Causes of migraine

Migraines occur in people whose nervous system is more sensitive than that of others. In these people, nerve cells in the brain are easily stimulated, producing electrical activity. As electrical activity spreads over the brain, various functions, such as vision, sensation, balance, muscle coordination, and speech, are temporarily disturbed. These disturbances cause the symptoms that occur before the headache (called the aura). The headache occurs when the 5th cranial (trigeminal) nerve is stimulated. This nerve sends impulses (including pain impulses) from the eyes, scalp, forehead, upper eyelids, mouth, and jaw to the brain. When stimulated, the nerve may release substances that cause painful inflammation in the blood vessels of the brain (cerebral blood vessels) and the layers of tissues that cover the brain (meninges). The inflammation accounts for the throbbing headache, nausea, vomiting, and sensitivity to light and sound.

Oestrogen, the main female hormone, appears to trigger migraines, possibly explaining why migraines are more common among women. Migraines can probably be triggered when oestrogen levels increase or fluctuate. During puberty (when oestrogen levels increase), migraines become much more common among girls than among boys. Some women have migraines just before, during, or just after menstrual periods. Migraines often occur less often and become less severe in the last trimester of pregnancy when oestrogen levels are relatively stable, and they worsen after childbirth when oestrogen levels decrease rapidly. As menopause approaches (when oestrogen levels are fluctuating), migraines become particularly difficult to control.

Oral contraceptives (which contain oestrogen) and oestrogen therapy may make migraines worse and may increase the risk of stroke in women who have migraines with an aura.

Other triggers include the following:

• Lack of sleep, including insomnia
• Changes in the weather, particularly barometric pressure
• Red wine
• Certain foods
• Hunger (as when meals are skipped)
• Excessive stimulation of the senses (for example, by flashing lights or strong odours)
• Stress

Various foods have been associated with migraines, but whether they trigger migraines is unclear. Which foods trigger migraines varies from person to person.

These foods include

• Foods that contain tyramine, such as aged cheeses, soy products, fava beans, hard sausages, smoked or dried fish, and some nuts
• Foods that contain nitrates, such as hot dogs and lunch meats
• Foods that contain MSG (monosodium glutamate), a flavour enhancer found in fast foods, broths, seasonings, and spices
• Caffeine (including that in chocolate)

Head injuries, neck pain, or a problem with the joint of the jaw ( temporo-mandibular joint disorder) sometimes triggers or worsens migraines.

Familial hemiplegic migraine

A rare subtype of migraine, causes weakness on one side of the body. It is associated with genetic defects on chromosome 1, 2, or 19. The role of genes in the more common forms of migraine is under study.

In some families, family members have different migraine symptoms. Some have mainly headache. Some have mainly vertigo (a type of dizziness) or weakness on one side of the body. Some have only a migraine aura with no headache. These findings suggest that migraine may be more than just a headache disorder

Symptoms of migraine

In a migraine, pulsating or throbbing pain is usually felt on one side of the head, but it may occur on both sides. The pain may be moderate but is often severe and incapacitating. Physical activity, bright light, loud noises, and certain odours may make the headache worse. This increased sensitivity makes many people retreat to a dark, quiet room, lie down, and sleep if possible. Typically, migraines subside during sleep.

The headache is frequently accompanied by nausea, sometimes with vomiting, and sensitivity to light, sounds, and/or odours. People have difficulty concentrating during an attack.

Attacks vary greatly in frequency and severity. Many people have several types of headache, including mild attacks without nausea or sensitivity to light. These attacks may resemble a tension-type headache but are a mild form of migraine.

Migraine attacks may last for hours to a few days (typically 4 hours to several days). Severe attacks can be incapacitating and disrupt family and work life.

A prodrome often occurs before a migraine. The prodrome is sensations that warn people that an attack is about to begin. These sensations may include mood changes, neck pain, food cravings, loss of appetite, and nausea.

An aura precedes migraines in about 25% of people. The aura involves temporary, reversible disturbances in vision, sensation, balance, muscle coordination, or speech. People may see jagged, shimmering, or flashing lights or develop a blind spot with flickering edges. Less commonly, people experience tingling sensations, loss of balance, weakness in an arm or a leg, or difficulty talking. The aura lasts minutes to an hour before and may continue after the headache begins. Some people experience an aura but have only a mild or no headache.

Migraines usually become less severe as people age. However, auras that affect vision without a headache occur more frequently in older people.

People with migraine often also feel tired, have problems sleeping, lose their appetite and/or taste for food, and lose weight. Their sex drive may decrease. These problems develop gradually.

Recurrent debilitating migraine attacks can prevent people from doing what they usually enjoy and starts to affect the mind as well. They may become depressed and anxious. They may stop their activities, withdraw socially, and become preoccupied with physical health. The mind-body complex is now fully affected and becomes a vicious circle which keeps an individual in suffering mode.

Diagnosis of migraine

A doctor’s thorough evaluation which includes physical; mental; emotional; social health and environmental influence.

Through this evaluation doctors try to identify the cause of pain, factors modifying pain and the impact of such pain on the daily life quality of a person.

Doctors ask how the person feels; eats; sleeps and goes through a routine day. Identifying these changes is critical because they can make the situation better or worse and, if present, must be treated for the pain to be treated effectively.

Doctors diagnose migraines when symptoms are typical and results of a thorough examination are normal.

No test or procedure can confirm the diagnosis.

Certain findings are warning signs that suggest that the headaches may be caused by a serious disorder. These findings include the following:

• A sudden headache that becomes most severe within a few seconds or less (thunderclap headache).
• Headaches that begin after age 50.
• Headaches that increase in intensity or frequency for weeks or longer.
• Headaches that occur in people who have had cancer or have a weakened immune system (due to a disorder or drug).
• A severe headache accompanied by a fever, a stiff neck, and/or confusion.
• Persistent problems that suggest a brain disorder, such abnormalities in sensation or vision, weakness, loss of coordination, and drowsiness or confusion.
• A clear change in the established headache pattern.

If headaches have developed recently or if certain warning signs are present, magnetic resonance imaging (MRI) of the head is often done, and a spinal tap (lumbar puncture) is sometimes done to exclude other disorders.

If people who are known to have migraines develop a headache that is similar to their previous migraines, doctors rarely do tests. However, if the headache is different, particularly if warning signs are present, a doctor’s examination and often tests are needed.

Homeopathic Treatment of migraine

After a thorough evaluation, each case is worked upon and a set of similar medicines is derived, from which one single medicine which fits the patient’s presentation at that time, in relevant intensity and repetitions is given.

The medicine for acute episode and symptom free period are different. As the improvement goes on you may need different medicine from the previous one, based on your presenting symptoms.

Some need only one medicine throughout the duration of treatment and some need few in sequence one after another across the treatment.

Timely follow-ups are essential to keep moving forward towards the goal of treatment and to identify, manage and overcome any obstacles to the outcome.