Migraine

Migraine is a biological disorder of the central nervous system, involving a complicated relationship between the blood supply to the brain and its nerve network. A recurrent, throbbing headache generally felt on one side of the head, migraines usually begin in early childhood, adolescence, or young adult life. 

There are many forms of migraine headaches. The classic migraine and the common migraine are the two main types: 

Classic Migraines: There is usually a warning (aura or prodrome) of an approaching headache attack.

Common Migraines: A throbbing headache begins suddenly without warning of an attack. The location of the headache varies. The pain may be on both sides of the head, or it may shift from side to side. 

Hemiplegic migraine: Patients with hemiplegic migraine have temporary paralysis on one side of the body, a condition known as hemiplegia. Some people may experience vision problems and vertigo--a feeling that the world is spinning. These symptoms begin 10 to 90 minutes before the onset of headache pain. 

Ophthalmoplegic migraine: In ophthalmoplegic migraine, the pain is around the eye and associated with a droopy eyelid, double vision, and other sight problems. 

Basilar artery migraine: This involves a disturbance of a major brain artery. Preheadache symptoms include vertigo, double vision, and poor muscular coordination. This type of migraine occurs primarily in adolescent and young adult women and is often associated with the menstrual cycle. 

Benign exertional headache: Benign exertional headache is brought on by running, lifting, coughing, sneezing, or bending. The headache begins at the onset of activity, and pain rarely lasts more than several minutes. 

Status migrainosus: This is a rare and severe type of migraine that can last 72 hours or longer. The pain and nausea are so intense that people who have this type of headache must be hospitalized. The use of certain drugs can trigger status migrainosus as can depression and anxiety.

Headache-free migraine: While all the symptoms of a migraine are felt in this form, no head pain is experienced. 

Migraine headaches affect about 6 out of 100 people. They are a common type of chronic headache. Migraines most commonly occur in women and usually begin between the ages of 10 and 46. They appear to run in families in some cases. Classical migraine accounts for about one-sixth of all migraines. Common migraine and other (rare) forms account for the rest.

The most common symptom associated with migraine is throbbing head pain made worse by routine activities like climbing stairs or bending over. The pain is often felt on one side of the head, although it can switch sides during an attack or from one attack to the next. People afflicted with migraine describe the pain as ‘hammering’ or ‘pulsating.’

Classic 

• Bright spots or zigzag lines are seen.
• Double vision or temporary, partial blindness. 
• Numbness and tingling of the lips, face, hands (on one or both sides), 
• Weakness of an arm or leg, 
• Dizziness, 
• Unsteadiness in walking, 
• Drowsiness, 
• Slight confusion of thinking
• Inability to speak or slurred speech. 

Because migraine headaches may recur for years and constant use of medication can lead to serious side effects, prevention is a key aspect in the management of migraines. Knowing what to avoid can lead to a change in the pattern and severity of migraine attacks.

Paying close attention to diet can prevent a migraine attack. Keeping a diary to record the factors that trigger a migraine can be helpful. If hunger precipitates a migraine, eating frequent small meals on a regular basis could be of help. Women who have migraines just prior to their menstrual period should lower the salt intake to decrease water retention associated with precipitating attacks. Women with a history of migraine headaches should avoid oral contraceptives. Alcohol causes the blood vessels in the body to widen, which contributes to the pain of migraines due to which alcoholic beverages must be avoided altogether.
Stress reduction is an important step toward reduction of migraines. Regular exercise and relaxation techniques may not only help reduce stress but, also, decrease the severity of the pain and frequency of the headaches. 
A regular schedule for sleep is necessary if fatigue precipitates attacks. Fatigue may become exaggerated at times of weather change.

The nervous system responds to a trigger such as stress by creating a spasm in the nerve-rich arteries at the base of the brain. The spasm closes down or constricts several arteries supplying blood to the brain, including the scalp artery and the carotid or neck arteries. 
As these arteries constrict, the flow of blood to the brain is reduced. Serotonin, a powerful constrictor of arteries, is released as a result of the clumping of platelets, further reducing the blood supply to the brain. As a result of a decreased oxygen flow to the brain due to the sluggish blood flow, symptoms signaling a headache, such as distorted vision or speech, may then result, similar to symptoms of stroke.

Reacting to the reduced oxygen supply, certain arteries within the brain open wider to meet the brain's energy needs. This widening or dilation spreads, finally affecting the neck and scalp arteries. The dilation of these arteries triggers the release of pain-producing substances called prostaglandins from various tissues and blood cells. Chemicals, which cause inflammation and swelling, and substances, which increase sensitivity to pain, are also released. The circulation of these chemicals and the dilation of the scalp arteries stimulate the pain-sensitive nociceptors. The result, according to this theory is a throbbing pain in the head. 

The following items and events (precipitants) have been reported to cause/trigger migraine attacks. 
Food triggers:

Migraine is diagnosed by determining whether some of a person's recurrent headaches meet migraine criteria (listed below). Not every migraine needs to meet all of the migraine criteria. For example, a person may have a left-temporal throbbing headache of moderate intensity worsened by physical activity. If a headache is not be accompanied by nausea or hypersensitivity to light or noise, it does not fulfill all the criteria for migraine.

• Some foods are found to induce migraine headaches in some people. These may include chocolate, cheese, citrus fruits, shellfish, alcohol, wheat, eggs, oranges, tomatoes, rye, yogurt, potatoes, canned fish, onions, peanut butter and beef. These foods contain vasoactive amines that can cause brain vessels to constrict. People who suffer from migraine might be deficient in platelet enzymes that are helpful in breaking down these amines.
• Try to avoid aspartame found in nutra-sweet, nitrates, and monosodium glutamate. They are all suspected to be migraine inducers.
• Low blood pressure and low sugar levels can also trigger off migraine. To counter these problems eat several small meals and avoid taking excess carbohydrates.
• Some migraines may be caused by food allergies. Try to avoid such foods.

• Keep a track of what you are eating before a migraine to see if there is any connection between what you eat and the headache.
• Migraines might come with taking birth control pills. Notify the doctor and try to change the type of oral contraceptives.
• As soon as you have a migraine attack, take an aspirin; apply a cold compress to your face and a soft ice bag to your head.
•  Lie in a quiet dark room for 2 to 3 hours or until the intensity of the headache decreases.
• Do not read during this time.
• Try getting a neck and head massage to see if this aggravates or alleviates your symptoms.

Physical therapies to decrease the intensity of the attacks are necessary.