoyance caused by light,
- speech difficulties.
- Phase postdromica
The effects of migraine may persist for some days after the complete disappearance of the headache; Many patients report
- a feeling of pain in the area where you had migraine
- severe fatigue,
- difficulty concentrating,
- sensitivity to light and sounds,
- mood changes.
Care and Treatment of Migraine
There are several suitable drugs for the treatment of migraine, also they can be used drugs that are usually used to treat other diseases. Drugs that fight migraines can be classified into two categories:
- Painkillers . The drugs of this type are taken during the attack of headache and are designed to stop symptoms that have already begun.
- Preventive therapies . The drugs of this type must be taken regularly, in many cases, once a day, to reduce the severity or frequency of episodes of headaches.
The choice of therapeutic strategy against migraine depends on the frequency and severity of migraine headaches, the degree of disability that causes the headaches and from any concomitant diseases.
The advice given by neurologists to all patients who suffer from migraines is to hire the painkiller prescribed at the first symptoms, possibly already in the prodromal phase; This greatly increases the likelihood of being able to stop the attack.
nonsteroidal anti-inflammatory (NSAID)
These drugs, such as ibuprofen (Moment®, Brufen® and others) or the ‘ aspirin , can help ease the pain of mild intensity head. The drugs marketed for the treatment of migraine specific, as the combination of acetaminophen , aspirin and caffeine (for example NeoCibalgina®) may be effective for mild sore head but, used alone, are not effective against migraine serious. If taken too often or for long periods, NSAIDs can cause ulcers, gastrointestinal bleeding and rebound headaches.
For many people who suffer from intense migraine attacks, triptans are the drug of choice. They are effective to relieve pain, nausea and sensitivity to light and noise associated with migraine. Among the drugs of this type we include: sumatriptan (Imigran®), rizatriptan (Maxalt®), the naratriptano, zolmitriptan (Zomig®), the almotriptan (Almotrex®), the frovatriptan (Auradol®) and eletriptan (Relpax®). Among the side effects of triptans are nausea, dizziness and muscle weakness. Not advisable if the patient has had a heart attack or a stroke.
The drugs containing narcotics, particularly codeine, are sometimes used to treat headaches if patients can not take triptans or ergotamine. Narcotics are addictive and are usually used if all other remedies have proven ineffective.
The ergotamine (Cafergot®) is much less expensive but also less effective than triptans. It seems most effective in those who suffer from a headache that lasts for more than 48 hours. The dihydroergotamine (Diidergot®, Seglor®) is an ergot derivative that is more effective and has fewer side effects than ergotamine.
A single dose of dexamethasone intravenously, when added to standard therapy of a migraine attack, it is associated with a decrease of 26% in recurrent headache in the following 72 hours.
Medications that combine the butalbital (a sedative) with the aspirin , the acetaminophen or other pain relievers (eg Optalidon®) are used in some cases to treat migraine attacks. Other combinations also contain caffeine or codeine. These drugs, however, have a high risk of rebound headaches and withdrawal symptoms, so they should be used with caution.
About half of people who suffer from migraines may benefit from preventive therapy, but only 10% of patients are they implemented. Prevention is recommended for those who have headaches for more than two days a week, they can not tolerate the drugs used to treat acute attacks or those with severe attacks that are not easily controlled.
Preventive therapies are able to decrease the frequency, severity and length of migraines and may increase the effectiveness of the drugs taken during the attacks. Your doctor may advise you to take preventive medications regularly or only when a predictable trigger, such as menstruation, is approaching.
In most cases preventive therapies do not completely eliminate the headache and some of them can cause serious side effects; if preventive therapies have had good results and the headaches did not show up for a period ranging from six to twelve months, your doctor may advise you to gradually decrease the dosage to see if the headache occurs.
For best results, you take medication carefully following the recommendations of your doctor.
- Drugs for cardiovascular disorders. Beta-blockers, usually used to treat hypertension and coronary heart disease, are able to decrease the frequency and severity of migraine attacks.
- Antidepressants. Several antidepressants are able to contribute to the prevention of certain types of headaches, including migraines. The most effective are tricyclic antidepressants, such as amitriptyline, nortriptyline and protriptyline. For other types of antidepressants, such as selective serotonin absorption inhibitors (SSRIs) and absorption inhibitor of serotonin and norepinephrine (SNRI), it has not yet been shown to be effective for the treatment of migraine.
- Anticonvulsant. Some anticonvulsant drugs such as topiramate (Topamax®) and gabapentin (Neurontin®) seem to be able to decrease the frequency of migraine attacks.
- Antihistamines, such as flunarizine and cinarizina, indicated if coexisting anxiety and insomnia and contraindicated in cases of depression and obesity.
- Botulinum toxin A . Botulinum toxin A is used in some cases to treat chronic migraine. The investigation up till now, however, give conflicting opinions on the effectiveness: several specialists, however, believe it may be helpful for some patients. Injections are given in the muscles of the face and neck.If successful, the therapy has to be repeated every three months.
Pregnancy and breastfeeding
The treatment of migraine with drugs should be as limited as possible when you are pregnant or breastfeeding, instead focusing its attention to avoid potential triggers.
When if they can not do without, your doctor may prescribe a painkiller such as paracetamol or, in special cases, a triptan.
Lifestyle and remedies DIY
To relieve headaches caused by migraine, you can try some non-drug remedies.
- “The real” acupuncture does not provide the best results of ‘ “sham acupuncture”, a practice in which the needles are inserted in a random way.
- Practice relaxation exercises . To practice progressive muscle relaxation, meditation and yoga do not need nessun’attrezzatura. You can learn them by attending a class or by reading a book or watching a DVD. Alternatively devoted at least half an hour a day to a few activities that you find relaxing: listen to music, gardening, taking a hot bath or reading.
- Get enough sleep, but not too much . On average, adults need six to eight hours of sleep per night. You should also go to bed and wake up at regular times.
- Rest and relax . If possible, when you feel the headache is approaching, rest in a dark, quiet room.
- Keep a diary of your headaches . Continue to write the diary even after you made to the doctor. It will help you understand better what are the triggers of headaches and what treatment is most effective.