What is a migraine?

Migraine is a severe and annoying headache that affects the daily life of those who suffer from it; Because this type of headache is usually associated with throbbing pain, nausea and sensitivity to light and sound. Migraines are caused by various reasons. Knowing these causes helps in better management of this disease. Therefore, in this article from Dr. Kihani Fard's website, we will fully discuss **what is a migraine**, its nature and causes, and **is migraine fatal** or not. Stay with us until the end of this article to know the answers to these questions. ### What is a migraine? A migraine is a headache that causes severe throbbing pain or a pulsing sensation on both sides of the head or on one side. This condition is often accompanied by nausea, vomiting and extreme sensitivity to light, sound and sometimes smell and touch. If migraine is not treated, migraine attacks may last from hours to even days (between 4 and 72 hours). Also, the pain caused by migraine headaches may be so bad that it affects a person's quality of life and interferes with his daily activities. Of course, the frequency of migraines varies from person to person; so that it happens late in some people; But another person suffers from it several times a month. In this video, Dr. Kihani Fred explains what migraine is and also talks about some types of migraine Migraine is not exactly like a headache and it can have different forms. For example, some people may experience warning symptoms called an "aura" before or with the onset of migraine headaches. Aura is a reversible nervous system symptom that is typically visual (such as visual disturbances), but can also include other disorders. Migraine symptoms usually start gradually and may last up to 60 minutes. To better understand the difference between headache and migraine, we have given some points in the table below: It should be noted that migraine is not completely cured; But fortunately, its symptoms can be controlled with medication and lifestyle changes. Treatments used to manage migraines include pain relievers, specific migraine medications, and preventative measures to help reduce the frequency of attacks. ### Migraine treatment and control - The purpose of migraine treatment and its control is to prevent migraine attacks and relieve the pain and symptoms caused by it, so the following should be considered: Among the painkillers used to reduce migraine pain are acetaminophen, ibuprofen and especially naproxen. - Botox injection is one of the migraine treatment methods - Caffeinated compounds can be consumed at the onset of an attack to prevent it from getting worse. - If someone uses anti-nausea drugs, they should take them at the same time as the symptoms begin - If the patient feels nauseous before the onset of the migraine attack, he should take an anti-nausea pill like metoclopramide as soon as possible so that he does not vomit after taking his migraine medication. - If normal painkillers are not responsive to the patient, he can use serotonin agonists such as sumatriptan. - Until now, the use of electronic headbands that emit waves has been used to reduce migraine pain. - It is important to know that migraine cannot be cured, but with the help of doctors, it can be controlled and the number of attacks can be reduced. One of the creative things you can do to improve yourself is to try to find things other than medication, or in other words, supportive treatments, that will help your headache. For example, sleeping in a dark room away from noise, massaging your head and temples, tying a cold cloth around your head and neck, lighting incense and aromatherapy, etc. may relax you and reduce your headache. The interesting point here is that those who have applied botox to their facial muscles to prevent wrinkles and the muscles in this area are temporarily paralyzed have less exacerbation of migraine pains. Of course, there is still not enough evidence to use this method in the treatment of migraine. In this video, Dr. Kihani Fard talks about migraine treatment methods, please watch the video until the end ### Surgical treatment for migraine This method is not yet approved by the US Food and Drug Administration (FDA) and includes nerve stimulation and migraine trigger point decompression surgery (MTSDS). This treatment is done by doctors who have passed certain courses and it is illegal if it is done by other people. For example, regarding nerve stimulation surgery, it can be said that by placing electrodes under the skin, the surgeon covers nerves such as occipital nerves, deep brain, vagus and ganglion. This treatment has so far been successful in controlling migraine headaches. In the decompression surgery method of migraine trigger points or MTSDS, the doctor releases the nerves around the head and face, which are also known as the trigger points of chronic migraines, and uses Botox injection for this purpose. This procedure is usually performed by plastic surgeons and for people who have chronic migraines and have not responded to other treatments. ### How can migraines be prevented? Due to the fact that the exact cause of this disease has not been determined, there is no way to prevent migraine attacks, but the