Everything You Need to Know About Migraines, From Causes to Cures

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Welcome to our column A Doctor’s Opinion, in which we put your most pressing medical questions to our resident doctor, Jane Leonard, a general practitioner and dermatologist based in London. This month, Dr. Leonard tackles a question about migraines.

Migraines are the worst. If you know, you know. And if you don’t, you have no doubt come across a friend, colleague or family member who suffers from them. This month, I’m going to reveal everything you need to know about these headaches from hell so you can understand the different types and how to deal with the pain.

So What Are Migraines Anyway?

A migraine is super-specific type of headache. Classically it’s a moderate to severe headache that’s throbbing in nature and tends to be localised to a particular area of the head. Migraines differ from the more common tension-type headache in that they tend to occur in episodes or clusters. It’s incredibly rare to experience migraines on a daily basis. They’re also associated with other symptoms such as nausea, vomiting and increased sensitivity to light.

What Causes Migraines?

The exact cause of migraines is unclear. They’re known as vascular headaches because they’re thought to be related to changes in blood flow in the brain. A popular theory is that blood vessels vasoconstrict and then vasodilate in response to changing levels of chemicals in the brain. The changes in chemicals can be triggered by a variety of causes such as food, drinks, fatigue and medication, but it can vary from person to person. Migraines are common, especially in women. One in five women—compared to one in 15 men—suffer from migraines regularly.

What Triggers Migraines?

This can be the trickiest area to uncover, as there are so many potential triggers, which vary greatly from person to person. Keep reading for some of the most common triggers.

A non-balanced or unhealthy diet—such as eating too much or one thing and not enough of others—can cause headaches. Other causes include irregular meals, dieting for long periods, cheese, caffeine, chocolate, red wine, citrus fruit, food additives (such as tyramine) and dehydration.

Environmental factors like cigarette smoke, computer screens, flickering lights and strong smells can trigger headaches.

Some medications can trigger headaches. If you’re on hormone replacement therapy or the combined oral contraceptive pill and you have or develop migraines, please see your doctor. Changes will need to be made to your medications, and your health could be at risk if you continue to use them.

Psychological disorders such as depression, anxiety, fatigue, lack of sleep and stress can all lead to migraines.

Hormonal changes such as menstrual migraines are due to changes in levels of oestrogen during your cycle. Menopause can also cause migraines.

What Are the Different Types of Migraines?

1. Migraine With Aura: Often, warning symptoms develop before the migraine symptoms set in. Aura symptoms include visual disturbances, which consists of a temporary loss of vision, changes in light or objects rotating in the visual field. Numbness and/or pins and needles, which can affect the face, hands or arms, are also common. Speech can be temporally affected, and odd smells and sensations can also develop temporarily.

2. Migraine Without Aura: This is the most common type of migraine.

3. Silent Migraine: This is the least common type of migraines. In this case, aura symptoms occur, but the headache symptoms don't develop.

How Are Migraines Diagnosed?

If you experience any of the symptoms above, it’s important to see your doctor to assess your symptoms thoroughly. Migraine diagnosis is made based on the clinical symptoms. Your doctor will also run blood tests to ensure there are no underlying causes to your symptoms.

Treatment Options

Simple painkillers are the first line of treatment, such as paracetamol and ibuprofen. Triptans are a specific group of medications that can be prescribed by your doctor. These target the chemical changes that trigger changes in blood flow in the brain, which is the underlying cause of a migraine. Anti-emetic medications (anti-sickness drugs) can be prescribed if nausea and vomiting are part of your symptoms.

If your migraine symptoms are affecting your ability to function on a daily basis, see your doctor. There are many medications that can be prescribed, such as prophylaxis, which prevents you from developing the migraines so frequently and severely. It’s worth keeping a headache diary to see if a pattern emerges regarding the possible triggers. The biggest challenge is often identifying the triggers, but once they have been identified they can be avoided and the frequency and severity of migraines can be significantly reduced.