Why Migraine Headaches Occur: Triggers and Causes

Definition:

A migraine headache is a type of recurring and often debilitating headache characterized by intense, throbbing pain typically on one side of the head. Migraines are typically accompanied by other symptoms such as nausea, vomiting, sensitivity to light, and sensitivity to sound. They can last for several hours to several days and can significantly disrupt a person's daily life.

 

Migraines are a neurological condition, and their exact cause is not fully understood. They are believed to involve a combination of genetic, environmental, and neurological factors. Migraine triggers can vary from person to person but may include certain foods, hormonal changes, stress, lack of sleep, and other factors.

 

In this article, I'll delve into the intricate world of migraines, shedding light on the perplexing question of "Why Migraine Headaches Occur: Triggers and Causes." Migraine headaches, more than just a throbbing head pain, are complex neurological events that affect millions worldwide. While their exact origins remain a subject of ongoing research, a myriad of triggers and underlying causes have been identified. Understanding these triggers is crucial in managing and preventing the debilitating pain and associated symptoms that accompany migraines.

Migraine sufferers often experience a range of symptoms, including severe head pain, nausea, sensitivity to light and sound, and sometimes visual disturbances. By unraveling the various factors that contribute to migraine onset, we can empower individuals with the knowledge needed to proactively manage their condition. From environmental influences to genetic predispositions, this exploration aims to demystify the enigmatic nature of migraines, providing insights into why they occur and offering a foundation for effective prevention and treatment strategies.

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There are two main types of migraines:

 

Migraine with Aura: Some people experience an "aura" before the onset of a migraine. Auras are usually visual disturbances, such as flashing lights or zigzag lines, but can also include other sensory disturbances or motor symptoms. Not all migraine sufferers experience auras.

 

Migraine without Aura: This is the most common type of migraine and occurs without the preceding aura. It is often characterized by severe headache pain, nausea, and sensitivity to light and sound.

 

Symptoms:

 

Pain: Crescendo pattern Pulsating/throbbing Moderate to severe pain

Patient retreats to dark, quiet room Sensitivity to light (Photophobia)

Sensitivity to sound (Phono phobia)

Nausea & vomiting

Taura (visual, speech, or motor deficits)

 

Duration:

v  4-72 hrs.

 

Potential triggers

 

Stress

Change in sleep pattern (too much or too little)

Hormonal changes

Variations in caffeine intake

Foods: chocolate, hard cheese, MSG, nitrates, tyramines

 

Diagnostic Criteria without Aura

 

At least five attacks fulfilling the following criteria: untreated headache

lasting 4 to 72 hours.

 

Group A (2 of 4):

 

1. Unilateral headache

2. Throbbing or pulsating pain

3. Moderate to severe pain that inhibits ability to function

4. Pain aggravated by routine physical activity

 

Group B (1 of 2):

 

1. Presence of nausea or vomiting

2. Presence of photophobia and Phono phobia

 

.

 

Underlying disorders that may cause Secondary headaches must be ruled out

 

Recommendations for use of prophylactic migraine medication:

 

Start with low dose and titrate slowly

Decrease in headache frequency may be imperceptible the 1st month;

For first month, 10% decrease in frequency is considered successful

Improvement is cumulative, may take 6 months to reach efficacy.

Success = 50% reduction in headache frequency

 

After a 6-month period of headache

 

Stability, periodically evaluate.

 

MIGRAINE HEADACHE PREVENTIVE DRUGS

 

B-Blockers:

Metoprolol, Propranolol, and Timolol have established efficacy. Atenolol and Nadolol probably effective.

 

ACEIS:

(Lisinopril) & ARBS (candesartan) probably effective.

 

Calcium channel blockers:

Conflicting evidence regarding efficacy despite their historical use.

 

Valproate and Divalproex sodium

(teratogenic), Established efficacy. As effective as ẞ-blockers. Side-effect is weight gain.

 

Topiramate

(may cause weight loss): Established efficacy. Consider side-effect of weight loss for obese patients. Tricyclic's (amitriptyline): probably effective; unrelated to antidepressant activity.

 

Selective serotonin reuptake inhibitors:

Venlafaxine, probably effective NSAIDs: use to prophylaxis known triggers (e.g., start before menses for menstrual migraine)

 

Pizotifen is effective

 

Riboflavin (Vitamin B2): Small studies suggest effectiveness.

