The migraine syndrome is a pattern of dysfunction integrated within the central nervous system and manifested as widespread bodily disturbances, both non-painful and painful. The outstanding feature is periodic headache, usually unilateral in onset but at times becoming bilateral or generalized. The attacks may vary in duration from a few minutes to several days and, in severity, from trifling symptoms to prolonged disabling illness. The headaches are associated with “irritability,” nausea, and often photophobia, vomiting, constipation, or diarrhea. Although most common in the temple, headaches may be experienced anywhere in the head, face, and neck. The syndrome runs in families.
For a period of several hours to several days preceding the headache, the cranial arteries undergo a variable contractile state indicated by a facial flushing or pallor and by other transient cranial vasomotor phenomena such as vertigo. In the hour preceding the headache, a variety of visual and other neurologic abnormalities due to transient local constriction of cerebral or retinal arteries occur in about 10 to 15 percent of the instances.
TheSe prodromes may take the form of scintillating scotomas, visual field defects such as unilateral or homonymous hemianopsia, and, occasionally, hemiplegia. More sustained neurologic defects and even cerebral infarction have rarely occurred. As the vasoconstrictor phenomena recede, vasodilator headache commences, sometimes overlapping, sometimes beginning after a short symptom-free interval. The pain is throbbing and aching, is appreciably reduced by pressure on the common carotid and the affected superficial artery, and is characteristically eliminated or reduced by vasoconstrictor agents, particularly ergotamine tartrate.
The walls of the dilated cranial arteries and the adjacent tissues become edematous and tender. With sustained vasodilatation for several hours, the easily compressible arteries become rigid and relatively noncompressible, and the pulsatile pain becomes a steady ache. Redness and swelling of the eye with excessive tearing, and redness and swelling of the nasal mucosa with or without epistaxis, may occur along with the headache. A secondary muscle contraction component of the headache may outlast the vascular pain and will not be modified by vasoconstrictor agents.
One variety of headache closely related to migraine syndrome is the cluster headache. This head pain affects men much more than women, usually beginning between the third and sixth decade. Attacks come on abruptly with intense throbbing pain arising high in the nostril and spreading to involve the region behind the homolateral eye and sometimes the forehead as well. During the attacks, which last up to two hours, seldom more, the nose and eye water. The skin reddens and a homolateral Horner’s syndrome with pupillary constriction and ptosis may develop. The attacks tend to occur from once to several times daily, in clusters lasting weeks or, less often, months.
Without apparent reason, the cluster subsides as suddenly as it began, and the patient commonly remains free of headache for weeks or months until another cluster begins. During a cluster period, but not between, alcohol is likely to induce attacks. When headaches recur in close succession, the Horner’s syndrome may outlast the headache.
Pathogenesis of Migraine Headache.
Before the onset of migraine headache a generalized accumulation of fluid may occur as part of a nonspecific disturbance in fluid and electrolytes that is found in many persons with and without the migraine syndrome during periods of stress. There is evidence of a general abnormality of vascular behavior in many migraine subjects, and the extracranial vessels of such subjects show more variability in their contractile patterns than those of normal subjects even during headache-free periods. Sym-pathetic nerve stimulation or section has little effect on these vessels or on the migraine attack, and humoral agents have long been sought as the basis of the migraine syndrome.
Local fluid collected from sites of swelling at the point of maximal headache and tenderness during an attack contains a vasodilatory polypeptide of the bradykinin type that lowers pain thresholds and may be a factor in a local sterile inflammation. However, neither kinins, histamine, nor substances such as acetylcholine satisfactorily explain the generalized manifestations of the disorder. Several lines of evidence suggest that abnormalities in the metabolism of serotonin may play a role in the migraine syndrome.
Reserpine, which induces a drop in serum serotonin levels, will often induce a migraine attack, and serum levels of serotonin have been found to drop spontaneously just before migraine attacks. During migraine attacks, an increased quantity of serotonin metabolites has been found in the urine. Methysergide, a powerful serotonin antagonist, prevents or reduces the frequency of migraine attacks in most subjects. How methysergide works is unclear. D’Alessio et al. suggested that it acts centrally on the brain to modify vasomotor regulation and peripherally to potentiate the vasoconstrictive responses of the cranial blood vessels to catecholamines. Curran and co-workers speculate that methysergide is a competitive antagonist to serotonin, occupying similar receptor sites in pain-sensitive vessels.
