When Serene Branson couldn’t get her words out in a post-Grammy report, she was scared. She knew what she wanted to say, but the words weren’t coming out. After an on-air failure of speech, people around her had her sit down. Her right cheek of her face went numb, her right hand went numb, and she lost some sensation in her arm. She refused a visit to the hospital, and went home to rest. The symptoms were similar to the more serious ailment of a stroke a TIA, which untreated could have been disastrous for Serene Branson. But now experts say she didn’t have a stroke or TIA or trans-ischemic attack — a sort of mini-stroke that warns of the onset of possible stroke.
Most people don’t have a warning before a migraine occurs, but about 20 to 30 percent experience disturbing neurological sensations and symptoms or aura before and during a migraine attack. The aura neurological symptoms appear gradually for five to 20 minutes before the headache, which usually starts within 60 minutes of the end of the aura phase.
Visual aura consists of flashing white or black and rarely multi-colored lights. Sometimes zigzag lines, clouded vision, tunnel vision or half-field vision occurs. Vision can also be fragmented — like looking through a shattered mirror. For example, during reading, the middle of words or sentences can disappear as if they are folded out of view. Some report a blurred object growing into a larger object such as a polygon with the zig-zag line interfering with vision. The blurred object grows to a maximum size and then starts moving slowly through the field of vision until it exits the field of view.
The facial numbness and other numbness that Serene Branson experienced is described as somatosensory aura, which consists of digitolingual parasthesias (pins-and-needles in the hands and arms) or cheiro-oral parasthesias (pins-and-needles in the face and mouth), hallucinations, temporary dysphasia, vertigo (dizziness), tingling or numbness of the face and extremities, and hypersensitivity to touch.
The typical migraine headache is unilateral pain (affecting one half of the head) and pulsating in nature. The headache lasts from 4 to 72 hours with symptoms including nausea, vomiting, photophobia (increased sensitivity to light) and phonophobia (increased sensitivity to sound). The headache and associated suffering is aggravated by routine activity — any tasks or form of concentration. Migrainous deliria is described as intense aura similar to hallucinosis, illusion and dreaming. The first time an aura is experienced, victims are afraid of a serious medical problem developing. Subsequent onsets of aura at later dates cause an intense feeling of dread for those that experienced the severe headache and vomiting and other symptoms that previously occurred. Simple tasks or any type of mental concentration can worsen symptoms, and cause the victim to want to cocoon and get away from any external stimulation, especially lights and sounds.
Headaches are usually intense. After the headache — the postdrome or postdromal phase — victims report vascular pain that is aggravated by bending forward, presumably caused by weight-bearing of internal anatomical structures and fluid dynamic changes that exert force on affected blood vessels. Although exact causes of migraine are unknown and may involved a multitude of sources, the mechanism of the migraine headache pain is related to painful dilation of the terminal branches of the external carotid artery — especially the temporal and occipital branches. Studies have shown that symptoms that occur during the aura phase involve constriction of blood vessels in the brain (arterial spasms), which may start in the occipital lobe in the back of the brain. This is probably where the similarity of symptoms and differential diagnosis with TIA (trans-ischemic attacks) and strokes come into play.
The experience of a migraine causes high motivation for the sufferer to prevent subsequent migraines. Even before migraine aura, another early warning system exists for migraine victims — the Prodrome. Prodromal symptoms occur in 40–60% of those with migraines. This phase consists of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e.g. chocolate), stiff muscles (especially in the neck), hot ears, constipation or diarrhea, increased urination, and other visceral symptoms. These symptoms usually precede the headache phase of the migraine attack by several hours or days. Experience and fear/avoidance teaches and motivates the victim or observant family member how to detect that a migraine attack is oncoming.
A unifying theory of the cause of migraine consists of the following:
1. stress triggers changes in the brain
2. the changes cause serotonin to be released
3. blood vessels constrict and then dilate
4. chemicals, including pain Substance P irritates nerves and blood vessels
Triggers associated with migraine include physical stress, mental stress, hunger, fatigue, and dietary triggers (e.g., hot dogs, chocolate, cheese, ice cream). However, dietary triggers are not well substantiated by scientific evidence. Hunger and hypoglycemia may be a trigger or may cause a state of the body that leads to vulnerability of other triggers. Extreme exertion during exercise is also known to cause migraines.
