Migraine: Causes, Symptoms, Treatment & Home Remedies

What is a migraine?

A migraine headache is a really severe headache with a throbbing and pulsing type of pain that is typically felt on one side of the head. Migraines can be very uncomfortable and they can sometimes last for a few days at a stretch. In some individuals, a migraine is preceded by abnormal experiences also known as “warning signs” or “aura” which can include trouble with speech, tingling sensation in the hands, fingers, or face, and problems with vision.

Are there different types of migraines?

According to general physicians, there are primarily two main types of migraines which include

• Common Migraine – in this type of migraine, there are no warning signs before the onset of the headache
• Classic Migraine – in this type of migraine there is a presence of warning signs followed by a headache. In some cases, there may be migraine without headaches after the warning signs. Classic migraine has other subtypes such as
  • Familial hemiplegic migraine: This is a rare type of migraine that runs in families. Muscle weakness is an additional feature of this type of migraine.
  • Sporadic Hemiplegic Migraine: This type of migraine is also associated with muscle weakness and preceding warning signs, but it does not run in families.
  • Basilar type migraine: In this type of migraine preceding warning signs are present along with ringing in the ears and speech disturbances, but there is no muscle weakness seen.

There are other migraine types that are seen such as

• Childhood Precursor Syndrome – seen in children the symptoms usually include vomiting, nausea, dizziness, and abdominal pain. This can lead to the development of migraines later in life
• Retinal Migraine – in this type of migraine there are visual disturbances along with headaches. In some cases, this type of migraine can lead to a temporary loss of vision.
• Chronic Migraine – in this type of migraine the symptoms of migraine last continuously for 3 or more months, and in each month the symptoms are seen for at least 15 days.

What causes migraines?

The exact causes of migraine headaches are still not fully understood. Migraines are believed by medical experts and researchers to be due to genetic factors, environmental factors, and neurological factors. Neurologists and general physicians also believe that during a migraine attack, there are changes seen in pathways of the brain, the blood supply to the brain, and the chemical neurotransmitters that carry brain signals, which leads them to believe that more than one factor is responsible for the development of a migraine. Some probable causes of migraine include

• Genetic factors: As some migraines tend to run in families, it is possible that there may be a genetic element responsible for this condition
• Environmental and other triggers: Certain triggers such as stress, changes in weather, lack of sleep, dehydration, hormonal changes, food or drinks, etc. can cause migraines in some people.
• Neurological causes:  Some abnormal changes in the brainstem and its interaction with the nerve responsible for sensation in the face and head can also result in migraines.
• Imbalances in Neurotransmitters: Imbalances in brain chemicals such as serotonin, etc., which plays a role in regulating pain may be responsible for migraine development.

What can trigger migraines?

The triggers of migraine can vary between people and an individual can have more than one trigger for their migraines. Some commonly seen migraine triggers include

• Stress: Emotional as well as physical stress like overexertion, hunger, fatigue, or poor sleep can act as a trigger of migraines.
• Hormonal changes: Changes in estrogen hormone levels, such as seen during menstruation or menopause can act as a trigger of migraines in some women.
• Food and drink: Certain foods and drinks such as alcohol (more commonly red wine), caffeine (or caffeine withdrawal), chocolate, some types of cheese, and processed red meats can act as a trigger for migraines.
• Environmental factors: weather changes such as an increase or drop in atmospheric pressure, or high humidity, exposure to bright lights or flickering lights, and strong smells of perfumes or chemicals can act as triggers of migraines.
• Physical factors: Intense physical activity including strenuous exercise or sexual activity can act as a trigger of migraines in some people.

What are the symptoms of migraine?