number of attacks and their severity can be reduced by taking actions. For example, you can prevent the onset of migraines by avoiding being in stimulating places, for example, where there is a lot of noise, a lot of light, etc. Also, you may have noticed your own triggering factors, which can be partially identified by recording the events before migraine attacks and try to change your lifestyle. For example, you may come to the conclusion that you can reduce the number of migraine attacks by exercising, eating healthier foods, sleeping more, stress less, drinking more water during the day, etc. In this video, Dr. Kihani Fard talks about how to prevent migraine attacks. #### some preventive drugs Preventive drugs such as propranolol beta blocker (known as an anti-stress drug), antidepressants such as amitriptyline and nortriptyline, anticonvulsant drugs such as topiromate and sodium valproate, vitamin B12 supplements, etc. can be used in order to eliminate the starting point of migraine attacks. But the most important point is that you must leave the identification of your underlying disease and the prescription of the required drugs to the doctor and avoid self-medication. ### What does migraine treatment depend on? The treatment plan for each migraine sufferer is determined by the doctor according to factors such as the person's other diseases, age, number of migraine attacks, duration of the attack, intensity of the attack, amount of pain, degree of incapacitation, presence or absence of nausea and vomiting, etc. Be careful to always bring your other medicines with you when visiting the doctor, so that you can be informed of any drug interactions and change your medication plan. ### What are the stages of migraine? Migraines occur in four stages (although not every migraine a person experiences will include all four stages). Knowing these steps can help people better manage their symptoms and seek appropriate treatment. In the following, we describe these steps: #### **Prodrome** This stage, which includes symptoms such as mood changes, fatigue, or sensitivity to light, is likely to occur hours to days before the onset of a migraine attack. #### **Aura** This stage includes visual symptoms (loss of vision, seeing different shapes, bright spots or flashes of light), sensory symptoms (such as numbness, tingling, or tingling on one side of the face, arm, or leg), weakness or numbness in the face or one side of the body, and difficulty speaking, and usually lasts a few minutes to an hour. #### **Headache attack** At this stage, severe and usually one-sided pain occurs. This attack lasts from several hours to three days and is accompanied by nausea, vomiting or sensitivity to light and sound. In the attack phase, people's tolerance threshold may be lowered and smell, sound, light and anything that is more than the tolerance of their sensory receptors may seem annoying. Throbbing headaches that occur due to the dilation of brain vessels with each heartbeat, nausea, dizziness (read the article on dangerous dizziness) and weakness, pain on one side of the head (right, left, front, temporal) and vomiting are other symptoms of this phase. When the brain undergoes an attack phase, there is a disturbance in the nerve mediators in it, and the person's psyche is offended, for this reason, the Postdrome phase occurs after that. #### **Postdrome** This stage is after a migraine attack and includes feeling tired, mild headache or mood changes and may last for several days. At this stage, the patient has the following symptoms, the duration of which is different in different people and may not even appear in some people: - - - A feeling of euphoria and happiness - Feeling uncomfortable, tired and lethargic - Weak headaches - Staring at a point - The person may even experience constant and dull headaches until the onset of the next migraine. It is interesting to know that sometimes a migraine attack occurs without a headache and only with a change in neurotransmitters to such an extent that a change in the person's mood and mood appears and even he himself is not aware of his illness. In this case, the person suddenly becomes happy or sad. ### What to do during a migraine attack ### What are the types of migraine? There are different types of migraine, the most common of which are migraine with aura (also known as classic migraine) and migraine without aura (or normal migraine). Next, we describe other types of migraine: - - - #### **Menstrual migraine:** This type of migraine is related to the menstrual period and usually starts 2 days before the onset of menstruation and lasts until 3 days after. This type of migraine will often be without aura. - - - #### **Migraine off:** In this type of migraine, the person experiences aura symptoms (which may include nausea) without having a headache. The attack usually lasts 20 to 30 minutes. Acephalgic migraine, migraine without headache, visual migraine without headache or silent migraine occurs when a person has an aura but no headache. These people include 40% of people who have migraines. In this type of migraine, first the symptoms of visual impairment begin, and then disorders occur in other body parts, such as speech problems, weakness, and a