The following medicines reported to be used for treatment of migraines. Most migraine suffers understand that the earlier these drugs are taken in the attack, the better their effect.
A number of analgesics are effective for treating migraines including:
Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen provides pain effective pain relief in about half of people. Naproxen can abort about one third of migraine attacks, which was 5% less than the benefit of sumatriptan. A 1000 mg dose of Aspirin (ASA for acetylsalicylic acid) could relieve moderate to severe migraine pain, with similar effectiveness to sumatriptan.
Paracetamol/acetaminophen either alone or in combination with metaclopramide is effective for migraines.
Simple analgesics combined with caffeine may help. During a migraine attack, emptying of the stomach is slowed, resulting in nausea and a delay in absorbing medication. Caffeine has been shown to partially reverse this effect. Excedrin is an example of an aspirin with caffeine product. Caffeine is recognized by the U.S. Food and Drug Administration as an Over The Counter Drug (OTC) treatment for migraine when compounded with aspirin and paracetamol. Even by itself, caffeine can be helpful during an attack, despite the fact that in general migraine-sufferers are advised to limit their caffeine intake.
Triptans such as sumatriptan are effective for both pain and nausea in up to 75% of people. They come in a number of different forms including oral, injection, nasal spray, and oral dissolving tablets. Most side effects are mild such as flushing however rare cases of myocardial ischemia have occurred They are non addictive however are associated with medication overuse headaches if used more than 10 days per month. Triptans are a family of tryptamine-based drugs that bind serotonin receptors in cranial blood vessels — causing their constriction and inhibition of pro-inflammatory neuropeptide release. Triptans may also inhibit release of Substance P and other pain-causing compounds from nerve endings. Tryptamine is a monoamine alkaloid found in plants, fungi, and animals. It is based around the indole ring structure, and is chemically related to the amino acid tryptophan, from which its name is derived. Tryptamine is found in trace amounts in the brains of mammals and is believed to play a role as a neuromodulator or neurotransmitter. Tryptamine is also a base structure of the illegal drug LSD.
Dihydroergotamine is an older medication that some find useful. They were the primary oral drugs available to abort a migraine prior to the triptans. They are much less expensive than triptans. Ergotamine continues to be prescribed for migraines.
A single dose of intravenous dexamethasone, when added to standard treatment of a migraine attack, is associated with a 26% decrease in headache recurrence in the following 72 hours.
Antiemetics by mouth may help relieve symptoms of nausea and help prevent vomiting, which can diminish the effectiveness of orally taken analgesia. In addition some antiemetics such as metoclopramide are prokinetics and help gastric emptying. In the UK, there are three combination antiemetic and analgesic preparations available: MigraMax (aspirin with metoclopramide), Migraleve (paracetamol/codeine for analgesia, with buclizine as the antiemetic) and paracetamol/metoclopramide (Paramax in UK).
Although migraines are differentially diagnosed, and less serious than TIAs (trans–ischemic attacks) and strokes (which can be fatal), women who experience auras have been found to be twice the risk of stokes and heart attacks over non-aura migraine suffers and women who do not have migraines. Migraine sufferers seem to be at risk for both thrombotic and hemorrhagic stroke as well as transient ischemic attacks — another motivation to counter triggers to migraines.
Migraine sufferers have been known to eliminate attacks with close attention to a diet that regulates normal blood sugar levels. While hypoglycemia or low blood sugar cause routine, average headaches, hypoglycemia is also a known cause of the more serious migraine headaches. Victims with migraines caused by hypoglycemia can prevent migraine attacks by eating healthy diets that include good quality protein with almost every meal — especially breakfast. Sufferers are advised to avoid foods with high glycemic index, especially while lacking protein in the meal. Migraine sufferers are also advised to avoid eating high glycemic foods after fasting — as in breakfast. In other words, eating food that spikes blood sugar and doesn’t promote sustained levels of normal blood glucose levels, put susceptible people at risk of migraine attacks.