Migraine is a common neurological condition that affects millions of people from all ages, nationalities and gender. Like any other disease, its presence is manifested by symptoms felt by the sufferer and whose existence allows physicians to make a diagnosis.

The most common migraine symptom and the most recognizable as well, is the headache. Although it is not present in the rarer forms of the disease, it is one evident sign of migraine. The headache that accompanies a migraine is not the kind that gives a dull ache. The pain felt by migraines is the intense, throbbing kind which sometimes necessitates complete rest and disrupts normal daily functions. However, a headache is not the only indicator that signals a migraine.

Depending on the migraine attack, a host of other symptoms arise as well. Analyzing them helps the medical practitioner in determining what type of migraine the patient is suffering from and in prescribing the appropriate medications.

An inventory of migraine symptoms could be quite lengthy due to the various types of the disease. A generalized list of these include: severe headache on one or both sides of the head, nausea, vomiting, weakness, vision disturbance, sensitivity to light and sound, pain over one eye, aura, blurred vision and temporary blind spots. When the migraine comes with aura, this gives rise to a whole new set of symptoms that consists of: seeing flashing lights or zigzag lines, temporary blindness, speech difficulty, tingling and weakness in the limbs and face, confusion, giddiness and noise sensitivity.

This does not mean the sufferer undergoes all the symptoms during the attack. Most likely, he will experience only a few. Symptoms also vary from person to person. Further, a migraine symptom could be felt days before the attack, during the prodrome stage. In these times, the migraineur has unexplained feelings of elation or intense energy, cravings for sweets, thirst, drowsiness or irritability and depression.

Diagnosing migraine is not an easy task for the physician. In order to make an accurate evaluation, he will need to have as much information as possible, obtained from the patient and from medical tests conducted. Observation and analysis of symptoms is very helpful in arriving at a diagnosis. By knowing what symptoms are experienced by the patient, the specialist will be able to tell what type of migraine it is and what treatments are to be administered.

During consultation, the patient will be required to describe the duration and frequency of his All kinds of Headache and how intense they are, where pain is located, presence of associated symptoms and behavior during a headache.

Since other illnesses also exhibit similar sings to migraine, these have to be ruled out. A case in point is the fact that people with sever sinusitis also experience double vision and vision loss.

Experiencing migraine, however mild, is not a pleasant event. But the sufferer can put this to good use by being observant and recording what he is going through. The complexity of migraine and the difficulty in diagnosing it means that no detail is insignificant. Thus, if the patient is to take an active role in the management of his disease, he needs to be vigilant of every single migraine symptom.

Migraine Symptoms

Migraines, which often begin in childhood, adolescence or early adulthood, can progress through four stages: prodrome, aura, attack and post-drome. Not everyone who has migraines goes through all stages.

Prodrome

One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including:

• Constipation
• Mood changes, from depression to euphoria
• Food cravings
• Neck stiffness
• Increased thirst and urination
• Frequent yawning

Aura

For some people, aura might occur before or during migraines. Auras are reversible symptoms of the nervous system. They’re usually visual, but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes.

Examples of migraine aura include:

• Visual phenomena, such as seeing various shapes, bright spots or flashes of light
• Vision loss
• Pins and needles sensations in an arm or leg
• Weakness or numbness in the face or one side of the body
• Difficulty speaking
• Hearing noises or music
• Uncontrollable jerking or other movements

Attack

A migraine usually lasts from four to 72 hours if untreated. How often migraines occur varies from person to person. Migraines might occur rarely or strike several times a month.

During a migraine, you might have:

• Pain usually on one side of your head, but often on both sides
• Pain that throbs or pulses
• Sensitivity to light, sound, and sometimes smell and touch
• Nausea and vomiting

Post-drome

After a migraine attack, you might feel drained, confused and washed out for up to a day. Some people report feeling elated. Sudden head movement might bring on the pain again briefly.