Management of Migraine Syndrome.
Headaches of low intensity are usually eliminated by 0 3 to 0.6 gram of aspirin, but sometimes require 60 mg. of codeine phosphate as well.For severe vascular headache, the restoration of the painfully dilated vessels to a nonpainful constricted state and the restoration of pain threshold to normal are accomplished best by the intramuscular administration of 0.25 to 0.5 mg. of ergotamine tartrate, not to exceed 0.5 mg. in any one week. If the agent is administered in amounts of 1.0 to 2.0 mg. by suppository, the side effects of nausea, vomiting, and elevated blood pressure are diminished. Ergotamine tartrate may also be given by mouth in 3.0 mg. amounts, to be swallowed or absorbed sublingually. This first dose may be repeated in 30 minutes, and a third given in another 30 minutes if the headache persists. Ergotamine tartrate, 1 mg., can also be given in tablets in combination with caffeine, 100 mg., up to 8 tablets for any single headache attack. The amount of ergotamine so administered should not exceed 10 mg. in any one week. Administration by mouth or by suppository is less predictably effective than intramuscular administration.
What Is The Prevention of Migraine Syndrome.
Of utmost importance in the prevention of attacks is a consideration of the personal problems of the patient. Patients with migraine headaches are anxious, striving, perfectionistic, order-loving, rigid persons who, during periods of threat or conflict, become progressively more tense, resentful, and fatigued. The person with migraine often attempts to gain approval by doing more and better than his fellows and to gain security by holding to a stable environment given system of excellent performance, even an n high cost of energy.
This pattern brings increased| responsibility and admiration, but little love. aSl that he feels greater and greater resentment at ism. pace he feels obliged to maintain. Then tensile associated with repeated frustration, sustained resentment and anxiety, often followed by fatigue and prostration, become the setting in which the migraine attack occurs. Treatment is best if it allows the patient free and repeated expression of his conflicts, resentments, and dissatisfactions, enables him to recognize the nature of his dilemma and its relationship to the physiologic basis of his pain, guides him toward accepting a more realistic appraisal of his needs, and establishes a more efficient regimen compatible with his individual equipment. About two of three patients can be appreciably helped by such aid.
For patients in whom attention to psychological attitudes and adjustment of life situations fail to bring significant relief, two forms of long-term pharmacotherapy have been useful. One is the monoamine oxidase inhibitor phenelzine sulfate, 45 mg. daily, which induces a significant reduction in headache frequency in most patients with migraine, and can be given indefinitely. The other is the serotonin antagonist methysergide, which in doses of 2 mg. three to four times daily is effective in about two of three cases in preventing headache of the migraine type. However, methysergide must be used with great caution.
Both ergotamine tartrate and methysergide possess the ability to induce profound vasoconstriction and are contraindicated in pregnancy, peripheral vascular disturbance, severe- hypertension, coronary artery disease, thrombophlebitis, and renal disease. Serious and unexpected vasospastic and psychic reactions have occasionally occurred with methysergide. Retroperitoneal fibrosis producing back pain and ureteral obstruction has been reported. Any of these serious complications necessitate prompt discontinuance of methysergide, and any single course of the drug should not outlast three months.
Various causes and triggers for frequent migraines
The most basic cause of migraine itself is still unknown. However, there are several factors, both environmental and lifestyle, that can trigger migraine attacks. If you do not avoid these factors, migraine attacks will often occur in the future.
However, it is important to note that each migraine sufferer may have different triggers. Therefore, it is important for you to recognize what factors can trigger a recurrence of attacks in you to prevent migraines in the future.
Here are some things that could be the cause of your frequent migraines:
1. Hormonal changes
Hormonal changes are the most common cause of migraine headaches, both on the left and right sides, in women. This occurs when women enter their menstrual period due to changes in estrogen levels. This usually occurs two days before to three days after menstruation.
