Migraine: Causes and treatments

Anyone who has had a migraine knows how debilitating it can be. An attack starts with a throbbing, often one-sided, pain in your head that spreads like cold metal from one eye to the other. You put your head down, trying to hide from bright lights and loud noises. A feeling of nausea sets in…

A migraine is not just a bad headache. It can wear you down like no other. For many people who suffer from chronic migraines, more than half the days in a month can be spent in this state. About one in two people on the planet get headaches from time to time, while migraines affect about 15% of people worldwide.

Migraine: Causes and treatments
"big headache" by 19melissa68 is licensed under CC BY-NC 2.0

Migraine is linked to brain hypersensitivity

Migraine is characterised as a hypersensitivity disorder in which abnormally sensitive neural connections are found in the human brain. Compared to healthy people, migraine sufferers have a greater sensitivity and are more likely to react to small changes in the environment, which can lead to headaches or more severe migraine attacks.

The onset of migraine is thought to be due to a disruption in the electrical activity of sensory neurons in the meninges, the membrane surrounding the brain.

When these neurons are activated, they send signals to the brain that cause headache, photophobia and other manifestations of migraine. These neurons are usually close to blood vessels, so the headache can feel like a throbbing heartbeat.

A migraine attack is often preceded by certain symptoms

These used to be called the prodrome of a migraine attack, but doctors have now abandoned this term. The symptoms usually last 1-2 days before a migraine attack. The most common of these are: food cravings or loss of appetite, irritability, drowsiness, reduced ability to work, mood swings, hyperactivity, increased thirst.

In about a quarter of people, a painful migraine attack is preceded by an aura – specific visual and physical sensations that are not painful in themselves. The aura is caused by a spasm of blood vessels in the brain that precedes the painful attack. Aura is most often visual: flickering, various geometric shapes, dark or bright spots appear in front of the eyes. A sensory aura is a tingling or numbness in one or more limbs, the face or tongue.

What triggers a migraine?

There are many factors that can trigger a migraine, and the set of factors can vary from person to person. Some of the most common include:

  • Bright lights and loud noises.
  • Strong odours, such as perfume, smoke or certain spicy foods.
  • Sleep problems: lack of sleep, disturbed sleep patterns or jet lag.
  • Poor diet or dehydration.
  • Excessive caffeine consumption.
  • Alcoholic drinks, especially red wine.
  • Hormone changes, such as before or during menstruation, pregnancy or the menopause.
  • Certain foods and diets, especially diets containing ultra-processed foods and processed sugars.
  • Anxiety and stress.

Ways to relieve migraine symptoms

Seclusion in a dark, quiet room: Many people with migraines experience hypersensitivity to light and sound during attacks. Creating a quiet and comfortable environment can help relieve tension and ease painful sensations.

Cold or warm compresses: Applying a cold or warm compress to the forehead or back of the head can provide temporary relief. Some people prefer cold compresses, while others prefer warm compresses.

Breathing exercises and relaxation: Deep breathing techniques and meditation can help you relax and reduce stress, which is often a trigger for migraines.

Biofeedback: This technique teaches you to control physiological functions such as heart rate, body temperature and muscle tension to help manage pain.

How to treat a migraine

Although there is no cure for migraines, there are treatments that can reduce the frequency and intensity of attacks. However, it is important to see a doctor who can prescribe the right treatment, as self-treatment can only make things worse.

There are two main areas of migraine treatment:

Suppressing the attack: This involves the use of painkillers, especially non-steroidal anti-inflammatory drugs (NSAIDs) and triptans, which are drugs specifically designed to relieve migraine pain.

Preventive treatment: This method aims to prevent attacks from occurring and to reduce their intensity and duration. Doctors may recommend the use of tricyclic antidepressants, vascular drugs, non-steroidal anti-inflammatory drugs (especially to prevent menstrual migraines), anticonvulsants and Botox injections in the neck to relax the muscles.

In recent years, new drugs have become available that block the protein CGRP, which is responsible for transmitting the pain signal in migraine.

Prepared by Mary Clair

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