Migraine refers to the neurological disorder that is characterized by recurring headaches of moderate to extreme severity. These are usually associated with a number of symptoms. The typical presentation of a migraine is a unilateral (one-sided), pulsating headache that lasts anywhere from two hours to three days.
This pain can be associated with triggers, and can be aggravated by external stimuli, such as loud sounds, bright lights, and physical activity. Up to a third of patients affected with migraine will also complain of an “aura” of associated symptoms, including nausea, vomiting, photophobia (sensitivity to light), and transient neurological symptoms.
It is estimated that 15% of the global population is affected by migraine. Migraine is more common in women (19%) than men (11%), although the prevalence of chronic migraine is estimated to be at 2.2% of the population.
The exact cause of migraine has not yet been identified, although current theories point to increased excitability of the cerebral cortex and abnormal firing of pain neurons in the trigeminal nucleus.
Several treatments that have been identified for migraine include:
1) Lifestyle modification: Changes to patient behaviors, such as regular exercise, proper diet, and correct sleeping habits have been shown to reduce the severity and frequency of migraine attacks
2) Avoidance of triggers: Patients who suffer from chronic migraines can identify things that trigger attacks, such as stress, loud sounds, among others. Avoiding these triggers will prevent migraine attacks from happening.
3) Preventive medications: Some medications have been proven to reduce both the frequency and severity of attacks. First line drugs include topimarate, propranolol, metoprolol and sodium valproate. Drugs such as gabapentin, amitriptyline and venlafaxine have also shown some promise, although further evaluation is still needed.
4) Analgesic medications: Migraines of mild to moderate severity can be treated with analgesic medications. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac, and celecoxib have been shown to be effective in reducing symptoms. Other drugs, including opioid derivatives like tramadol, can also be used.
5) Triptans: Drugs such as sumatriptan have been shown to reduce pain and nausea in over 75% of patients, and are recommended therapies for moderate to severe attacks. However, the use of triptans is not recommended for patients with a history or risk of myocardial ischemia, stroke, or other cardiovascular diseases.
6) Ergotamines: Older medications such as ergotamine and dihydroergotamine can also be used for treatment of migraine, with effectiveness that equals triptans. These are also the most effective in resolving severe and debilitating attacks (status migranosus).
7) Intravenous Medications: For those requiring emergency treatment, intravenous metoclopramide has been shown effective in resolving migraine symptoms. An intravenous dose of dexamethasone can also reduce the incidence of migraine recurrence for up to 72 hours.
8) Acupuncture: Complementary alternative medicine interventions such as acupuncture have also shown promise in the treatment of migraine, although patient response varies from each case. Large scale studies are still needed to validate its effectiveness
9) Alternative Medicine: Supplementation with vitamins and herbal preparations has been used for the treatment of migraines, although its effectiveness remains debatable. There is some evidence that supplementation with magnesium, zinc, Co-Enzyme Q10 and Vitamin B complex can reduce the severity of symptoms.
10) Surgery: Patients whose migraines do not respond to conservative, non-operative interventions may require surgery. The implantation of biofeedback and neurostimulator devices has been used, with considerable success, in the treatment of intractable migraines. Migraine surgery, or the decompression of certain nerves, has also been shown to be effective in some cases.