series of body parts. - - - #### **vestibular migraine or vestibular migraine:** In this type of migraine, a person experiences balance problems, dizziness, nausea and vomiting. Vestibular in some conditions is accompanied by headache and sometimes without it. This type of migraine is more common in people who have a history of motion sickness. - - - #### **Abdominal migraine:** This migraine causes severe abdominal pain, nausea and vomiting. It is more common in children and may turn into classic migraines over time. - - - #### **hemiplegic or hemiplegic migraine:** This type of migraine causes temporary paralysis or weakness on one side of the body. Other symptoms such as numbness, dizziness or vision changes also occur with it. In this case, the person should see a doctor quickly. - - - #### **Ocular migraine:** This type of migraine, which is also known as retinal migraine, is a rare type of migraine that causes a temporary loss of vision or blindness in one eye and is usually accompanied by a headache. This decrease in vision usually lasts less than an hour, after which the vision returns to normal. - According to healthline magazine, sometimes eye migraines are painless. Most people with ocular migraines have had another type of migraine in the past. - - - #### **Migraine with brain stem aura:** Migraine symptoms originate from the brain stem and include dizziness, diplopia, balance problems, and speech disorders. This complication is usually associated with a severe headache at the back of the head and may also occur with more extensive neurological symptoms. - #### **Prolonged or continuous migraine:** This severe type of migraine does not respond to standard treatments and can last more than 72 hours; This condition is so painful and debilitating that some patients require hospitalization and immediate medical treatment. - #### **Ophthalmoplegic migraine:** This type of migraine causes temporary weakness or paralysis of the muscles that control eye movements. In addition, it may be associated with severe pain around the eye and cause symptoms such as vision changes, double vision, or drooping eyelids. ### What is the frequency of migraine? Migraine frequency refers to the number of times or days a person experiences migraine headaches in a certain period of time (usually a month). This criterion helps doctors to categorize the severity and type of migraine and to consider the best treatment methods. Due to the fact that the frequency of migraines can vary from sporadic periods or episodes to continuous headaches, migraines are divided into different types, which we will introduce below: #### Migraine types based on frequency ##### Episodic migraine It refers to a state of migraine in which a person suffers from migraine headaches for less than 15 days in a month. This type of migraine occurs sporadically and has severe or moderate attacks. ##### High-frequency episodic migraine In this type, a person gets migraine between 8 and 14 days of every month. This condition is usually more severe than a typical episodic migraine. Chronic migraine If a person experiences migraine headaches on more than 15 days of each month, for 3 months or more, this condition is diagnosed as chronic migraine. ### What is the cause of migraine? Doctors still don't know exactly what causes migraines. In fact, for years scientists thought that people get migraines because of changes in blood flow to the brain; Many now believe that changes in blood flow to the brain contribute to the pain, but this is not what triggers migraine attacks. Today, some experts believe that a migraine attack is triggered by chemical changes in a person's brain. In other words, overactive nerve cells send signals that lead to changes in the levels of certain chemical compounds such as serotonin and calcitonin gene-related peptide (CGRP) in the body. CGRP swells the blood vessels around the brain; while serotonin causes them to shrink and an imbalance in these chemicals will lead to inflammation and pain. Therefore, we can conclude that although the causes of migraine are not fully known yet, it seems that the cause of migraine is related to genes and changes in the brain, and in fact, it is genetics and environmental factors that play a role in the occurrence of migraine. ### Common symptoms and signs of migraine headaches - Throbbing and vague headache - Progressive pain - It may be unilateral, middle, surrounding, front of the head, bilateral or even the whole head - Sensitivity to light, sound and smell - Nausea, vomiting and heartache - Loss of appetite - Pallor - Fatigue - dizziness - Blurred vision - Diarrhea - Feeling cold or very hot and rarely fever Migraine symptoms usually last about four hours, but with medication, its duration can be reduced to half an hour. Of course, severe types of migraine can affect the patient for up to three days. ### What are migraine triggers? Migraine triggers are factors that can trigger or aggravate migraine attacks. Identifying these triggers for people with migraines will be helpful in managing and reducing the number of attacks. Therefore, in the following section, we describe some of the most common migraine triggers: - - #### **Hormonal changes in women:** Changes in