Migraine

The exact cause of migraines is not completely understood, but it is known to be hereditary. Neurological processes in the brain contribute to the condition, as demonstrated by brain scan studies. Although migraines were once thought to have psychological causes, this has been disproven. 

Disrupted blood circulation is a key factor. During migraines, spasms and dilation of blood vessels occur in the brain, leading to the release of certain substances that can cause inflammation and pain. 

Although the root cause is medical, psychological factors like stress and emotions can trigger a migraine episode. Stress can cause blood platelets to clump together, releasing excessive serotonin and causing spasms in the head.

As mentioned, a migraine can be preceded by an aura, which includes visual disturbances like flashes of light, spots, or stars, as well as numbness or weakness in certain body parts. About 30% of migraine cases involve an aura. The early warning signs vary, from mood changes to vomiting and chills. 

• Basilar migraine: Involves an aura with symptoms such as slurred speech, muscle weakness, and double vision, followed by headache at the back of the head. This type affects the brainstem and can lead to a transient ischemic attack (TIA). 
• Exertion migraine: Triggered by physical exertion, particularly intense sports like sprinting or squash. 
• Migraine with mental confusion: Involves severe disorientation during the headache, often affecting young people. 
• Other types include: 
  - Footballer’s migraine (following head trauma) 
  - Ophthalmoplegic migraine (paralysis of eye muscles) 
  - Familial hemiplegic migraine (aura with one-sided paralysis) 
  - Abdominal migraine (severe abdominal pain without a clear cause) 

There is also a severe headache type called cluster headache, more common in men, that causes one-sided pain around the eye. Episodes can occur several times a day and may cause restlessness.

1. Prodromal phase (warning phase): Many people notice early signs of a migraine, such as mood changes, altered sensory perception, yawning, or fatigue. Recognizing these signs can help take preventive measures. 
2. Aura phase: The aura can cause visual symptoms like flashes or spots and may also involve neurological issues such as numbness, speech difficulties, or muscle weakness. 
3. Headache phase: This follows the aura and can last from 30 minutes to several days. It is often accompanied by nausea, vomiting, and sensitivity to light and sound, making any activity difficult. The pain is usually throbbing and one-sided. 
4. Recovery phase: Recovery can take several days or even a week, with symptoms like fatigue and irritability. 

Symptoms of migraines include: 

• An aura phase with visual disturbances like flashes of light 
• A clearly defined start and end to the headache 
• The need to lie down during an attack due to hypersensitivity to light and sound 
• Pain usually located on one side of the head 
• Nausea 
• Severe, throbbing headache 

If you experience two or more of these symptoms, you likely have migraines. Additionally, neurological symptoms such as blurred vision, body chills, or confusion may occur. 

During a migraine attack, performing activities is nearly impossible. To reduce pain, avoiding stimuli like bright lights, loud noises, strong odors, or extreme temperatures can help. There are also medications available for migraine relief.

Migraine treatments include medications like triptans and preventive therapies. Triptans, which include almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan, are the most effective. They work by constricting blood vessels and reducing inflammation. Other pain relief options include paracetamol combined with caffeine, or anti-inflammatory drugs like diclofenac, ibuprofen, and naproxen. 

Additional options for constricting blood vessels are ergotamine and methysergide. Preventive medications may include beta blockers, pizotifen, topiramate, valproic acid, botulinum toxin type A (if other treatments are ineffective), flunarizine (rarely), or amitriptyline.

Alternative treatments

• AtlasPROfilax: This treatment involves a neuromuscular massage around the upper cervical vertebrae. Manual tests are conducted to realign the skull, atlas, and second cervical vertebra, which may relieve migraine symptoms. 
• Dietary changes: Phytotherapy suggests dietary modifications to alleviate migraine symptoms, with a focus on liver and gallbladder health. 
• Cefaly: A device that delivers electrical impulses to the trigeminal nerve, located on the forehead. This treatment may be covered by some insurance policies. 
• Cannabis: Although research is still ongoing, cannabinoids show potential in relieving migraine symptoms. 
• Online behavioral therapy: Keeping a migraine diary can help identify triggers and improve treatment. 
• Psychotherapy: Given the impact of migraines on daily life, therapy may help alleviate associated stress and anxiety. 

Lifestyle changes

Migraines significantly affect daily life and may contribute to depression. Keeping track of dietary habits, migraine episodes, and triggers can aid in managing the condition. Regular exercise and relaxation techniques can help reduce stress, a known migraine trigger. Relaxation therapies and activities such as massage may also offer relief.

Hersenstichting. (n.a.). Migraine. Retrieved from: https://www.hersenstichting.nl/hersenaandoeningen/migraine/

Alles over hoofdpijn. (n.a.). Alles over migraine. Retrieved from: https://allesoverhoofdpijn.nl/soorten-hoofdpijn/alles-over- migraine/

Migraine. (n.a.). Retrieved from: https://www.hierhebikpijn.nl/aandoening/63/migraine https://www.gezondheidsnet.nl/hoofdpijn-en-migraine/veelvoorkomende-oorzaken-van-migraine https://www.mijnkwartier.nl/migraine/oorzaken/

https://mens-en-gezondheid.infonu.nl/aandoeningen/186356-basilaire-migraine-aura-en-hoofdpijn-aan- achterhoofdgebied.html

https://mens-en-gezondheid.infonu.nl/aandoeningen/47970-migraine-wat-helpt-er-tegen.html https://www.farmacotherapeutischkompas.nl/bladeren/groepsteksten/triptanen https://www.atlasprofs.nl/over-atlasprofilax/atlasprofilax-behandeling/

https://allesoverhoofdpijn.nl/soorten-hoofdpijn/alles-over-migraine/welke-andere-behandelingen-zijn-er-bij-migraine/ https://wewordenbeter.nl/ziektebeelden/migraine/