Migraine

Cause

Migraine is caused by contracting and dilating of blood vessels in the head. Substances that transfer nerve impulses in the brains (neurotransmitters) probably play a major role. Why one person has more frequently or more symptoms than the other, is not clear. It is true that a person is more likely to suffer from migraine as the condition also occurs in the family. What can trigger a migraine attack is individual. The most common factors are:

• Tension and stress.
• The transition from stress to relaxation.
• Particular substances in foods: flavor enhancers (such as in Chinese food and ready-made meals), sulphite (in wine), nitrate (in celery, endive, spinach, lettuce, fennel, conical cabbage, Chinese cabbage and red beets) and artificial sweetener (aspartame).
• Women have triggers that have to do with the female hormones, such as the period around the menstruation, pill use or hormonal contraception and menopause.

Symptoms

The signs and symptoms of migraine are:

• Throbbing or stabbing, severe headache at one side of the head.
• Hypersensitive to sounds or light.
• Nausea and vomiting.
• Sometimes numbness at one side of the face or in the limbs.

Flashes of light, blurred vision, black spots before the eyes, speech disorders, tingling and limpness sometimes precede the headache.

Diagnosis

The diagnosis of migraine is made on the basis of the symptoms the patient has. If the headache proceeds according to a typical pattern, the diagnosis is quickly clear. In special cases, additional examination takes place, such as a CT or MRI scan.

Treatment

The treatment of migraine is made up of regimens and medications. The regimens are: regular sleeping, eating and exercising, avoiding the use of alcohol, caffeine and aspartame (sweetener) and ensure sufficient relaxation.
There are two types of medications for migraine attacks:

• Drugs that combat the symptoms of migraine attacks. These are painkillers, anti-inflammatories (also called NSAIDs), drugs for nausea and antimigraine drugs.
• Drugs that can prevent migraine attacks. These are only prescribed when a person has more than two migraine attacks per month. The medicines are beta blockers and other drugs for migraine attacks.

Prognosis

For some patients, migraine is an occasional, tolerable inconvenience. For others it’s a devastating disease, resulting in frequent periods of reduced capacity, loss of productivity and seriously decreased quality of life. Therefore, treatment is based on the frequency, duration and severity of the attacks. A thorough explanation of the disease helps patients to understand that, although migraine cannot be cured, it can be well managed so that they can better participate in the treatment.

Considerations

• Avoid light, pungent odors and noise. Find a quiet, dark room.
• Apply cold, wet compresses to the forehead and temples.
• Try to do relaxation exercises in order to relieve the symptoms.
• It’s also important to figure out what causes the migraine attack. This can be done by keeping a headache diary. In this diary, the patient can write down when the migraine attack occurs and how severe the headache is. Furthermore, it’s possible to record in the headache diary what one ate and drunk that day and has done that day. On the basis of these notes, there may be a pattern to detect, that may indicate a cause. Think of eating certain foods. If, for example, it appears that a person has migraine attacks each time after eating spinach or red beets, then it’s better to avoid these products.

Facts

• The term ‘migraine’ is derived from the Greek word hèmikranion, that is composed of hèmi (half) and kranion (skull).
• The prevalence of migraine is 10%.
• Women are three times more likely to have this condition than men.
• Although migraine can occur at any age for the first time, it usually starts at the age of 10 to 40 years.
• In most people with migraine, headache occurs regularly, but over the age of 50 or 60 years, the attacks are usually significantly less severe or the migraine disappears entirely.