the level of hormones (especially in women) can have a great impact on the occurrence of migraines. In fact, fluctuations in estrogen (before or during periods, pregnancy, and menopause) seem to cause headaches in many women. In addition, hormonal drugs such as oral contraceptives can also aggravate migraines. - #### **Food agents and additives:** Some foods and drinks such as chocolate, cheese, salty foods, coffee (too much caffeine), alcohol and processed foods can trigger migraines for some people. Food additives such as the sweetener aspartame and the preservative monosodium glutamate (MSG), which are present in many food items, are also considered stimulants. - #### **Hunger or dehydration:** Hunger and lack of hydration are other triggers of migraine. In other words, migraine symptoms may worsen when the body is deprived of adequate nutrients or fluids. Therefore, maintaining hydration and a healthy diet can be effective in reducing the frequency and severity of migraine attacks. - #### **Stress and anxiety:** Stress at work or emotional and physical stress at home increases the intensity and frequency of migraine attacks. - #### **Environment:** Environmental factors such as reflection or strong light, flashing light, loud noises, unpleasant or strong smells (perfume, cigarette smoke, chemicals such as paint thinner) and changes in air pressure, temperature and humidity can be other triggers of migraine. - #### **little****sleeping or sleeping too much:** Not having enough rest or sleeping too much also acts as a migraine trigger in some people. - #### **Physical activity:** Physical stress or some intense or sudden physical activities (including sexual activity) may trigger migraine attacks in some people. - #### **Other diseases and disorders:** Some chronic diseases such as asthma and high blood pressure can also be related to the occurrence of migraines. - #### **Medications:** Some drugs and chemicals such as hormonal drugs (oral contraceptives), antidepressants (especially SSRIs and TCA), blood pressure drugs (beta-blockers) and vasodilators (such as nitroglycerin), some antibiotics (especially cephalosporins), non-steroidal anti-inflammatory drugs and drugs such as pseudoephedrine may also cause migraines. ### What are the risk factors of migraine? Migraine risk factors refer to characteristics and conditions that increase the probability of migraine in a person. In simpler terms, risk factors predispose a person to migraine. In the following section, we have discussed in detail some of the most important risk factors associated with migraine: #### Genetics and family history One of the important factors in the occurrence of migraine is family history. If one of the parents or other family members is suffering from migraine, the possibility of another family member suffering from migraine disease increases. Studies have shown that four out of five people with migraines have a family member or members who also suffer from migraines. If one of the parents has a history of this type of headache, the probability of the person getting it is 50%, and if both parents are affected, the risk of their child getting it increases to 75%. In this video, Dr. Kihani Fard talks about the hereditary factors in migraine. #### age Migraines can occur at any age; But it usually starts during adolescence or early adulthood. In many people, migraine attacks peak during their 30s and become less severe with age and gradually in the following decades. Of course, this is not always the case, and by the way, it is possible that the disease of some people continues in adulthood or even increases in severity. #### Gender Gender is one of the important risk factors in the occurrence of migraine, which has a significant effect on the prevalence and severity of this disorder. Research has shown that migraine is far more common in women than in men; Women are three times more likely to suffer from migraines than men. This difference may be due to women's hormonal changes, especially during menstruation, pregnancy and menopause, when the levels of hormones such as estrogen and progesterone change significantly. ### When should we see a doctor? If a person regularly experiences migraine signs and symptoms, they should keep a record of migraine attacks and how to treat them. Then make an appointment with a specialist and explain to him all the details about your migraine headaches. Also, if a person has a history of headaches, but the pattern of his headaches has changed or even the headaches have suddenly become different, he should still consult a doctor. In addition, if someone experiences any of the following signs and symptoms (which could indicate a more serious medical problem), they should see a doctor or emergency room right away: - Very severe and sudden headache - Headache after a blow to the head - Headache with neck stiffness, fever, convulsions, nausea and vomiting - Headache with confusion, double vision, numbness or weakness in the limbs - Headache that gets worse and worse over time - Headache with redness in one eye - Chronic headache that worsens after coughing, exercising, straining, or moving suddenly - The person is over 50 years old and this is the first time he experiences