Migraine: symptoms, causes and treatment

Migraines are severe, recurring, and painful headaches sometimes preceded or accompanied by sensory warning signs and other symptoms. It can last for 4 hours and up to 3 days.

Some people who experience migraines can clearly identify triggers or get a warning symptom before the start of the migraine headache.

Some triggers include:

• Hormonal changes: Example menstruation, due to changing hormone levels.
• Emotional triggers: Stress, depression, anxiety, excitement, and shock can trigger a migraine.
• Physical causes: Tiredness and insufficient sleep, shoulder or neck tension, poor posture, and physical overexertion have all been linked to migraines. Low blood sugar and jet lag can also act as triggers.
• Triggers in the diet: Alcohol and caffeine can contribute to triggering migraines. Irregular mealtimes and dehydration have also been named as potential triggers.
• Medications: Some sleeping pills, hormonal medications etc
• Triggers in the environment: Strong smells, second-hand smoke, and loud noises can set off a migraine. Stuffy rooms, temperature changes are also possible triggers.

Preventive Migraine Treatment

Consider preventive treatment for migraine patients in any of the following situations:

• When Migraine attacks are frequent (≥4 migraine headache days per month) and/or the attacks interfere with patients' daily routines even with acute treatment

Non Drug management:

• getting enough sleep
• reducing stress
• drinking plenty of water
• avoiding certain foods
• regular physical exercise

Pharmacological Treatments:

Oral treatments should be offered for migraine prevention. These include  beta-blockers. 

Start oral treatments at a low dose and titrate slowly.

Give oral treatments for at least 8 weeks to optimize therapeutic response.

Acute Migraine Treatment

Use evidence-based treatment at the first sign of a migraine attack.

Use NSAIDs (including aspirin, ibuprofen etc), non opioid analgesics, acetaminophen (paracetamol), or caffeinated analgesic combinations for mild‐to‐moderate attacks. and migraine‐specific agents (triptans, dihydroergotamine) for moderate or severe attacks and mild‐to‐moderate attacks that respond poorly to NSAIDs or caffeinated combinations.

Use a non oral option for select patients, including those with nausea or vomiting or those who have trouble swallowing.

Options for outpatient rescue include SC sumatriptan, or corticosteroids. Inpatient options may include parenteral formulations of triptans, antiemetics, NSAIDs, anticonvulsants (eg, valproate sodium and topiramate, except in women of childbearing age who are not using reliable birth control), corticosteroids, and magnesium sulfate.