In addition to menstruation, hormonal changes during pregnancy and entering menopause can also trigger migraines in women , and generally improve after menopause. Then, the use of drugs containing hormones, such as birth control pills or hormone replacement therapy, also has the potential to worsen the headaches you are experiencing.
2. Extreme weather changes
No one knows exactly what causes migraines. However, many scientists believe that the brains of migraine sufferers tend to be more sensitive to changes in the weather.
Storms, excessive heat, extreme cold, and changes in air pressure have been linked to migraine attacks in some people. This is because high humidity and heat can easily lead to dehydration, another migraine trigger.
3. Smell a pungent odor
Smelling strange, strong, and pungent odors can be a trigger for migraines in some people. This is because these odors can activate certain nerve receptors in the nasal passages that can trigger a migraine attack or worsen one that has already started.
About half of migraine sufferers report an intolerance to odors during an attack. This phenomenon is known as osmophobia and is unique to migraine sufferers. Perfumes, strong food odors such as durian, the smell of gasoline , and cigarette smoke are some of the most common odors that trigger migraines.
4. Light display
For many migraine sufferers, light or glare is the enemy. This condition is called photophobia, and is one of the criteria for diagnosing migraine.
Light sources that cause migraines can be artificial light, such as neon lights, strobe lights, flashing lights, flashing decorative lights, to natural sunlight and its reflection. This makes it difficult for sufferers to spend time outside or in an office environment.
5. Stres
According to the American Migraine Foundation, stress is the biggest trigger for migraine attacks. One study found that 50-70 percent of people are more likely to experience headaches when stressed .
Because, when stressed, the brain releases chemicals that cause changes in body function, such as muscle tension and narrowing of blood vessels in the brain, which can make migraines worse. Stress itself can come from many things, from household aspects, personal life, to work. Your body can also be stressed if you exercise too long or don’t get enough sleep.
6. Changes in sleeping habits
Getting enough quality sleep is important to keep your body healthy. Because with enough sleep, all parts of the body, including the brain, can be renewed and repaired.
Therefore, if you sleep less, too much, or your sleep schedule is irregular, including when you are too tired, you will be more susceptible to illness, including frequent migraine attacks. Changes in sleep habits that cause migraines also include jet lag after traveling long distances by plane or sleeping in the morning.
7. Dehydration
About a third of migraine sufferers report that dehydration is a factor in their frequent attacks. In fact, some of those people say that even mild dehydration can be a fast track to headaches.
This is indeed possible. Because dehydration affects the body’s function at all levels. This condition can cause dizziness , confusion, and can even be a medical emergency. Therefore, drinking lots of water can be one way to deal with migraines in yourself.
8. Skipping meals
Late or missed meals often cause a relative drop in blood sugar, which can be a trigger for migraines. This usually occurs in children who are still growing or who do heavy exercise. However, it can also be a cause of frequent migraine headaches in adults.
Generally, if you skip breakfast, it can trigger a migraine in the morning before noon, while eating late at noon can trigger an attack in the afternoon. However, if you skip eating at night, it can cause a headache when you wake up the next morning.
9. Use of certain medications
Taking certain medications can also be a factor in causing frequent migraines. Therefore, if you feel that migraine attacks occur after taking certain medications, you should consult a doctor immediately. However, in general, medications that often trigger migraines include sleeping pills, birth control pills, vasodilators such as nitroglycerin, and cocaine and marijuana.
In addition, excessive use of migraine headache medication can also cause migraine attacks to occur more often. So, it is best to use these drugs according to the dosage and provisions given by the doctor.
10. Computer or mobile phone screen
Working in front of a computer for too long or often playing with a cellphone ( handphone/ HP) can be the cause of frequent migraines in you. This is thought to be due to exposure to light or flashing lights from cellphone and computer screens. Bad posture when working in front of a computer or using a cellphone can also be the cause.