a strange headache ### Is migraine fatal? For those who constantly experience migraines, the question arises, do migraine headaches lead to death? In response, we must say that an extensive and large-scale study was conducted in 2020 on women, and fortunately, in the end, no connection was found between migraine and death. However, researchers have found that migraines with aura can lead to an increased risk of death from cardiovascular problems. According to the American Migraine Foundation (AMF), migraines can increase the risk of heart disease, including heart attacks and angina, and increase the risk of stroke, coronary events and other related deaths by about 50 percent. In addition, this disorder may double the risk of heart disease due to reduced blood flow. In fact, migraine (especially migraine with aura) is associated with an increased risk of cardiovascular problems and stroke. Studies show that people who suffer from migraines are at a higher risk for heart attacks and strokes due to inflammatory factors, blood clots and changes in the inner lining of blood vessels. Also, migraine can be associated with risk factors such as high blood pressure and obesity, which themselves increase the risk of heart problems and stroke. ### Can migraines cause permanent damage? Now that we have answered the question of whether migraine is fatal, it is not bad to give a clear answer to the question of whether migraine causes permanent damage or not. Fortunately, according to the American Headache Society, migraine does not lead to long-term brain damage. To reach this conclusion, this organization used brain scans of healthy and migraine sufferers to investigate the long-term effects of the disease on the brain. After 9 to 10 years of follow-up, these researchers found white lesions in the brains of some people with migraines, but these lesions were not associated with changes in neurological problems and cognitive or brain function. ### What are the diseases related to migraine headaches? There are times when you have a disease and it has provided a basis for your headache or vice versa. 1. There is no documented evidence to show that migraine causes stroke, but there were those who suffered from both at the same time. For example, the occurrence of stroke in those who have Aura, are women and are under 45 years old has been reported. 2. High blood pressure can increase the frequency of migraine headaches. This happens because a migraine sends a large volume of blood to the brain and its pulsating is due to the heartbeat, so this happens when the blood pressure increases. 3. The probability of a heart attack or Myocardial infraction (MI) is higher in men who suffer from migraine, especially the type with aura. Of course, the number of migraine attacks has no relationship with the possibility of heart disease. 4. Having a migraine doubles the chance of having a seizure. One of the reasons for this is that those who have migraine and epileptic patients have a significant genetic similarity. 5. Hearing disorders or sudden hearing loss are among the rare cases seen in migraine sufferers. 6. Fibromyalgia syndrome has symptoms such as chronic pain, fatigue, etc., and according to studies, it is more common among people with migraine. 7. Those who suffer from depression and anxiety have a high risk of getting migraines. ### Migraine and stroke, when should we see a doctor? According to healthline magazine, sometimes the symptoms of migraine headaches may mimic the symptoms of a stroke. The important thing is to seek immediate medical attention if you or someone you love experiences a headache with the following characteristics: - Cause speech disorder or drooping on one side of the face - cause new weakness in the leg or arm - Occurs very suddenly and severely without any initial symptoms or warnings - Occurs with fever, neck stiffness, confusion, convulsions, double vision, weakness, dizziness or difficulty speaking. - Has an Aura whose symptoms last more than an hour - probably called the worst headache ever - Be accompanied by a decrease in consciousness ### Migraine in children Migraines in children are very similar to adults and are very related to the level of depression in them. So, to treat migraine disorders in children, one thing that should be taken into consideration is their life experiences and the possibility of them being depressed. Common signs and symptoms of migraine in children - Pallor - Headache - Dizziness - Blurred vision - Fever - Feeling uncomfortable - Abdominal pain - Nausea and vomiting - Sensitivity to light and sound Conclusion In this article, we learned that migraine is a complex neurological disorder characterized by severe and throbbing headaches on one or both sides of the head. This type of headache is usually accompanied by symptoms such as nausea, vomiting and extreme sensitivity to light and sound. Migraine attacks can last from a few hours to a few days and prevent a person from performing daily activities. However, fortunately, migraine is not fatal in itself and only in some rare cases may it be associated with complications such as an increased risk of stroke. Therefore, it is very important to consult a doctor for its control and management.