Migraine: Types, Causes, Diagnosis and Treatment

The molecule that triggers migraine attacks, CGRP (calcitonin gene related peptide), was first discovered back in 1984. For more than 30 years, scientists have tried to find a way to destabilize its effects in the body in order to come up with an effective drug for migraine treatment. 

And only last year, the FDA (the Food and Drug Administration) – the organization that registers and monitors drugs in the United States – registered the first drug for use, which reduces the number of migraine attacks by blocking the activity of this molecule or its receptor. So far, the drugs are only allowed to be consumed by adults, but clinical trials are already underway for children.

Types of headaches

Headaches can have more than 150 different causes. For example, a headache, like any pain, can be a sign of danger, if some structure is damaged in the body – a vessel, shell, skin, joint or ligament. This pain is characterized as a symptomatic or a secondary headache. In this case, doctors need to understand where the danger signaled by the pain is located and treat the cause.

However, it is much more often the case that a headache is a manifestation of an independent neurological disease. Such pain is defined as primary, and accounts for approximately 95% of all headache incidences. 

It most likely occurs that before a headache strikes during a migraine attack, you may experience vision changes: patterns of flashes in the eyes, flickering zig zags, spots, as well as transient numbness of the face or hands. This is called a migraine aura. According to recent reports, migraine with an aura is a slightly different condition than a migraine without aura. In fact, migraine attacks with aura are less frequent but more severe.

Migraine Myths and Unnecessary Tests

There is a common myth that in children and adults, one of the most common causes of headache is associated with issues occuring with the cervical spine. In reality, such a relationship is extremely rare, and in such a condition, one would experience a cervicogenic headache.

Indeed, 80% of migraine attacks begin from discomfort in the neck, but this is due to the fact that the trigeminal nerve system is connected by the occipital nerve. As a rule, with headache attacks, neck pain is a consequence of the onset of a migraine attack, and not its cause.

In 2016, a large study was carried out on the genetic data of more than 300 thousand patients in order to analyze the genetics that cause higher incidence of migraine. As a result, scientists have identified 44 nucleotide polymorphisms associated with an increased risk of migraine headaches. But this is not a diagnostic test system.

Simply put, no biochemical or genetic tests currently exist to confirm the diagnosis of migraine. There is only clinical criteria for the diagnosis that is collected on the basis of a conversation with a patient and his examination. They are clear and simple enough. In most cases, it’s not difficult to diagnose and treat migraines. All additional examinations are conducted only if other possible causes of the headache are suspected.

Tension Headache and Migraine

More than 90% of people experience tension headaches periodically in their lives. If we work for an extended period of time in a static position on the computer in a stuffy room, we may experience bilateral, squeezing pain in the temples or in the crown of the head. Usually it is light – on a ten-point scale, probably around 3-4 points in terms of the pain level. For the pain to subside, you simply need to leave the workplace, take a walk, drink coffee, get some air, go workout and change your scenery. However, if the pain lasts a long time, does not diminish, and becomes stronger, then you could think about taking medication. 

When it comes to migraines, it’s a different story altogether. The condition manifests itself as a headache with additional debilitating symptoms. As a rule, in addition to pain, an attack is usually accompanied by nausea and increased sensitivity to light, sounds and smells. Migraine can be bilateral or unilateral, migraine attacks are severe or mild, but even with a mild attack, the pain is difficult and unnecessary to endure.

Without the timely use of anesthetic, the attack usually intensifies in severity and may be accompanied by vomiting. If you do not take medication, the attack lasts anywhere from 4 hours to 3 days. During a mild attack, simple drugs can be effective – Ibuprofen, Paracetamol and other pain relievers, which are sold in most supermarkets around the world.

Thankfully, there is enough information out there about migraine triggers that patients can utilize to make informed understanding about which triggers are unique to their own condition – either dark chocolate, red wine, hard cheese, or lack of sleep. If attacks occur more than twice per month, or if their frequency and severity begin to increase or are accompanied by other symptoms, this is a prime reason to see a doctor.

As for the choice of drugs, there is neither a perfectly safe drug nor universally effective one. Any pain reliever can be unsafe with frequent and prolonged use. For migraines, it is important to use any drugs in the correct dosage.

It is also important to be aware of the risk of developing a drug-induced headache. Each drug has its own permissible conditional “norms” – for example, Ibuprofen is recommended to not be taken more than 15 times per month. Exceeding these “norms” for a long stretch of time can cause additional headaches to occur. 

Fortunately, many patients were able to cure migraines without medication. More information can be found on the website.

For moderate or severe migraine attacks, it is useless to take simple pain relievers; in such cases, other medications may be needed. This is a fairly large group of drugs, which is collectively called triptans. If an attack begins with nausea, which is then connected to a headache, no matter what drugs you take – triptans or simple pain relievers, their effectiveness can be dramatically reduced.

Trigeminal autonomic cephalalgia

Trigeminal autonomic cephalalgias are a group of rare primary headaches characterized by very severe pain – 10 points out of 10 in pain levels. They are always unilateral, emerging in the temporal zone or the eye area. This term comes from the words “cephalgia,” which is associated with the trigeminal nerve, and “vegetative,” because for this condition, it is typical to experience a bright vegetative accompaniment in the form of lacrimation, redness of the eye, and eyelid edema.

The attacks of TAC are short, lasting anywhere from a few seconds to one and a half hours. Sometimes these pains are called “suicidal,” because there are cases of pain so debilitating, that people tried to commit suicide, unable to bear it. Fortunately, today doctors have the opportunity to help patients with TAC by alleviating pain at the time of an attack and reducing attack occurrences. 

Headaches in children

Unfortunately, children experiencing headaches is a common situation. Migraine frequency at the ages of 10-17 is as common in children as in adults. 

It has been known for over 50 years that boys can first get migraines at the age of six or seven, while girls a bit later, around twelve or thirteen. In adolescence, this ratio changes to the same as in adults – girls suffer from migraines three times more often than boys. If we take all schoolchildren from 6 to 18 years old, approximately 10% will suffer from migraines, and 40-50% will have tension headaches.

Abdominal migraines and other unusual migraines in children

In children, migraine can manifest itself not only as a headache. For example, an abdominal migraine does not manifest itself as a headache, but as recurrent abdominal pain. Children that suffer from migraine also often have kinetosis – a tendency to develop motion sickness in transport. Another variant of the migraine equivalent is the attack of dizziness, which occurs abruptly, lasts from several minutes to several hours and disappears without a trace.

Known as a syndrome of cyclic vomiting in children of four to six years old, this condition prompts vomiting throughout the day that is not attributed to either metabolic or gastroenterological disorders. It is important to keep in mind that such children’s periodic syndromes can be considered the equivalent of migraine only after excluding all possible other causes – gastroenterological, neurological, ENT pathology (for episodes of dizziness), etc. 

The Best is Yet to Come

In the near future, we will undoubtedly see big changes in the treatment of migraines. There are already reliable and safe methods of treating this condition safely and naturally. You can stay informed about the latest discoveries and learn more about effective migraine treatments on our website!