12 March 2019 Author : Raquel Gil-Gouveia According to the World Health Organisation, it is the eighth cause of years lived with a an incapacity in the world , taking all the known illnesses in the world into consideration. This incurable chronic disorder is a public health problem. It affects a significant proportion of the population and has a substantial impact on the quality of life of sufferers. Nonetheless, people with migraines often do not seek medical attention. This means that they are not aware of effective treatments that can minimise symptoms and substantially improve their quality of life. What are migraines and who suffers from them? Migraine is a special type of headache with attacks lasting from a few hours to several days. They occur more or less regularly, ranging from once or twice a year to several times a month. They also vary in intensity. Migraines may begin in childhood , though they are more common in the 20s and 30s , and less so after the age of 40. They affect women two to three times more than men. It is estimated one in every 7 adults suffers from migraines. What causes migraines? Migraines are a brain disorder , in which pain is associated with dilation of the blood vessels due to a number of causes that are still not well understood. There seems to be some genetic or hereditary influence behind migraines. Family members of migraine sufferers are more likely to have the disorder. When one of the parents suffers from migraines, there is a 50% risk of their child also suffering from them. The risk is 75% if both parents suffer from migraines. Given migraines are more common in women, if a mother is affected then there is a 66% chance her daughters will also develop the disease. Migraine sufferers have a genetic predisposition for headaches. Research studies have not identified a single gene that causes migraines , but rather several different genetic variants. What these variants have in common is that they create a predisposition for headaches when there are certain triggers. Although they are not the cause of migraines, there are number of factors that can help trigger or exacerbate migraine attacks. In other words, these factors facilitate the onset of a migraine attack. These triggers are not the same for all migraine sufferers and vary over the years. If you are able to avoid exposure to these factors , you may be able to reduce the number of migraine attacks, although this is not always possible. The most common triggers of migraine attacks are: Hormonal factors (in women) – menstruation, ovulation, hormone treatment or the contraceptive pill; Emotional factors – anxiety, stress, post-stress relaxation and depression; Changes in sleep patterns – sleeping too much or not enough; Environmental factors – changes in weather, long journeys or physical exercise; Exposure to olfactory, visual or auditory stimuli – exposure to strong perfume, paint or cigarette smoke, exposure to light or loud noises and dietary factors such as going a long time without eating, drinking alcohol or too much caffeine. What are the most common symptoms of migraine? Migraine attacks can be divided into four phases, although they may not all occur in one attack. Initial phase In this phase, some patients may experience some of the following headache warning signs: Changes in behaviour (anxiety and irritation); Neurological symptoms (dizziness and visual disturbances); General symptoms (tiredness and muscle pain); Changes in eating habits (hunger and cravings for certain foods). Around 60% of migraine sufferers mention these symptoms, which are generally similar in the same person. Aura phase Before the headache phase there may be an aura phase , which involves: Visual disturbances (flashing lights and blotches); Numbness in the limbs; Difficulty speaking. The aura occurs in around 15% of migraine sufferers , although these people may have attacks with no aura. Headache phase The headache phase causes the most discomfort. The headache is generally on one side, intense and usually throbbing. It is often accompanied by: Nausea (with or without vomiting); Loss of appetite; Intolerance of light and noise. The pain may increase with: Head movement; Physical effort; Light; Noises or smells. On the other hand, the pain may be relieved by: Sound; Rest. Memory and concentration are also affected. There may also be other symptoms. Resolution phase Migraine attacks are self-limiting , i.e. after a while the headache fades. In the resolution phase , the patient may still experience some symptoms, such as: Sensitivity to light and head movements; Tiredness; Difficulty concentrating. How are migraines diagnosed? If there are typical migraine symptoms and a family history of the condition, the diagnosis is essentially based on the patient’s history and a clinical examination. In many migraine patients, it has never been diagnosed or properly treated. Everyone who has regular headaches should keep a record of their characteristics and how they were treated. This information may be a valuable help in determining the best treatment plan. How are migraines treated? Although migraines are incurable, they can be treated. The aim of treatment is to relieve the pain and other symptoms during attacks, reduce the frequency of attacks and improve quality of life. Treatment of migraines includes medication (pharmacological treatment) and non-pharmacological measures that help control triggers or exacerbating factors. Pharmacological treatment A number of specialists may be involved in the diagnosis and treatment of migraines and headaches. Neurology is a specialism that plays a very important role in the condition. There are two types of pharmacological treatment of migraines : Treatment of attacks or symptomatic treatment – administered during a migraine attack. The medications are designed to reduce or eliminate pain and other symptoms and curtail the attack so that patients can return to normal life as soon as possible; Prophylactic treatment – administered over long periods, often daily. It is intended to reduce the frequency, duration or intensity of attacks and improve the efficacy of acute treatments. It is mostly used when attacks are frequent and accompanied by an aura, numbness or marked incapacitation. As migraine attacks can be triggered and exacerbated by certain factors, identifying and controlling these factors help considerably in improving the quality of life of patients. Generally speaking, migraine sufferers should take a number of simple daily measures. They can help reduce the number of migraine attacks they have. Day-to-day measures: Adopt a healthy lifestyle; Engage in regular physical exercise; Avoid fatigue and tiredness; Drink plenty of water; Keep to a regular sleep schedule and avoid sleep deprivation (sleeping less than necessary) and sleeping too much; Eat meals at regular times; Identify and avoid medications that can exacerbate migraines (e.g. hormonal contraceptives); Pinpoint factors that cause stress and anxiety and try to control them with relaxation techniques, psychotherapy, acupuncture or other methods. Is there a connection between migraines and food? It is often said that diet and some foods can trigger migraine attacks . This only happens in a small proportion of people, however. The foods most often mentioned as migraine triggers are: Alcohol (especially red wine); Too much caffeine; Cured products (e.g. bacon); Chinese food; Citrus fruits (oranges and lemons) and tomatoes; Fats; Dairy products; Condiments; Chocolate. This is a controversial subject , however. Migraine sufferers who followed restrictive diets (stopped eating foods or food groups that were thought to cause migraine attacks), demonstrated contradictory results — i.e. some people improved, while others remained the same or even got worse. The best idea is to use your common sense and only give up a food if you notice you suffer a migraine attack every time you eat it. Migraine sufferers should have a healthy diet , avoid excesses as well as too much tea or coffee. It has been found that people who do not drink enough water suffer migraine attacks more often . Drinking a lot of water is recommended. It is very important not to go too long without eating and to eat regularly – at least every three hours. Prolonged fasting and not eating breakfast often trigger migraine attacks, especially in children and young people. This is easy to avoid. Meet the neurology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