 

 

 

Rx

ER Rx for Acute Attack:

 

Inj. Ketorolac 30mg (Toradol) + Metoclopramide 10mg (Metacion) x IV slow x Stat (dilute in 2ml N/S) - no data suggest dilution.

Or

Inj. Diclofenac sodium 75mg (Voren) x IM/IG PLUS Inj Metoclopramide 10mg (Metacion) x IM/IV x stat.

 

Note: Decreased gastric motility may limit effectiveness, Dopamine antagonist (metoclopramide: GI motility and may help as antiemetic and maybe used as monotherapy for treatment by IV route).

 

Home Rx for Acute Attack:

 

Tab Sumatriptan 2.5mg + Naproxen sodium 550mg (Sumoxen plus).

 

OR Zolmitriptan 2.5mg nasal Spray (Zolmipine) X intranasal.

 

OR Tab Sumatriptan Serotonin 5-HT receptor agonists ("triptans") - Drugs of choice for moderate or severe migraines or if no response to analgesics.

 

Rx

Mild to Moderate Migrain

Behavioral modification

Avoid "triggers" (e.g., foods, alcohol, caffeine, nicotine, nitrates)

Regular sleeping patterns

Minimize stress

 

Tab. Paracetamol 500mg (Panadol, Calpol) x TDS.

Or

Tab. Mefenamic acid 500mg (Ponstan forte, Mefnac DS) x TDS.

Or

Tab. Naproxen sodium 250mg, 500mg (Neoprox, Flexin) x BD.

 

Rx

For Prophylaxis Rx 1:

 

1. Cap. Flunarizine 5mg (Sibelium, Lunar) two Caps, at night x OD.

 

2. Tab. Naproxen 250mg, 500mg (Flexin, Synflex, Neoprox) 1-0-1(BD).

 

Long term NSAIDs causes gastritis so add on

 

3. Cap. Omeprazole 40mg (Risek, Ruling) 0-0-1(OD)

 

کھانے سے 30 منٹ پہلے

 

4. Tab. Propranolol 10mg (Inderal, Cardinal) 1-0-1(10mg x BD), 2-0-2 (20mg x BD)

 

 

Rx

For For Prophylaxis Rx 2:

 

1. Tab. Divalproex sodium 500mg (Epival CR) 0+0+1(OD)

 

2. Tab. Diclofenac potassium 50mg (Caflam, Dyclo-P) 1+0+1(BD)

 

Long term NSAIDs causes gastritis so add on

3. Cap. Esomeprazole 40mg (Esso, Nexum) 0+0+1(OD)

کھانے سے 30 منٹ پہلے

 

4. Tab Propranolol 10mg (Inderal, Cardinal) 1-0-1(10mg x BD), 2-0-2 (20mg x BD)

 

 

Rx

For Prophylaxis Rx 3:

 

1. Tab. Topiramate 25mg, 50mg 0-0-1(OD).

 

2. Tab. Diclofenac potassium 50mg (Caflam, Dyclo-P) 1+0+1(BD).

 

Long term NSAIDs causes gastritis so add on

3. Cap. Esomeprazole 40mg (Esso, Nexum) 0-0-1(OD)

 کھانے سے 30 منٹ پہلے

 

4. Tab Propranolol 10mg (Inderal, Cardinal) 1-0-1(10mg x BD), 2-0-2 (20mg x BD)

 

 

 

Conclusion:

I hope this article has shed light on the complex and often mystifying realm of migraines, particularly regarding their triggers and causes. Migraine headaches are not merely a source of excruciating pain but rather a intricate interplay of genetic, environmental, and physiological factors. As we've explored various triggers, from dietary influences to stressors and hormonal fluctuations, it's evident that there is no one-size-fits-all explanation for why migraines occur.

In concluding, it's crucial to emphasize the importance of personalized approaches to managing migraines. Individuals affected by migraines should work closely with healthcare professionals to identify their unique triggers and causes, enabling the development of tailored prevention and treatment strategies. Whether through lifestyle modifications, medication, or complementary therapies, there are numerous avenues to explore in pursuit of migraine relief. By staying informed and proactive, migraine sufferers can gain a greater sense of control over their condition, ultimately improving their quality of life and reducing the burden of these debilitating headaches.