A migraine is a brain disorder that is characterised by severe bouts of headache in combination with other symptoms. This is a neurovascular headache caused by dilation of the blood vessels.
Treatments for migraine
What is a migraine?
A migraine is a brain disorder in which a serious bout of headache can be accompanied by other symptoms, such as nausea, vomiting, sensory hypersensitivity or deficiency symptoms (also called aura). The difference from a normal headache is that a migraine is a neurovascular headache in which the blood vessels dilate through stimulation. This results in hypersensitivity of the entire nervous system. The frequency, severity and duration of migraine bouts vary from patient to patient. Migraines can return for life, but they can also be limited to a certain period of a person’s life. Approximately one third of women experience migraines at some point in their lives, while this percentage is much lower for men. A migraine is most common in the age group 15 to 55 years. In some women the bouts only occur around the time of menstruation. This is called a menstrual migraine. The pain associated with a migraine often occurs on one side of the head, and is characterised by a beating or pounding sound. During a migraine bout, it is impossible to perform other activities. The triggering factors vary from menstruation to alcohol, bright light and stress.
What are the causes of a migraine?
The exact cause of a migraine is not yet entirely clear. However, it has been proven to be a hereditary disorder. In addition, we know that there is a neurological process underlying the disorder. In the past it was sometimes thought that the cause was psychological, but this has now been disproven. The activity in the brain stem has been demonstrated by means of brain scans. However, in addition to these perceptible changes in the brain and nervous system, it is difficult to explain exactly how the pain is caused. Disturbed circulation is one of the causes of a migraine. In people suffering from a migraine, spasms of the veins in the brain and vasodilation of small veins around the skull are detected. The vasodilation leads to the formation of certain substances, which can in turn cause inflammation. These inflammations would cause the pain of a migraine bout. Despite the fact that the cause of a migraine is of a medical nature, psychological factors can lead to a migraine bout. A bout can be provoked under the influence of stress and emotions. The combination of hypersensitive blood vessels and stress causes the platelets to stick together. This sticking causes excessive serotonin, which causes spasms to form in the head.
What forms of migraine are there?
We have already touched on the symptom of the aura above. A migraine bout can be announced by an aura. Symptoms of an aura are often visual, such as flashes of light, spots or asterisks. The aura can be accompanied by loss of strength or loss of sensation in certain parts of the body. The aura occurs in 30% of migraine types. Many people suffering from a migraine feel that they are about to have a migraine. The signs are very diverse and vary from an aura to mood changes, vomiting and a cold.
- Basilar migraine: a migraine with aura is called a basilar migraine. An aura announces a migraine bout, and is characterised by, among other things: imprecise speech, loss of strength, double vision. The aura is followed by a headache at the back of the head. This type of migraine involves the brain stem. In the worst case, this type can lead to an ischemic stroke (TIA).
- Exertion migraine: this type is caused by a lot of exertion, particularly explosive sports like squash and sprinting can provoke a migraine.
- Migraine bout with mental confusion: in this type, the person is severely confused during the headache, he or she then no longer knows where and who he or she is. This type is most common among young people.
Other types include:
- Footballer’s migraine (migraine following a blow to the head)
- Ophthalmoplegic migraine (migraine involving paralysis of eye muscles)
- Familial haemiplegic migraine (migraine with aura and semi-sided paralysis)
- Abdominal migraine (severe abdominal pain without direct cause)
In addition to a migraine, one of the most common types of headaches, there is also cluster headache. This is a severe type of headache that is more common in men than in women. The headache is located on one side of the head, around the eye. The pain is acute or throbbing, and during the bout there is an urge to move. A bout can occur several times within 24 hours.
Phases of a migraine
- The prodromal phase or warning phase: many people who suffer from migraines sense a bout coming long before it arrives. They often notice it due to a change in their body, this can be both a mood change and a sensory change, for example, taste or heat/cold. Yawning and extra fatigue can also be omens.
- The aura phase: an aura is often accompanied by flashes of light or glare. Neurological symptoms may also often occur. Parts of the body can become numb, speech can be difficult and muscle strength can be greatly reduced.
- The headache phase: the headache follows the aura phase. The duration of this phase is very different, and varies from half an hour to several days. Sometimes the headache is accompanied by nausea and vomiting. The patient is often hypersensitive to light and sound, and needs to stay in bed because every activity is too much. The pain is throbbing or pounding and is usually located on one side of the head. Sometimes the headache phase does not occur after the aura phase.