Migraine attack symptoms vary greatly between people. Migraine attack symptoms can be divided into 4 phases, and some people with migraine experience the symptoms of all 4 phases, some others might not experience all of them. Symptoms can include

• Phase 1 - Occurs 2 hours to 2 days before the headache and can include
  • Irritability and altered mood
  • Tiredness accompanied by yawning
  • Stiffness of neck muscles
  • Increased sensitivity to smells or noise
  • Constipation in some or diarrhea in others
  • Increased feeling of thirst
• Phase 2 - Occurs either before or along with the headache and can last for a few minutes to an hour. The symptoms can include:
  • Seeing flashes of lights, shapes, or colors, or loss of vision in some
  • Tingling, or a sensation of pins and needles in the arms, face, or legs
  • Numbness or weakness over the face or one side of the body
  • Speech troubles
  • Ringing in the ears
  • Hearing noises or music
  • Jerking or shaking of the limbs or body which happens involuntarily
• Phase 3 - Can last from a few hours to 3 days or more if left untreated. This phase can be worsened by physical activity and the symptoms can include
  • Severe pulsating or throbbing pain on one or both sides of the head
  • Nausea and vomiting
  • Sensitivity to light, sound, smell, or touch
  • Feeling of lightheadedness or confusion
• Phase 4 – is the phase after the pain has subsided and the symptoms may include
  • Feeling of either depression, euphoria, or irritability
  • Soreness & muscle pain
  • Tiredness
  • Food Cravings in some or loss of appetite in others

How are migraines diagnosed?

Migraine diagnosis by general physicians and neurologists is done based on the individual’s medical history and by conducting a clinical examination. In most cases, no further investigations are necessary.

However, in some cases, such as when the symptoms may suggest another underlying cause, doctors may advise imaging tests such as a CT scan or MRI of the brain to rule out other potential causes of headache, such as infections, stroke, brain tumors or aneurysms. In rare cases, a lumbar puncture or a spinal tap to analyze the spinal fluid may also be advised, especially if the migraine is not responding to any treatment and has become chronic and intense.  

Situations where further investigations are advised include

• If it is the first episode or a really severe episode, or the first episode occurs after the age of 50 years
• There is a change in the pattern of symptoms from a previously diagnosed migraine including its frequency, intensity, or onset
• There are other abnormalities observed when a neurological examination is done
• Migraine is accompanied by seizures
• Migraine is accompanied by fever
• The individual has a weakened immune system
• The individual complains of headaches on the back of the head

What is the treatment for migraines?

The main aim of migraine headache treatment is to provide relief from migraine symptoms and prevent future migraine headache symptoms. Relief from symptoms and prevention of future attacks is essential to improve the quality of life which can greatly suffer if migraines are not properly managed. Migraine headache treatment is mainly through medications and lifestyle modifications. Medical therapy mainly consists of

• Pain relieving migraine headache tablets – Depending on the severity of pain, over-the-counter migraine medicines such NSAIDs or paracetamol may be prescribed for mild pain, while moderate to severe pain is treated with migraine medicines such as ergotamine derivatives, opioids, or triptans.
• Migraine Prevention Medications – Medications such as anti-depressants, anti-seizure medications, and beta blockers are prescribed to prevent future attacks.
• Botox injections – are usually given to individuals for chronic migraine treatment and provide relief from chronic migraine symptoms.

What lifestyle modifications can help with the management of migraine?

Lifestyle modifications in combination with medications can greatly help with the management of migraine. Some lifestyle modifications that should be made by people with migraine include

• Regular Sleep: Getting enough and consistent sleep is essential for relief from migraine headaches.
• Exercise: The frequency and severity of migraine headaches can be greatly reduced with regular exercise.
• Reducing Stress: Stress management through deep breathing, meditation, or yoga can help in preventing frequent both acute and chronic migraine symptoms.
• Identifying and avoiding trigger foods and drinks: chocolate, alcohol, and cheese can trigger migraines. Identifying the trigger and completely avoiding them can prevent frequent attacks of migraine.
• Staying Hydrated: Consuming adequate quantities of water and avoiding dehydration can help reduce migraine attacks.
• Identifying and avoiding other environmental triggers: loud sounds, strong smells, and bright lights, can trigger migraines, and it helps avoid these environmental triggers. It is important to note that triggers vary between people and therefore it is important to first identify which of these is a possible migraine trigger and then take necessary steps to avoid exposure.  
• A healthy diet: A healthy diet with plenty of vegetables, fruits, and lean proteins can help prevent migraines.
• Avoiding excessive caffeine and alcohol consumption

Are there any Migraine home remedies that can help with migraine cure?

