Understanding Migraines: Types, Triggers, Treatment

What is a migraine?

A migraine is more than just a regular headache, it's like your body is hitting the 'pause' button. Generally it feels like a severe throbbing headache, only on one side of the head. 

It might make you feel like you need a quiet day in bed with the curtains closed. Things like bright lights or loud noises can make the pain worse and leave you feeling washed out, nauseous, or just not quite like yourself. 

But don't worry, reaching out to a healthcare provider is a great step. They can help you find ways to manage these moments, so you can get back to feeling like your wonderful self again.

Types of migraines

There are two main types of migraines, migraine with aura (classic migraine) or migraine without aura (common migraine). A typical migraine goes through four stages, a process that can take up to 72 hours. Let's go through the four stages:

1. Prodrome stage

About 60% of people who experience migraines say they feel symptoms up to 24 hours before the headache pain starts. Everyone experiences this phase a little differently, however symptoms may include:

• More sensitive to light, sound, and smells
• Unusual tiredness or uncontrollable yawning
• Difficulty concentrating
• Food cravings
• Mood changes 
• Drinking more and going to the toilet more often
• Loss of appetite or inability to eat
• Constipation or diarrhoea

2. Aura stage

Sometimes, a migraine brings along a little "heads-up" called an aura. An aura can show up as shimmering lights, a bit of tingling like pins and needles, or even feeling a little clumsy. These symptoms usually develop over 5-60 minutes and can start either before, or during the headache pain. 

Visual aura symptoms may include: 

• Vision loss on one side
• Vision loss in a one small part of your sight 
• Tunnel vision
• Complete loss of vision
• Shimmering or glittering zigzag patterns occurring across your vision.

Sensory aura symptoms may include: 

• Pins and needles (often starting in the hand, moving to the arm, and then jumping to involve the face, lips, and tongue) 
• Numbness
• Ringing in the ears
• Sensitivity to touch. 

Motor aura symptoms may include: 

• Heaviness of your arms and legs
• Difficulty speaking properly
• Body weakness. 

3. Pain stage

The common migraine headache can be pretty intense. It's generally felt as a moderate to severe throbbing, pulsing, pounding or dull pain on one side of the head that is aggravated by movement. 

The pain may move from one side to the other and may also be felt around your eyes, temples or elsewhere through the face and neck. People often also suffer from nausea and vomiting, and symptoms are made worse by lights, sounds and smells. The pain peaks and then subsides and usually lasts between 4 to 72 hours in adults and 1 to 48 hours in children. 

4. Postdromal stage

Postdromal symptoms (symptoms after the headache has subsided), are also known as a migraine hangover and can feel similar to a hangover from alcohol. This stage can last up to 48 hours and may include the following:

• Tired, “washed out,” or irritable feelings
• Trouble focusing 
• Dizziness
• Muscle weakness or muscle pain such as neck stiffness
• Loss of appetite or food cravings.

What can trigger a migraine?

For some people, migraines can happen as often as every week, while for others, they might arrive fewer than once a year. On average, though, they tend to occur about two to four times a month. 

These difficult moments are sometimes closely tied to a woman's menstrual cycle or how stressed you happen to be feeling, and usually, there is a specific trigger that sets one off.

Common triggers include:

• Hormonal changes (e.g. those resulting from menstruation, ovulation, oral contraceptives, or hormone replacement)
• Either too much or too little exercise 
• Changes to your sleep
• Some medications
• Stress
• Sudden or extreme weather changes
• Missing meals 
• Bright lights, loud noises or strong smells
• Use of tobacco products
• Certain foods and drinks (aged cheese, alcohol, chocolate, coffee, processed foods, fermented foods, additives such as nitrates and MSG, and others)

How can I manage migraines?

Unfortunately, there is no cure, however migraines can be managed by medications, avoiding triggers and some other strategies that we will go through below. 

Medication:

If you suffer from less than two migraines per month, just treating the symptoms when they occur may be enough. Medication options include:

• Over-the-counter pain relief medications such as paracetamol and ibuprofen
• Strong pain relief medications from your doctor 
• Migraine specific medicines known as tripans which include, Sumatriptan, Rizatriptan, Zolmitriptan, Naratriptan, and Eletriptan
• Nausea medicines including Prochlorperazine, Promethazine, and Metoclopramide 

Non-medication strategies:

• Resting in a dark, cool, quiet room
• Apply a hot or cold pack, or facewasher to your forehead or the back of your neck
• Massage your scalp
• Rub and apply pressure to your temples in a circular motion
• Meditate 

Avoiding your migraine triggers

You should try to work out what it is that causes your migraine, and try to avoid that trigger. For example, try to get plenty of sleep, eat well, don’t miss any meals and where possible avoid and manage stress. 

If you’re having trouble identifying what is causing your migraine, try keeping a diary which notes on what is happening in your life and see if you can identify any patterns. 

Other things that may help:

• Relaxation therapies such as yoga
• Cognitive-behavioral therapy (CBT)
• Acupuncture
• Biofeedback therapy
• Certain vitamins such as: Vitamin B2, B6 and B12, Magnesium, Tanacetum parthenium, Co-enzyme Q10, PEA (Palmitoylethanolamide), and Folinic Acid.

When should I see a doctor?

If you are getting a migraine more than twice a month, over-the-counter medicines aren’t working for you, or you notice the migraines are associated with your period, you should have a chat with a doctor as they will be able to help. 

Your doctor may prescribe medicines to prevent migraines which may include:

• Beta-blockers such as propranolol
• Tricyclic Antidepressants (TCAs) such as Amitriptyline
• Valproic acid 
• Calcium channel blockers such as Verapamil 
• For menstruation-related migraines, the progesterone-only pill (POP), or "mini-pill”.