Neurology
Summary
Migraines are characterized by a distinct set of symptoms that can vary among individuals. The most recognizable is the visual aura, often described as an expanding central visual loss or a scintillating scotoma, which refers to shimmering lights that can take on diverse patterns and shapes. While visual auras are the most common, migraines can also present with auditory, sensory, language, or motor auras, though these are rarer. The hallmark migraine headache is typically unilateral and can be described as having an intense throbbing or boring quality. Accompanying symptoms often include phonophobia, photophobia, and vomiting. Typically, a migraine attack persists for a day or less. Notably, migraines have a genetic component and can be triggered by a variety of factors, including fluctuations in estrogen levels, foods high in nitrates, alcohol, and stress.
Migraine diagnosis is typically clinical, and there's generally no need for imaging unless specific headache red flags emerge that suggest another underlying issue. Effective management of an ongoing migraine attack involves reducing sensory stimuli, best achieved by placing the patient in a dark, quiet room. The treatment strategies for migraines include abortive migraine medications and preventative migraine medications. Abortive medications are available to alleviate symptoms once a migraine has begun and include NSAIDs, triptans (like sumatriptan), acetaminophen, caffeine, antiemetics (like metoclopramide), and ergotamines. For those prone to frequent migraines, preventative medications can be prescribed. Options include valproate, tricyclic antidepressants (TCAs), beta-blockers, and topiramate.
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FAQs
A visual aura is a common symptom associated with migraines, often occurring before the headache phase of a migraine attack. These auras can be described as a central and expanding visual loss or as a scintillating scotoma, which are shimmering lights that can form into various patterns and shapes. Auditory, sensory, language and motor auras are also possible, though less common.
A migraine headache is often described as being unilateral, meaning it affects one half of the head. The pain is usually intense, throbbing or boring in character. This can be accompanied by other symptoms such as phonophobia (fear of sounds), photophobia (sensitivity to light) and vomiting.
Migraines can be triggered by a variety of factors. Some common triggers include fluctuations in exogenous and endogenous estrogen levels, certain foods that contain nitrates, alcohol, and stress. Nevertheless, triggers can vary greatly among individuals and understanding and avoiding these triggers can help in managing migraine attacks.
While it can vary among individuals, a migraine generally lasts a day or less. However, in some cases, it can last for several days. The length of a migraine can be influenced by various factors including the severity of the attack, whether or not treatment is administered and how quickly it is administered after the onset of symptoms.
There are two main strategies for treating migraines: abortive and preventative. Abortive treatments are used to stop the progression of the migraine once it has started and include drugs like NSAIDS, triptans (e.g. sumatriptan), acetaminophen, caffeine, antiemetics (e.g. metoclopramide), and ergotamines. Preventative treatments, on the other hand, are used to reduce the frequency and severity of the migraines, and include medications such as valproate, TCAs, beta-blockers, and topiramate. Additionally, reducing stimuli by providing a dark, quiet room can also help alleviate symptoms.
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