List of foods and drinks that can cause or trigger migraines
Not only skipping meals, consuming certain foods can also trigger migraines. Therefore, if you suspect that you are having a migraine attack after consuming certain foods, you should avoid consuming those foods. Here are some foods that can generally cause migraines:
1. Alcoholic drinks
Alcohol is a beverage that is often reported to be a major trigger for migraine attacks. Certain types of alcohol, including red wine , contain certain compounds that can directly affect blood vessels and trigger the release of migraine-causing chemicals.
2. Caffeinated drinks
Excessive consumption of caffeinated beverages, such as coffee, tea, or soda, can cause migraines in some people. However, some others have found that suddenly stopping caffeine consumption can also be a trigger. Therefore, if you often consume caffeine, you should stop consuming this drink gradually.
3. Foods containing MSG
Packaged foods that have a savory taste generally contain MSG (monosodium glutamate). Some people report that MSG is often the cause of migraines. The American Migraine Foundation notes that as many as 10-15% of people experience migraine headaches after consuming foods containing MSG.
4. Artificially sweetened foods and drinks
In some studies, it was found that some people experienced an increase in migraine frequency after consuming foods containing artificial sweeteners, namely aspartame, in large amounts. However, other migraine sufferers did not experience this. The effects of these artificial sweeteners may vary between individuals.
5. Chocolate
Chocolate can be a food that triggers migraines, especially in people who are sensitive. According to the American Migraine Foundation, chocolate is the second most common migraine trigger after alcohol, at 22 percent. The phenylethylamine and caffeine content in chocolate may be the reason why chocolate triggers migraines.
6. Cheese
Cheese is a food that contains tyramine and can be a trigger for migraines, especially for those who are sensitive to tyramine. Tyramine is an amino acid that can trigger changes in blood vessels that are typical of migraine sufferers. In addition to cheese, tyramine is also found in other foods, such as yogurt, nuts, bananas, citrus fruits (oranges), pickles, cured meats, and smoked fish.
7. Processed meat
Sausages and ham are examples of processed meats that can cause migraines. The nitrate and nitrite content as preservatives in processed meats can widen blood vessels so that they can trigger migraines in some people. So, maybe not everyone will experience migraines after consuming processed meat.
In addition to the list above, other foods are also said to be able to trigger migraines in some people, such as foods or drinks with strong or pungent aromas, fatty foods, and cold foods and drinks.
But keep in mind, the triggers for each migraine sufferer can be different. To recognize and prevent migraine attacks, you can make a written note or list of triggers, including symptoms, duration, time of occurrence, what you are doing, and environmental conditions during the attack.
Factors that can increase the risk of migraines
Migraines can happen to anyone and at any time. However, there are certain conditions or factors that can increase a person’s risk of getting migraines. Having these risk factors does not mean that you will definitely get migraines. Conversely, those who do not have risk factors are not necessarily free from this disease. Here are the risk factors:
1. Family history
As mentioned earlier, researchers suspect genetic factors may be involved in causing migraines in a person. The American Migraine Foundation says that if one of your parents has a history of migraines, you have a 50 percent chance of having the condition. However, if both of your parents have a history of the disease, your chances can increase to 75 percent.
2. Age
Migraine is indeed a disease that can happen to anyone, including children. However, this disease more often begins in teenagers or young adults, which then peaks around the age of 30. However, gradually, this disease begins to improve and attacks rarely occur in the years after.
3. Gender
Migraine is a disease that is more often experienced by women. In fact, women are said to be three times more likely to experience migraine headaches than men. Migraines in women are generally related to changes in the estrogen hormone that they experience during menstruation, entering menopause, and during pregnancy.
4. Certain medical conditions
Having certain medical conditions is also said to increase a person’s risk of experiencing migraines. Some medical conditions that are often associated include depression, anxiety, bipolar disorder, sleep disorders , and epilepsy .
Not only that, digestive disorders are also said to be closely related to the possibility of migraines in someone. In a study, it was stated that people who often experience disorders in the digestive system are at higher risk of experiencing migraines than those who do not. This condition leads to irritable bowel syndrome (IBS) and Celiac disease (gluten intolerance).