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A migraine is moderate to a severe headache lasting up to 1 to 3 days. Migraines affect approximately 12% of adults and children and occur primarily in women. These headaches are often incapacitating and associated with additional side effects such as nausea, autonomic dysfunction, and aura (visual impairment). Migraines are some of the most taxing neurological disorders in the world and a major cause of disability in the world.
Migraine symptoms vary from person to person. Classic symptoms include; throbbing head pain on one side of the head, sensitivity to light and sound, nausea, fatigue, dizziness, and vision changes. People with migraines will often seek quiet dark places to rest as the pain can be quite severe.
There are two main types of migraines: a migraine without aura (MO) and migraine with aura (MA). Patients with migraines with aura experience an assortment of neurological symptoms, usually visual, such as shiny shapes, hallucinations, and seeing black spots. However, the aura can impair other abilities such as sensory, speech, motor skills, eye function and brainstem functioning. Only around 20-30% of migraine sufferers experience MA.
In addition to migraines with and without auras, migraines can be further divided into subgroups based on their symptoms or causes. There are five types of migraines:
A chronic migraine occurs frequently or continuously (or more than 15 headache days per month) for at least 3-months. At least 8 of the headaches must be migraines. Approximately 1-5% of people experience a chronic migraine. These cases are usually caused by medication overuse and have much more severe symptoms than episodic migraines (migraine conditions in which the patient experiences less than 15 headache days per month). A chronic migraine is often more debilitating and results in greater need for healthcare, and bouts o depression and anxiety. These migraines are also less responsive to treatments.
Retinal migraines are rare and cause temporary loss of vision associated with a migraine. Vision loss has also been reported during other forms of a headache such as a cluster, idiopathic stabbing, chronic and other headaches. Retinal migraines typically occur in patients in their 20s or 30s. Many patients also have a history of migraines with pronounced auras prior to these retinal migraines. The visual effects of retinal migraines last approximately less than an hour, although longer attacks have been reported. Some cases of retinal migraines can result in long or permanent vision loss.
The rarest and severe MA is a hemiplegic migraine or HM. HM is a prolonged migraine that occurs in conjunction with an aura that impairs motor functioning. Side effects include muscle weakness, numbness, confusion, comas, making coordinated movements and fevers. In some cases, the memory loss and difficulty maintaining attention can be affected for weeks. HM is usually hereditary, although sporadic cases have been reported. Mutated genes include those involved in calcium and sodium channel construction and ion transportation, such as CACNA1A, SCN1A, and ATP1A2.
Probable migraines are headaches that meet all the criteria of a migraine except one. This one criterion may be any criteria. These headaches are often considered to be low-grade migraines.
Menstrual-associated migraines have been reported in more than half of women with migraines without aura. Some women only experience migraines during their premenstrual and menstrual period. These typically start with the first menstrual cycle and are associated with menstrual cramps and premenstrual syndrome (PMS). Typically symptoms improve during pregnancy, however. Migraines are considered menstrual migraines when 90% of them occur during the two days before and the end of menstruation.
These are caused by changes in estrogen between premenstrual and menstrual periods of time. Estrogen declines during the late phase of the menstrual cycle. This decline alters estrogen by regulating multiple neurotransmitters such as serotonin, norepinephrine, dopamine, and β-endorphins. These neurotransmitters are messengers for pain and can cause nausea.
Menstrual migraines are typically resistant to most treatments compared to other migraines. There are several options for treatment including, hormonal, non-pharmacological, dietary and psychological.
In patients that rarely experience menstrual migraines, abortive therapies such as Sumatriptan and Dihydroergotamine may be efficient. These treatments work by blocking pain pathways activated by neurotransmitters. Women that experience these migraines more frequently may consider using prophylactic medication during premenstrual phases. Taking NSAIDs a few days before the migraines begin have also been shown to be effective. Barbiturates and narcotics are also helpful; however, they should be used with caution as drug dependence is a significant risk of their use. Treatments that block receptor and neurotransmitter activity may also be effective. These include calcium channel blockers, beta-blockers, serotonin antagonists, antidepressants, re-uptake inhibitors and monoamine oxidase inhibitors. Hormonal treatments such as oral contraceptives containing estradiol with testosterone may help.
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