PEDIATRICS

Migraine

A migraine is a type of headache which can have adverse effects on a patient’s daily life and can restrict daily activities. Migraine pain is usually felt in the neck, temples or around the eyes and can worsen with movement depending on the type of pain. Migraines are usually accompanied by symptoms including sensitivity to light and sound, nausea and vomiting.

Patients sleeping in a dark room or vomiting can reduce the pain or eliminate the migraine all together. These attacks can vary from person to person. For example, migraines which occur at intervals are known as “episodic migraines”. On the other hand, if migraines are occurring at least fifteen days per month or more in a preceding three month period, then these are known as “chronic migraines”. Depression, mood swings and sleep disorders can accompany chronic migraines. Chronic migraines left untreated can lead to serious health problems.

Most migraine attacks are known as “migraine without aura”. People who suffer migraines without auras do not experience early symptoms such as nausea, vomiting, and sensitivity to light, sounds and smells. People suffering migraines with auras suffer sensory disturbances between 5 and 60 minutes prior to the start of the headache. Auras are also referred to as temporary neurological disorders and patients can experience both visual and sensory effects including speech disorders and a tingling sensation. The most common of these symptoms is the visual aura where patients experience flashes or light or blind spots prior to the headache.

Migraines and headache attacks can be treated using medication. Small changes in lifestyle supported by the correct medication can be successful.

Symptoms of Migraines

Migraines generally start between the ages of 20 and 30. Headache attacks can be experienced in childhood or adolescence.

Migraines can comprise four stages: prodrome, aura, attack and postdrome. Patients may not experience each stage every time they have a migraine.

Prodrome

  • Patients may notice small changes one or two days prior to the start of the migraine attack:
  • Constipation
  • Mood changes, anxiety
  • Food cravings
  • Stiff neck
  • Enhanced thirst and going to the toilet
  • Frequent yawning

Aura

Many patients experience attacks which do not include this stage. The aura of the migraine can lead to neurological disorders experienced before or after the pain. Patients who suffer migraines with auras can experience a range of symptoms including sensory weakness, speech impediments, vision loss, and tingling sensations.

Attack

Migraine attacks which are left untreated can change from person to person but usually last between 4 and 72 hours. Although attacks are rare, they can also occur a few times per week or per month. During the attack phase patients can experience a variety of symptoms including a throbbing head, nausea, vomiting, extreme sensitivity to light, sound and even touch, blurred vision, dizziness and even fainting.

Postdrome (post-attack)

During the postdrome (post-attack) phase, the patient is likely to feel exhausted, run down and slightly relieved. The patient can continue to experience weakness, dizziness, anxiety and sensitivity to light and sound for a further 24 hours.

When should you consult a neurologist?

Patients who do not visit a neurologist but try to treat their migraines using painkillers are usually less informed about the causes and treatment of migraines which can result in prolonged pain. If you are suffering migraines on a regular basis then it is worth writing down the symptoms you are experiencing. If you feel that your attacks are increasing in pain, or occur frequently then you must consult a neurologist without delay.

If you are experiencing any of the following symptoms then you must urgently visit a specialist;

  • A sudden, severe headache
  • A temperature, stiff neck, confusion, double vision, tingling or a speech defect
  • An escalation of the severity of a headache, particularly if it has developed following a head trauma
  • A headache which develops after a cough, exertion, strain or a sudden movement
  • A headache which has just begun if you are aged 50 years and over,

Causes of Migraines

The exact cause of a migraine is unknown but it is has been shown that genetics and environmental factors play an important role. It is thought that imbalances in chemicals in the brain including serotonin result in migraines.

During migraine attacks, the membranes enclosing the brain excrete several chemicals which results in the migraine pain being felt. Calcitonin gene-related peptide (CGRP) is one of the leading chemical transmitters which plays an integral role in the development of migraines.