- The recovery phase: this is the phase in which the body recovers from the migraine. The period of recovery sometimes takes a few days and sometimes even a week. The patient really needs to recover and it is therefore possible that irritability or fatigue may occur in this phase.
How can you recognise migraines?
We already mentioned a number of characteristics above by which a migraine can be recognised.
- In many cases, the migraine is heralded by an aura phase. The aura consists of a wide range of symptoms, but one of the main characteristics is flashes of light or glare.
- A migraine bout has a clear beginning and end.
- During a migraine bout, the patient has no choice but to lie in bed.
- The patient is hypersensitive to light and sound.
- The pain is often on one side of the head.
- The patient feels nauseous.
- The headache is severe and throbbing or pounding.
If you have two or more of these characteristics, there is a good chance that you have a migraine. In addition to the typical migraine symptoms described above, a migraine can also cause many other symptoms. The side effects are of a neurological nature and are caused by stimuli of the nervous system. Here are a few of the side effects: poor visibility, rapid cooling of the body, confusion.
Is there anything I can do myself about migraines?
As mentioned above, it is impossible to perform activities during a migraine attack. In addition to lying still, there is medication that can relieve the pain. We will discuss below which medication is often prescribed.
Avoid further stimuli from the senses:
- Bright light
- Loud noises
- Strong smells
- High or low temperatures
What are the forms of treatment?
The treatment of the bouts consists of medication, these medicines are called ‘triptans’. In addition, there are treatments aimed at prevention. Preventive treatment also consists of administering medication in advance to limit or prevent bouts.
The ‘triptans’ that relieve the pain are: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan. In a migraine bout, the blood vessels in the brain are dilated, the triptan medicines constrict the blood vessels. They also have an anti-inflammatory effect and reduce pain. In addition to triptans, paracetamol is also prescribed. Often in combination with propyfenazone and caffeine. There are also anti-inflammatory painkillers such as diclofenac, ibuprofen and naproxen that can be recommended.
Other substances that constrict the blood vessels in the brain include: ergotamine and methysergide. Other drugs that have been shown to be effective in treating migraines: beta blockers, pizotiphene, topiramate, valproic acid, botulinum A toxin (only if other medicines do not work), flunarizine (very rarely), amitriptyline (only if beta blockers and pizotiphene have no or too little effect).
- AtlasPROfilax: an alternative treatment for migraines is AtlasPROfilax. This treatment, developed by René Claudius Schümperli, treats the area around the atlas. The atlas is the area around the highest cervical vertebra. The treatment consists of a neuromuscular massage of this relatively unknown area. Manual tests are performed to investigate the relationship between the skull, atlas and second cervical vertebrae. The atlas will return to its original place after the treatment, and this has an enlightening effect on the entire area.
- Food: from phytotherapy the cause is sought in food. It is thought that there is a link between migraines and overloading of the liver and gallbladder. It can be useful to have a close look at diet with a dietician to see which foods have an influence on the bouts.
- Cefaly: Cefaly, a device that gives electrical impulses to a nerve, is placed on the forehead. This is where the trigeminal nerve that is involved in migraine runs.
The treatment is regular and certain insurers reimburse such treatment.
- Cannabis: not enough is known about this drug as a medication yet. However, scientific research has shown that cannabinoids have a positive effect on migraines.
- Online behavioural therapy: keep track of how often bouts occur and under what circumstances. Recognising the bouts early allows for a more targeted use of the medication.
Due to the far-reaching consequences that migraines have in a person’s life, psychotherapy is often recommended as a complementary therapy to medication. Research into migraines and their causes is a continuous process. A great deal of research is currently being done into heredity and the relationship between depression and migraines.
A migraine has a major impact on daily life. This can lead to depressive symptoms. This causes the patient to enter a vicious circle. It can be useful to go into therapy in order to alleviate or remedy the concerns caused by migraines. It is important to be conscious of the condition and your way of life. Keeping track of what you eat, when the bouts occur and what your triggers are can help you deal with migraines. For example, you can better adjust medication.
Sport and relaxation are recommended to reduce stress, which has a negative effect on migraine. Relaxation therapies are offered especially for migraines.
Other potentially useful and relieving activities include relaxation massages or relaxation exercises.
Hersenstichting. (n.a.). Migraine. Retrieved from: https://www.hersenstichting.nl/hersenaandoeningen/migraine/
Alles over hoofdpijn. (n.a.). Alles over migraine. Retrieved from: https://allesoverhoofdpijn.nl/soorten-hoofdpijn/alles-over-migraine/
Migraine. (n.a.). Retrieved from: https://www.hierhebikpijn.nl/aandoening/63/migraine