Migraine is a neurological condition that causes one-sided throbbing headache. It may also present with nausea, vomiting, photophobia, and hyperacusis which are extreme sensitivity to light, and sound respectively. Migraine attacks can last for hours or for days and can interrupt your daily life activities.
According to the Migraine Research Foundation, migraine is the sixth most disabling disease and the third most prevalent illness in the world. Approximate 1.2 million Emergency Room (ER) visits in the United States every year are due to an acute migraine attack.
Despite its prevalence, the causes of migraine are still not completely understood. However, it is a known fact that genetic factors and environmental factors play a big role in the development and persistence of migraines. Genetic factors are especially important since migraines are known to run in families. Currently, studies are being performed with the purpose of understanding brain chemistry and its association with migraine development.
Migraine attacks are very common between the ages of 18 and 44. The reason behind this age group’s migraine attacks can be understood by analyzing the migraine triggers. This age group is prone to high stress in personal and professional life, which is an important trigger for a migraine attack. Some of the other triggers include caffeine, alcohol, disturbed sleep or lack of proper, eight hour sleep, and physical activities, including but not limited to sexual activity.
Signs and Symptoms
Migraine symptoms are divided into four stages but it is important to note that not every migraine attack is going to progress through these stages. You may experience symptoms from only one or all four of the following stages.
The prodrome stage occurs a day or two before the migraine attack and is kind of a warning, letting you know that a migraine attack will occur soon. Some of the symptoms of this stage include
- Constipation
- Persistent yawning
- Stiffness of your neck
- Drastic mood changes
- Aura
Aura can be defined as a reversible symptom of the nervous system that can present itself either right before or during the migraine. These symptoms begin slowly, peak in a few minutes, and then stay for half an hour to an hour before resolving completely, on their own. Often associated with visual disturbances, the symptoms you may experience during this stage are:
- Vision loss
- Hearing music or noises without any external stimuli
- Weakness or numbness in one side of the body
- Difficulty speaking
- Attack
This refers to the migraine attack that can last for up to 72 hours if not treated properly. During this stage, you may experience a throbbing, pulsatile one-sided headache but it can occur on both sides. You may also experience nausea, vomiting, and sensitivity to light, sound, touch, and even, smell.
This stage can last for up to a day after the migraine attack and you may experience fatigue and tiredness during this stage.
Diagnosis of Migraine
Your migraine attacks may be diagnosed by your doctor based on your family history, personal history, and your specific symptoms. Your doctor may ask you to get imaging scans like an MRI or a CT scan to rule out other medical conditions, especially if the symptoms are severe and you have no family history of migraines.
Management of Migraine
The treatment of migraine can be divided into two categories; pain relievers and preventive medicine. Pain relievers, as the name implies only work on relieving the pain during the attack, and include over-the-counter painkillers, triptans, Lasmiditans. To prevent future attacks, blood pressure-lowering drugs, anti-depressants, and anti-seizure drugs may be considered.
Newer Therapies for Migraine
Currently, studies and clinical trials are being performed to find new pain-relieving and preventive therapies for migraine. Many studies have resulted in new experimental drugs being tested for the treatment of acute and chronic migraines, along with the prevention of migraine attacks.
Nerve Block: A team of researchers is currently working on evaluating the effectiveness of supraorbital nerve and superior occipital nerve block using Lidocaine hydrochloride, a numbing medication in treating acute migraine attacks in the emergency department.
A nerve block is known to be an effective treatment for migraine and is often used as both, therapeutic and preventive treatment. The use of supraorbital nerve and superior occipital nerve block using Lidocaine hydrochloride is still being tested in clinical trials which are currently in Phase 4. But it has shown great primary results and is expected to be completed by the end of the year.
Botox: Another experimental drug being tested for the treatment of chronic, treatment-resistant migraine is BOTOX. The Botulinum toxin is administered an injection on both sides of the face so the toxin is directly injected into a ganglion. The purpose of using Botulinum Toxin Type A is to alleviate the pain and reduce the frequency of migraine attacks in the setting of chronic migraine attacks.
This treatment option is still under clinical trials as it only started in the year 2019. The clinical trials investigating Botulinum Toxin as a treatment option for chronic headache is expected to be completed by the year 2024 as the BOTOX injections and their effectiveness can be completely known only through long-term follow-ups.
Fremanezumab: To prevent chronic migraine attacks in children, an investigative study has begun to look into the effects and safety of the drug Fremanezumab. Often administered as a subcutaneous injection, right below the skin, it is used to prevent migraines in adults. It is an effective and well-tolerated treatment option that has very few side-effects in the adult population. However, the new investigation aims to test the tolerability of this drug in children and adolescents so that it can be approved for use in the pediatric population too.
Fremanezumab’s safety and tolerability are being tested in an interventional, multi-center study that is still recruiting children and adolescents. The clinical trial is expected to complete by the year, 2024 as both, short-term and long-term effects of the drug need to be analyzed before approving the drug to be officially used in the hospital settings.
