Migraine

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General

A migraine is a neurological condition, commonly including headache as a symptom. It is a primary headache disorder. [1] There are different types of migraines. The mains classifications are classic and common. There are also more rare type of migraines (see below).

Phases

Migraines have four "phases," which may be distinct or overlapping. These stages are prodrome, aura, migraine (or "headache"), and postdrome.

Triggers

Specific instances of migraine may be "triggered" by external or internal forces. Triggers include lifestyle changes, types of food, atmospheric conditions and a variety of other forces and conditions. Some migraineurs successfully lessen the frequency and/or severity of their migraines by tracking and avoiding their triggers.

Symptoms

Symptoms of migraine vary by stage: aura, prodrome, "headache," and postdrome.

Symptoms also vary from migraineur to migraineur. In addition to the commonly known symptom of headache, migraineurs may suffer neurological symptoms and other physical symptoms.

Causes

Generally

Migraines can be inherited from family members (that is, a genetic trait). Migraines can also occur after physical trauma. Recent studies have indicated a possible link with childhood abuse, specifically emotional abuse, and migraines later in life.[2] Other theories are that migraineurs have low levels of certain vitamins, minerals, supplements, or combinations thereof, including magnesium[3], Vitamin D[4][5], Riboflavin[4][5], and CoQ10[4][5].

Migraine Onset

It is unclear what actually starts a migraine. There are many theories regarding triggers, discussed above. One theory is that migraines begin near or in the brainstem, sometimes called the "migraine generator."[6] Neurogenic inflammation plays a key role in the onset of migraine.[7] Another dominant theory involves cortical spreading depression.[7] Information and research about migraines is constantly evolving; some prior theories surrounding the physical cause and condition of the brain during onset have been debunked. Vasodilation is also thought to be involved in the onset of a migraine, but there is not definitive research regarding causation versus correlation.

Links with Other Conditions

Diagnosis

The International Headache Society (IHS) has developed a checklist to aid in migraine diagnosis:[10]

  • The patient should have had at least five of this type of headaches
  • The headache lasts from 4 to 72 hours
  • The headache must have at least two of the following:
    -One-sided location
    -Pulsing or throbbing quality
    -Moderate or severe intensity, inhibiting or prohibiting daily activities
    -Headache is worsened by routine physical activity
  • Headache must be accompanied by at least one of the following:
    -Nausea and/or vomiting
    -Photophobia and/or phonophobia
  • Secondary causes of headache are excluded with a normal exam and/or normal CAT scan or MRI scan.

Other Headaches

Migraine can be confused with a number of other types of headaches, which may lead to wrong diagnoses. It is possible to suffer from more than one type of headache (that is, one or more of the following may occur simultaneously or asynchronously with the occurrence of migraines). These other types of headaches include:

Rare Types of Migraines

  • Basilar migraine [11]
  • Confusional migraine [11]
  • Retinal migraine[11]
  • Hemiplegic migraine[11]
  • Migraine accompaniments[11]
  • Status migrainous[11]
  • Ophthalmoplegic migraine[11]

Treatment

There is no cure for migraines, but there are many possible methods of treatment and management. Treatment for migraines may be preventative or abortive. Preventative treatment is done in advance of a migraine, often daily or as part of a routine, in order to avoid future migraines. Abortive treatment is undertaken once a migraine has already begun, in order to stop that particular migraine from continuing.

Physicians may ask migraineurs to keep a "headache diary" in order to better understand the migraineur's individual symptoms and triggers. This may also be used to discover if the migraines are chronic or episodic.

References
  1. Jerry W. Swanson, M.D. Mayo Clinic on Headache. Mayo Foundation, 2004: p. 13
  2. Bushak, Lecia. "Emotional Abuse In Children May Be More Likely To Cause Migraines Than Sexual Or Physical Abuse." Medical Daily. March 2, 2016. [1] December 18, 2016.
  3. Stewart J. Tepper, M.D. Understanding Migraines and Other Headaches UP of Mississippi, 2004, p. 22.
  4. 4.0 4.1 4.2 Cincinattie Children's Hospital Medical Center. "Many with migraines have vitamin deficiencies, says study." EurekAlert. AAAS. June 10, 2016. [2] December 18, 2016.
  5. 5.0 5.1 5.2 Bushak, Lecia. "High Percentage Of People With Migraine Headaches Have Vitamin D, Riboflavin, Coenzyme Q10 Deficiencies." Medical Daily. June 10, 2016. [3] December 18, 2016.
  6. Stewart J. Tepper, M.D. Understanding Migraines and Other Headaches. UP of Mississippi, 2004, p. 26.
  7. 7.0 7.1 Gelb, Douglas, J. "Introduction to Clinical Neurology."New York, New York: Oxford University Press, 2011. pp 350-375.
  8. 8.0 8.1 David J. Dickoff, MD. "Primary Restless Limbs Syndrome, Migraine, and Bruxism: A Common Clinical Triad." Sleep Review. September 10, 2015. [4] December 18, 2016.
  9. Pamuk, G., Top, M., Uyanık, M. et al. Wien Klin Wochenschr (2015). doi:10.1007/s00508-015-0740-8 [5] December 18, 2016.
  10. (Stewart J. Tepper, M.D. Understanding Migraines and Other Headaches. UP of Mississippi, 2004, pp. 3-4. See also "IHS Classification ICDH-II." [[6]]
  11. 11.0 11.1 11.2 11.3 11.4 11.5 11.6 [(Jerry W. Swanson, M.D. Mayo Clinic on Headache. Mayo Foundation, 2004: p. 38-39)]