Migraines: Symptoms, Causes, and Management

Lying in a dark room with constant pain shooting into your forehead is a painful experience that is all too familiar to many migraine sufferers.

This debilitating disease can have a huge impact on relationships, work and mental health. Women are particularly affected, with migraine attacks three times more likely than men.

But what exactly causes migraines? What methods can help manage the condition?

According to the Migraine Trust, a British charity, approximately one in every seven people worldwide is affected by migraine, equivalent to more than 1 billion people.

Migraine is a genetic neurological disorder that makes the brain more sensitive to changes.

Dr Katy Munro, a migraine expert at the National Migraine Center, a British charity, said that some people who carry the relevant gene may never be triggered and therefore "live a smooth life."

But for others, different external factors may trigger specific pathways in the brain, causing the release of neurochemicals that trigger migraine symptoms.

These symptoms may include headaches, but may also include vomiting, dizziness, and brain fog.

"Sometimes people will have one set of symptoms one attack and slightly different symptoms the next," says Dr. Munroe, who hosts the migraine podcast "Heads Up." "Symptoms can vary among family members and certainly change at different stages of life."

What are the causes of migraine attacks?

It is unlikely that a single factor triggers a migraine attack. It is often the gradual accumulation of multiple small factors that eventually exceed the critical point that the patient can bear.

These factors may include hormonal changes, unstable blood sugar levels, and not getting enough sleep or sleeping for too long.

Stress also plays an important role. But the state of relaxation that occurs after a period of stress can also trigger migraines.

Dr. Munro said the condition is particularly common in women.

"We tend to be the ones keeping everything running, multitasking and organizing the schedules for everyone in the family."

Weather changes, including changes in temperature, air pressure and humidity, may trigger attacks. The reason may be that the body needs to adapt to changes in the weather itself, such as changes in air pressure, or it may be related to related effects, such as dehydration.

Health problems such as iron deficiency, celiac disease (gluten intolerance/gluten intolerance/gluten-sensitive enteropathy) or hypothyroidism may also trigger migraines.

What are the effects of hormones?

About 10% of children suffer from migraine, with boys and girls affected equally. But during puberty, when girls start having menstrual cycles, things change.

Dr. Monroe, a former family physician, said: "This is one of the reasons why the gap gradually widens in girls and more women have more migraines than men. And we see this continues until menopause."

Hormonal fluctuations are an important trigger, and the sharp drop in estrogen levels before a woman's menstrual period is why migraines are particularly severe during this time.

Rapid changes in hormonal levels during perimenopause—the transitional period before menstruation—can also make migraines worse.

"Hormonal levels change very dramatically. Migraines during perimenopause are a major and serious problem for many, many women," she said.

But the problem isn't just hormones.

"You may be caring for teenage children and elderly parents at the same time, or you may be having trouble sleeping due to menopausal symptoms," she said.

After menopause, migraine attacks may become less severe and less frequent because hormone levels are more stable.

How do you know if you are having a migraine attack?

Migraine attacks are usually divided into four stages.

The first stage is the prodromal or premonition period, when changes within the brain begin to accumulate. Some people experience warning symptoms such as yawning, extreme tiredness, or neck pain.

This is followed by the aura period, which can last up to an hour and often presents with visual disturbances such as jagged lines or white spots of light. This condition occurs in about one-third of patients.

This is followed by the headache phase, or impact phase, which can last from four to 72 hours. Some people may also experience nausea and vomiting.

The final stage is called the postdromal, or hangover phase, which can last one to two days after the headache has generally subsided.

"It felt like being run over by a steamroller," Dr. Monroe said.

"You're trying to recover, and that's often when people go back to work, but they may not be fully operational yet."

What lifestyle changes can help manage migraines?

In the past, migraine sufferers were often advised to avoid triggers such as caffeine or chocolate. But Dr. Monroe said that instead of doing this, we should think about how to maintain a regular life as much as possible.

She explains that becoming a "migraine detective" and reviewing what has changed in the two or three days before the obvious onset of a migraine can help identify the problem and try to avoid a recurrence of the same situation.

But Dr. Monroe said there are always variables in real life.

"We can't do everything perfectly, so don't beat yourself up with guilt. Just do your best."

It is important to eat regularly to avoid drops in blood sugar. It's also important to get a good night's sleep and try to go to bed and wake up at the same time.

While exercise is important for everyone, it can also trigger migraines, so patients should consider whether they are getting enough energy and staying hydrated.

This way of thinking may also explain why weekends are high-risk times, because our patterns on Fridays may be different, Dr. Munro said.

"You might be in a rush to get work done. You might be starting to wind down in the evening, maybe having a glass of wine you wouldn't normally drink. You might be sleeping a little later, too," she says.

"The key is to think about what has changed and what could become more regular."

What supplements and medications can help?

It is very important to use effective medication as early as possible in the early stages of a migraine attack.

"By then, the snowball effect has accumulated so much that it will be difficult to reverse no matter what you do. Taking medicine early is to suppress the snowball while it is still small."

Dr. Monroe recommends considering taking antinausea and pain relievers, such as ibuprofen or aspirin.

She said paracetamol was less effective and warned against using codeine as it could make headaches worse.

Scientists have discovered which neurochemicals play an important role in migraines. One of the peptides, called CGRP, is particularly critical for some patients, and there are treatments that can block its effects.

Other treatments include Botox injections, which scientists believe may block chemicals that release pain signals. In addition, holistic therapies such as acupuncture, yoga, tai chi, and pain reprocessing therapy may also be helpful.

Dr. Monroe said the most important thing is to proactively seek more information.

"There's still hope out there, so don't give up and don't think you've tried it all, because that's not the case," she said.