What is migraine?
Migraine is the result of activation or irritation of the trigeminal nerve fibres. This nerve has three branches that transmit sensation in the head. The fibres of the first branch surround the blood vessels found in the membranes known as the meninges.
The meninges are made up of different layers of tissue that lie over the brain and it is in these structures where we feel the pain. It is the membrane covering it, not the brain itself, where the pain is felt.
During a migraine, the meninges become inflamed as a consequence of inflammatory substances being released from the trigeminal fibres. This inflammation, or non-infectious “meningitis” is responsible for producing the pain and means that it increases or worsens when upon moving the head. For this reason, resting and staying still brings relief.
A migraine attack may last from 4 to 72 hours. This type of headache may occur any number of times, from once a year to several times in succession.
- Pulsing, intense or dull pain on one or both sides of the head
- Pain increases with physical activity
- Lack of appetite, nausea or vomiting
- Altered vision, which may be blurry or with blind spots
- Sensitivity to light, sound or odours
- Tiredness and confusion
- A blocked nose
- Feeling cold or sweating
- Neck is stiff or sensitive to touch
- Mild dizziness
- Sensitivity to touch on the scalp
Who does migraine affect?
This condition is three times more common in women than men. It generally starts before thirty years of age and no later than fifty.
There is often a family history of migraine. It can be triggered by various stimuli such as food and drink (cheese, red wine, chocolate), intense odours, bright lights, changes in the weather, changes in sleep patterns, hormonal changes and stress.
The symptoms a patient describes must be taken into account when making a diagnosis. A detailed physical and neurological examination should then be carried out, which should be normal in a person with migraine.
After this first stage, the health professional will decide whether additional examinations are necessary to confirm it is migraine and not another illness.
Certain conditions require further medical investigation such as when:
- the patient is over 50 years old and it appears for the first time
- the pain arises with physical effort
- it wakes them up during the night
- it appears suddenly and is very intense
- it has appeared recently and is progressively worsening
- it has occurred before, but now with increased frequency or intensity
- other changes have occurred with the headache: changes in personality, behaviour, loss of consciousness or the ability to focus
Although there is no cure for migraine, the right treatment can relieve the pain and prevent it occurring.
- Non-pharmacological treatment: the person affected identifies their specific migraine triggers and avoids them. Physiotherapy can be useful in some cases.
- Pharmacological treatment: there are two kinds of medication: symptomatic, which is used to alleviate pain; and preventative, which aims to stop it appearing.
The first group includes anti-inflammatories, paracetamol, ergotamine and its derivatives, and drugs generically known as triptans. Preventative treatment is advisable when migraines are very frequent and do not respond well to symptomatic treatment.
The choice of a symptomatic or preventative treatment should be decided and monitored by a doctor. It is very important not to self-medicate to avoid chronic headaches that may be triggered by abusing analgesic medication. If used often or in large doses, both prescription and non-prescription medications can cause other problems.
One way to prevent migraine is to try to avoid the things that trigger it. However, some trigger factors are outside our control, such as migraine caused by menstruation or certain weather conditions.
Keeping a regular schedule and avoiding certain food and drink that may cause migraine, as well as getting enough sleep, are important to prevent it. It is important to have a balanced lifestyle with regular mealtimes and bedtimes.
Frequent and gentle exercise also helps reduce the illness.
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