Migraine – Symptoms, Treatments, Clinical Trial Findings and More

Keywords: Migraine, Migraines, Symptoms of Migraines

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• What is A Migraine?
• Symptoms of a Migraine
• Migraine Causes
• When to see a doctor
  • Diagnosis
• Treatments for Migraines
  • Pain Relieving Medications
  • Prevention Medications
• MedBuzz Clinical Trial Findings

What Is a Migraine?

A migraine is a moderate to severe recurring headache, that is usually felt as a throbbing or pulsating pain on one side of the head. Migraines are often coupled with other symptoms such as nausea, vomiting, weakness, and increased sensitivity to light and sound. 

Migraines occur in more women than men, affecting 1 in 5 women and 1 in 15 men. Repeat migraines often start appearing in early adulthood. They can occur anywhere between several times per week to once every few years and can last for hours to days.

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Symptoms of a Migraine

Migraines have 4 different phases, but you might not experience all phases each time you have a migraine. The phases are: Prodrome, Aura, Attack, and Post-Drome

1. Prodrome

From 48 up to a few hours before a migraine, over 50% of people experience signs and symptoms warning them of the upcoming migraine. These include: 

• Mood changes
• Food cravings
• Increased urination and fluid retention
• Excessive yawning
• Constipation 

2. Aura

An aura can occur just before or during a migraine and are mostly visual disturbances, such as seeing 

• Bright flashes
• Spots or shapes
• Temporary vision loss

Other physical disturbances include pins and needles in the arms and legs, difficulty speaking. 

Though, most experience migraines without aura, you can also have what is called a ‘silent migraine’ where an aura or other physical disturbances including nausea, and vomiting are experienced without a headache. 

3. Attack, or headache

The attack or onset of the headache can last anywhere between four to 72 hours. During this stage you can expect to experience: 

• Throbbing or pulsing pain on one or both sides of your head, 
• Sensitivity to light and/or 
• Nausea and vomiting

4. Post-drome

After the attack, or headache, you may feel drained, confused and weak for up to a day. In saying that, some people feel elated after the passing of the attack. Sharp head movements may cause the pain to return.

Want to find answers? Join a treatment research group at a Migraine Clinic. Learn more here.

Migraine Causes

The exact cause of migraines is not known, but doctors do know it is related to changes in the brain and genes. 

The current understanding of the cause of a migraine starts with overactive nerve cells sending signals which trigger the trigeminal nerve (the nerve that gives sensation to your entire head). As a result, your body releases a calcitonin gene-related peptide (CGRP) which makes the blood vessels lining your brain swell, resulting in neurotransmitters causing inflammation and pain.

Several factors can trigger a migraine. Those susceptible should take note of any triggers that bring on their migraine, and avoid when possible.

• Stress or Anxiety
• Strong sensory experiences (loud noises, bright lights, strong smells etc.)
• Hormonal changes in women
• Changes in sleeping schedules
• Certain medications
• Changes in weather or environment
• Tobacco
• Caffeine or caffeine withdrawal

Additionally, several foods can trigger migraines including:

• MSG
• Aged cheeses
• Fermented or pickled items
• Yeast
• Cured or processed meats

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When to see a doctor

If you are experiencing frequent migraines, keep a documented list of triggers, symptoms and signs; this will help your doctor diagnose or make a recommendation easier. If you have experienced a number of migraines, or your headaches change in frequency, pain level or duration, you should visit a doctor to rule out any other more serious issues. Additionally, if your migraines are interfering with your daily activities, causing a lot of pain or psychological stress, see a doctor about possible treatments. 

If you experience any of the following, visit your doctor or an emergency room immediately. 

• An abrupt headache reaching a peak within 1 minute
• A headache with a fever, seizures, double vision, numbness, frozen neck or difficulty speaking
• A headache after being struck from a head injury
• A headache that increases in pain following any exertion or sudden movements
• Onset of headaches over the age of 50

Diagnosis

Migraines can be diagnosed by your GP. They will ask about your own and your family’s medical history, as well as the specifics of your symptoms including, and conduct a physical and neurological examination

To rule out other more sinister causes for your pain, your doctor might conduct several tests including: 

1. MRI scan: This can help diagnose tumors, strokes, bleeding in the brain or other neurological conditions
2. CT scan: This can help discover tumors, infections, brain damage or other neurological conditions.

