A migraine is a neurological disorder characterised by episodic headaches. These can start with warning symptoms called auras, including issues with vision, tingling sensations or weakness of the upper and lower limbs, speech difficulties, as well as various other indicators. The auras, or warning symptoms, are followed by the onset of a headache, usually pulsating, or throbbing on one side of the head.
Migraines are often accompanied by nausea, vomiting, and hypersensitivity to light and sound. Attacks can last from hours to days, sometimes with devastating consequences to the patient’s quality of life. A proper assessment of the condition, followed by a comprehensive treatment plan can be life changing.
Migraine attacks may progress through four stages: prodrome, aura, attack, and post-drome. Not everyone experiences all the stages.
A few days before a migraine attack the patient may experience some of the following symptoms: mood swings, frequent yawning, painful neck or neck stiffness, food cravings, constipation, or frequent urination. Sufferers can have temporary symptoms that affect the nervous system, such as visual issues before or during an attack. Visual aura includes loss of vision, seeing various shapes, bright spots or flashes of light. The patient may feel a pins and needles sensation in their limbs, weakness or numbness in the face, or one side of the body. Speech difficulty is another possible symptom.
Migraine attacks can last from a few hours up to 3 days, if left untreated. The frequency of attacks varies from patient to patient and may be rare or happen several times a month. The pain usually occurs on one side of the head, but sometimes on both. It is typically described as throbbing or pulsating, accompanied by hypersensitivity to light, sound, and sometimes smell and touch, as well as nausea and vomiting.
After a migraine attack, the patient may feel tired, drained or weary and experience problems with concentration. This is called the postdrome phase and may last up to a day.
A neurologist will make a diagnosis based on medical history, symptoms and a neurological examination. If the headache includes some atypical clinical features, or does not respond to treatment as expected, the neurologist may also recommend an MRI brain scan to review structural brain changes, and to exclude brain tumours, strokes or other problems which might mimic migraine attacks. The neurologist may also consider blood tests and/or a lumbar puncture, with cerebrospinal fluid analysis, to rule out neuroinfection and other conditions.
For the treatment of migraine, the neurologist will usually first recommend identifying and avoiding the migraine triggers. They may also prescribe specific medication called triptans, which can effectively help to manage acute attacks. Besides triptans, the neurologist can also recommend more common painkillers, such as Paracetamol or Ibuprofen, to manage severe headaches.
To decrease the frequency of migraine attacks, the neurologist may use different prophylactic medications or other more advanced treatment interventions such as Botulinum toxin injections for chronic migraine.
When to see a doctor
Migraines are often undiagnosed. Untreated they can have a catastrophic impact on the patient’s personal and professional life. It is recommended that all patients suffering from migraines see a neurologist. Prior to meeting with the doctor, they are advised to keep a record of attacks, including their regularity, symptoms and treatment.
If the headache is new or abrupt and/or is accompanied by a fever, stiff neck, confusion, double vision, numbness, or weakness in any part of the body, or occurs after a head injury, or is atypical and a new headache after the age of 50, seek immediate medical attention via an accident and emergency department. Additionally, should the pattern or feeling of the headaches suddenly change, please consult a doctor.