Migraine Triggers

There are many migraine triggers:

  • It is easier for migraines to occur due to hormonal changes in women. Changes in levels of estrogen can trigger headaches in many women. Women who have a history of migraines can experience headaches before or during menstruation when estrogen levels drop. Pregnancy or menopause can cause the onset of migraines or change the symptoms of existing migraine attacks.
  • Hormonal treatment medication including oral contraceptives (birth control pills) and hormone replacement treatment can cause an escalation in headaches.
  • Some food including aged cheese, salty and processed goods can trigger migraine. It is known that sweeteners including aspartame which is found in many foods and the preservative monosodium glutamate can trigger migraine.
  • A change in eating habits such as skipping meals or overeating can trigger migraine.
  • Beverages, especially alcohol, wine and drinks that are high in caffeine can trigger a migraine.
  • Stress plays a significant role in triggering migraines. Stress related issues at work or at home can cause frequent migraine.
  • Loud noises, bright lights or sunlight can trigger a migraine. Some smells and aromas for example, perfume, paint thinner, and cigarette smoke can act as a triggers also.
  • Changes in sleep patterns are one of the known triggers of migraine. Fatigue, chronic sleep, sleep disorders and jetlag can cause an increase in the frequency of migraines and act as a trigger.
  • Sexual activity or intensive physical exertion
  • Air pressure or barometric changes
  • Medication including vasodilators (used to dilate the veins) such as nitroglycerin or oral contraceptives (birth control pills) can escalate the severity of migraine.

Risk factors

The reasons listed below can increase the risk of suffering a migraine:

  • People are more susceptible to suffering from migraine if there is an existing sufferer in the family.
  • Migraine can occur at any age. Hormonal changes during puberty play a significant role in triggering migraine. However, it is more common for migraine to begin between the ages of 20-30. Headache is possible that the severity and frequency of migraine can decrease over the following years.
  • Women suffer from migraine more than men. Migraine during childhood are more common in boys whereas there is a considerable increase in the frequency of migraine in girls during and after puberty.
  • Migraine can occur immediately before or at the start of menstruation.

The character and frequency of migraine can vary during pregnancy or the menopause. Migraine usually disappear after the menopause. Some women claim that their migraines either began or got worse during pregnancy. Many migraine patients do not suffer an attack during pregnancy. However, migraine generally resume after childbirth.

Unwanted results of migraines

Trying to control migraine pain can result in the development of different problems;

  • Gastrointestinal disorders: High doses or frequent use of painkillers can result in a range of gastrointestinal disorders including stomachaches, bleeding, gastritis and ulcers.
  • Headaches as a result of over-medicaton: Taking prescription medication for more than ten days in a month over the last three months can result in a severe, permanent headache related to over-medication. Headaches related to over-medicating occur when painkillers loses its effectiveness and begins to appear as a headache instead. This vicious cycle can result in stronger doses of painkillers. However, this will not only be ineffective in alleviating headache pain but can make it chronic.
  • Serotonin syndrome: Serotonin syndrome is a rare but potentially life threatening condition where the body is exposed to excess serotonin. Patients should be extremely careful about serotonin syndrome and use medication prescribed by a doctor.
  • Chronic migraine: Migraine attacks can become chronic. People who have suffered migraine for more than 15 days per month over the last three months should consult a neurologist.
  • Status migrainous: If migraine attacks remain untreated or poorly treated then they can be expected to last between 4 and 72 hours. Severe migraine headache which continue for more than three days are known as “status migrainous”.
  • Persistent aura without infarction (blocked blood vessel): Temporary neurological disorders known as aura usually pass once the headache begins. However, in rare cases it can continue for more than a week. In the event of a persistent aura without infarction, patients will usually be required to have an MRI taken to ensure than there is no further problem with the brain tissue.
  • Migrainous infarction (blood vessel blockage): It is advised that patients consult a neurologist in the event of an aura lasting longer than one hour to ensure there is no blockage blood vessels in the brain. Your doctor may request further imaging tests in order to eliminate the probability of a stroke or blood clots.

Diagnosis

Migraine is a clinical diagnosis. Migraines can be diagnosed during a doctor’s consultation without having to be examined further by a neurologist. In cases where symptoms which are not usually associated with migraines are experienced then a neurologist may request some tests to eliminate other causes.

Laboratory tests and radiological examinations can help eliminate other causes of migraines or headaches.