Migraines: Causes, Risk factors and Treatment

What are migraines?

According to the World Health Organization (WHO), up to 15% of the world’s population suffers from recurrent migraines. Migraines are a complex headache disorder and are characterized by recurrent moderate to severe headaches. The onset of migraines typically occurs around puberty, and recurrent migraine episodes usually happen throughout one’s lifetime. Migraine headaches are generally unilateral, meaning that they occur on one side of the head. Sometimes, migraines occur with visual or sensory systems, which are referred to as an “aura,” and which often occur before the onset of the migraine headache, but sometimes occur during or after the migraine. Migraines can last to up to 72 hours after their onset and are often followed by fatigue. Migraines occur more often in women than in men, with 19% of women experiencing recurrent migraines, compared to 11% of men.

What are the warning signs of migraines?

Sometimes, specific warning signs can be felt up to two days before the migraine occurs. These include constipation, diarrhea, neck stiffness, irritability, depression and hyperactivity.

What are the signs and symptoms of migraines?

Typical signs of migraines include the following:

  • Throbbing or pulsing headache of moderate to severe pain that worsens with movement or physical activity
  • Intense headache localized to one side of the head (unilateral), as well as pain,  felt throughout the head, across the forehead and pain behind or near the eyes. However, sometimes the pain is not localized and may be felt anywhere around the head or neck
  • Nausea and vomiting, as well as dizziness and food intolerance
  • Extreme sensitivity to light and sound
  • Irritability

Also, many individuals suffering from migraines also report experiencing “migraine aura,” the characteristics of which include the following:

  • The aura often occurs before the headache, but sometimes occurs during or after migraines
  • The visual aura consists of seeing “floaters” or bright spots and usually happens in combination with vision blurring
  • The aura typically occurs visually, but sometimes, can be sensory or motor, or consist of a combination of these symptoms.

Why do migraines occur?

It is currently thought that migraines occur due to both environmental and genetic factors. So far, research studies have identified several genetic factors which can contribute to the development of migraines. Genetics play an essential role in the event of migraines, with statistics showing that 70% of migraine sufferers have a first-degree relative with a history of migraines. So far, research studies have demonstrated that migraines with aura have a stronger genetic component than migraines without aura.

What can trigger a migraine?

External factors can often trigger migraine headaches. Factors such as stress, hunger and fatigue can all serve as migraine triggers. Specifically, psychological stress is commonly reported as a trigger for migraines. It seems that hormonal changes can also influence the onset of migraines, which often occur around the time of menstruation, menopause or pregnancy, or due to the use of oral contraceptives. Other factors associated with triggering of migraines include smoking, alcohol consumption, sleep problems, fasting or skipping meals, and use of certain medications.

Diet can also serve as a trigger for migraine headaches. Dietary intolerance to some compounds called biogenic amines has been reported to cause migraines. Specifically, the trace amine tyramine, derived from the amino acid tyrosinehas been associated with triggering migraine headaches. Tyramine is contained in higher quantities in smoked and fermented foods, as well as in foods containing soy and in most cheeses. Monosodium glutamate (MSG), which naturally occurs in some soy foods, but which can also be added artificially to enhance food flavour, has been associated with triggering some types of migraine headaches. Other dietary factors associated with increased risk of triggering migraines include consumption of caffeine, aspartame or other artificial sweeteners, and preserved meats containing nitrites.

Environmental factors, such as indoor air quality, lighting and strong odours have been associated with migraine attacks, although their role in causing migraines is not entirely understood.

How are migraines treated?

   1. Medication

Some medications can be taken to stop the progression of migraine and refer to as “abortive” migraine medications. These include some selective serotonin receptor agonists (such as triptans), ergotamines, and analgesics. Medications can be prescribed to prevent the occurrence of migraines known as “preventive” migraine medications, which include antiepileptic drugs, beta-blockers, non-steroidal anti-inflammatory drugs (NSAIDs), and botulism toxin. Some medical practitioners may recommend magnesium supplementation to treat the severity and frequency of migraine headaches.

   2. Alternative treatments

Medical practitioners may prescribe medication to treat chronic migraine headaches. It is important to note that some patients do not respond well to migraine medication due to side effects or prefer to avoid medication for other reasons. A number of alternative therapies exist to reduce or prevent the occurrence of migraines.

  3. Lifestyle changes

Effective migraine prevention strategies that do not involve taking the prescription medication include lifestyle changes and focus on the reduction of migraine triggers (improving quality of sleep, reducing stress levels, as well as avoiding cigarette smoke, alcohol and certain foods).

Avoid foods such as aged cheeses, MSG, pickled foods and smoked meats to help reduce the number of migraine attacks. Some health practitioners recommend taking nutritional supplements of vitamin B2, coenzyme Q10 and butterbur. Additionally, regular exercise can help to reduce the frequency of migraine occurrence significantly.

 4. Acupuncture and manual therapies

Several types of acupuncture have been proven to be an effective method for migraine prevention. Manual therapies, such as chiropractic manipulation, physiotherapy, and massage treatment, are as effective as certain medications used to treat migraines. Stress reduction techniques, such as relaxation techniques and yoga, can also be used to prevent migraines.

 5. Non-pharmacologic treatments

 Other therapies used to reduce the severity and frequency of migraines include biofeedback and cognitive-behavioural therapy (CBT). Transcranial magnetic stimulation (TMS) and vagus nerve stimulation (nVS) have also been shown to be effective in reducing the frequency and severity of migraine headaches.

  6. Surgery

In some severe cases, surgery involving the decompression of some nerves around the head and neck can be used to treat migraines which do not respond to medications and non-pharmacological treatments.

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