When to see a doctor

Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which could indicate a more serious medical problem:

• An abrupt, severe headache like a thunderclap
• Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
• Headache after a head injury, especially if the headache worsens
• A chronic headache that is worse after coughing, exertion, straining or a sudden movement
• New headache pain after age 50

Migraine Causes

Though migraine causes aren’t fully understood, genetics and environmental factors appear to play a role.

Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. So might imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system.

Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).

How are migraines diagnosed?

Despite their dramatic symptoms, migraines are almost never due to an underlying problem that will show up on any testing, even on brain MRIs. Many experts do not recommend brain imaging at all, even in severe cases, as long as the patient’s symptoms are typical for migraines and a thorough neurological examination is normal.

There are extremely rare families that have migraines as a result of a single genetic mutation in one of four known genes that can lead to the condition called familial hemiplegic migraine. There are no genetic tests for the vast majority of patients. Because the condition cannot be diagnosed by scan or blood test, the diagnosis is “clinical” — made by an experienced physician.

How are migraines treated?

Migraines that are severe, frequent or accompanied by neurological symptoms are best treated preventively, usually with a combination of dietary modification, lifestyle changes, vitamins and daily prescription medications. Most of our best preventive medications are often used for other medical purposes as well; the majority are blood pressure drugs, antidepressants or epilepsy medications. Individual headache attacks are best treated early, often with one or more of the following types of medications: triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), anti-emetics (anti-nausea), and sometimes narcotics or steroids.

Migraines typically last a few hours to a couple of days and respond well to specific treatments. However, in some patients, the migraine is particularly severe and long-lasting — and may even become chronic, occurring continuously for weeks, months or even years. If improperly managed or left untreated, intermittent migraines may essentially transform into a chronic daily headache, with continuous and smoldering symptoms that periodically erupt into a “full-blown” migraine. This condition is extremely difficult to treat.

Other patients may develop increasingly frequent headaches as a result of overusing their short-acting headache medications. See medication overuse headache. While they are considered primary headaches, meaning they have no known underlying cause, migraines are associated with an increased risk of stroke, brain scarring as seen on MRI scans, a heart defect called a patent foramen ovale (PFO) and other medical conditions.

At the Johns Hopkins Headache Center, located at the Johns Hopkins Bayview Medical center, we have expert physical therapists, nutritionists and psychologists who work closely with our neurologists to help manage patients with frequent migraines. Biofeedback and relaxation techniques are available to complement our standard medical treatments.

Migraine triggers

There are a number of migraine triggers, including:

• Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.Hormonal medications, such as oral contraceptives and hormone replacement therapy, also can worsen migraines. Some women, however, find their migraines occurring less often when taking these medications.
• Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.
• Stress. Stress at work or home can cause migraines.
• Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — including perfume, paint thinner, secondhand smoke and others — trigger migraines in some people.
• Sleep changes. Missing sleep, getting too much sleep or jet lag can trigger migraines in some people.
• Physical factors. Intense physical exertion, including sexual activity, might provoke migraines.
• Weather changes. A change of weather or barometric pressure can prompt a migraine.
• Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
• Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skipping meals or fasting.
• Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods.

Why Fioricet is good for migraine relief ?

• Fioricet is a combination pain-reliever (analgesic) containing acetaminophen, butalbital, and caffeine.
• Experts aren’t sure exactly how acetaminophen works, but suspect it blocks a specific type of cyclo-oxygenase (COX) enzyme, located mainly in the brain.
• Butalbital belongs to the class of medicines called barbiturates. When used for pain due to tension headaches experts believe it works by relaxing muscle contractions and causing sedation via an enhancement of the inhibitory effects of GABA (a neurotransmitter that regulates communication between brain cells).
• Caffeine is thought to enhance the pain-relieving effects of acetaminophen by up to 40%. In addition, it has vasoconstrictive properties, narrowing blood vessels in the brain thereby decreasing blood flow and oxygen tension (before a headache or a migraine, blood vessels tend to enlarge). This also helps to relieve pain.
• Fioricet belongs to the class of medicines known as barbiturates because it contains butalbital. It may also be called a combination analgesic.