Treatments for Migraines

There is no cure for migraines, so current treatment and most clinical trials are aimed at either reducing or stopping symptoms (pain-relieving), or preventing attacks (preventative). Deciding which treatment to choose should be based on how disabling, severe and frequent your migraines are, taking into consideration your doctor’s recommendation.

1. Pain Relieving Medications

Pain relief medications for migraine should be taken as soon as possible during the onset of symptoms, or any first signs. Medications used to relieve pain caused by migraine include:

• Pain relief: These include aspirin, ibuprofen or paracetamol which can be purchased over the counter or with a prescription. Side effects may occur for longtime use. Care should be taken whilst consuming pain relief medication for migraines as they can sometimes add to the headache, and some can become dependant on them producing ‘rebound headaches’.
• Nausea medication: If nausea is a problem with your migraines, your doctor might prescribe you some nausea medication. 
• Triptans: Triptans balance the chemicals in your brain and block pain pathways. These are prescription drugs and might not be safe for those at risk of stroke or heart attack. 
• Chemical balancing medications: Some chemical balancing medication for your brain are useful in the treatment of pain relief.
• Lasmiditan: This is a new medication that has been approved to treat migraines. It is useful in improving pain as well as nausea and sensory sensitivity, although it can cause drowsiness so shouldn’t be taken with alcohol or while operating machinery.
• Ubrogepant: As we stated previously in this article, the current understanding of migraines suggests the involvement of CGRP. This is an oral CGRP receptor antagonist and can treat acute migraines, showing results within 2 hours. Side effects may occur, and it should not be taken with some drugs.

Prevention Medications

In some cases, medications that can help prevent migraines might be a better option, especially if you’re experiencing multiple in a week/month. They are aimed at reducing the severity, frequency and duration of migraines.

• Beta-blockers: These are blood pressure-lowering medications.
• Calcium channel-blockers: Blockers can help prevent migraines.
• Some antidepressants: Sometimes, tricyclic antidepressants are prescribed due to their ability to prevent migraines. Side effects may occur.
• Anti-seizure drugs: Some anti-seizure drugs have shown some use in reducing the frequency of migraines. Side effects may occur.
• Onabotulinumatoxin injections: Onabotulinumatoxin injections have shown some success in preventing migraines in adults if injected once every 12 weeks.
• Single Pulse Transcranial Magnetic Stimulation (sTMS): A sTMS is a magnetic device that is used at the onset of a migraine with aura. It sends energy to a part of your brain which has shown to reduce pain in some adults.

MedBuzz Clinical Trial Findings

We do the research so you can be better informed!

Clinical Trials on migraine are primarily on the prevention of chronic and episodic migraines. There are a number of unconventional therapies that could be suitable for people with medication overuse, or side effects to other treatments 

Prevention 

• Cognitive behavioural therapy (CBT): A clinical trial in 2016 found that CBTin children and adolescents with chronic migraine (more than 15 days per month with a migraine) was more successful in reducing the number of afflicted days per month, compared to those who received headache education plus other assistive drugs.
• Galcanezumab: In a randomised clinical trial of ~400 episodic migraine patients in 2018, certain doses of galcanezumab proved more successful than placebo in reducing the number of days patients experienced migraines per month. Another study in 2018 showed similar results, reducing the average number of days by 4 days 
• Eptinezumab: In a randomised clinical trial in 2019, eptinezumab was effective for the treatment of chronic migraines.
• Fremanezumab: in a randomised clinical trial in 2018, fremanezumab proved successful in reducing the number of days patients experienced episodic migraines in a month by 1.3 – 1.5 days.
• Acupuncture: For the treatment of chronic migraines, a clinical trial in 2011 showed that acupuncture was more successful than a common treatments, in reducing symptoms including number of headaches per month, headache disability and psychological distress. 

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Sources:
Mayoclinic.org
Medlineplus.gov
NHS.uk
WebMD.com