Some home remedies combined with lifestyle modifications can help with migraine headache relief. Some of these measures include

• Heat or cold applications:  Applying a cold or warm compress to the head or neck can help ease migraine pain. While cold applications may work for some, for others a warm compress may help ease the pain. With a little experimentation, the right compress can be identified and used to get relief from pain.
• Using relaxation techniques
• Rest in a cool dark room, especially during episodes of a migraine
• Drink plenty of water throughout the day.
• Avoid triggers
• Get enough sleep
• Don’t overdo over-the-counter medications: while OTC pain medications like aspirin, NSAIDs, and paracetamol may help reduce migraine symptoms, it is important to follow medical advice from a general physician or neurologist before taking any new medications.
• Essential oils: Certain essential oils such as peppermint oil or lavender oil may help provide relief from the symptoms of migraine when applied topically or when diffused into the air.

What are some relaxation techniques that can help with migraine?

Relaxation techniques help to reduce stress, and as stress is a known trigger for migraines, inculcating relaxation methods such as yoga, meditation, or breathing exercises can help reduce the frequency and severity of migraine attacks.

• Yoga – Yoga is a form of physical activity that utilizes incorporates physical postures, breathing, as well as meditation in its practice. Regular practice of yoga promotes relaxation of the body and the mind, and greatly reduces stress. There are several yoga poses such as the Balasana, Adho Mukha Svanasana, Paschimottanasana, Garudasana, and Sarvangasana that can help to relax the mind, relieve tension in the neck muscles and shoulder muscles, and increase the blood flow to the brain. The benefits of yoga in reducing the frequency and severity of migraine can differ greatly between people, as it depends on a number of factors including but not limited to the manner, frequency, and the correctness with which it is done. One should always seek proper guidance from qualified and trained practitioners before incorporating these exercises into their daily routine. Improper practice of yoga can lead to other problems and complications which are surely not desirable.

• Breathing Techniques – Breathing techniques can help to a certain extent in managing and reducing the severity and frequency of migraine. Some breathing techniques that can be helpful include
  • Deep breathing: Start by sitting in a quiet place and begin to inhale slowly through the nose, filling the lungs with air. Hold the breath inside for a few seconds, and then slowly exhale through the mouth, completely emptying the lungs. This cycle of inhaling and exhaling should be repeated for several minutes in a session.
  • Breathing through alternate nostrils: Close the right nostril with the right thumb and inhale deeply through the left nostril. Hold the breath for a few seconds, then open the right nostril and exhale through it. Next, inhale through the right nostril while closing the left nostril with the right middle finger, hold the breath, and exhale through the left nostril. This cycle should be repeated for several minutes in a session.
  • Abdominal breathing: Lie down on the back and place hands on the abdomen. Make a deep inhalation through the nose, filling the abdomen with air so as to push the hands out. Hold the breath for a few seconds and then slowly exhale through the mouth, allowing the abdomen to fall back downwards. This cycle should be repeated for several minutes in a session.

• Meditation Techniques – there are many meditation techniques that can probably help to calm the mind and relieve stress. This in turn can help with migraine headache treatment. However, the benefits of meditation in managing migraine can vary greatly between people, and it may or may not be helpful for everyone. Some meditation techniques that can help with migraine management include Mindfulness Meditation, Body Scan Meditation, Progressive Muscle Relaxation, Guided Imagery, etc.

Suffering with migraine can greatly impact an individual’s quality of life and functioning. It is therefore important to seek medical advice from qualified healthcare specialists such as general physicians or neurologists, so that it can be effectively managed