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Types of migraine: symptoms, possible causes and treatment

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Migraine, also known as migraine, is a disease that affects approximately 12 to 16% of the population, with a tendency to affect more women than men, being three times more susceptible to migraines .

The exact cause of migraine is unknown at the moment, although there is great interest in the discovery of the mechanism of migraines. This is not only due to the suffering and disability that they cause in a large part of the population, but the economic impact of migraines is high. Migraines cause economic losses of about 27,000 million euros a year to the European community .

What is migraine?

Migraine is a disease of which we have medical records dating from ancient Egypt, around 1200 BC There are descriptions of migraines with auras in manuscripts of the Hippocratic School of Medicine, 200 BC In the seventeenth century, trepanation was recommended, open a hole in the patient’s skull to relieve his symptoms. Despite knowing its existence for so long, the cause of migraines remains a mystery.

Modern research points to neural or circulatory disorders, in the brain area, as a possible explanation. There is also evidence that migraines have a genetic component, thanks to studies with twins and the fact that if a family member of ours has migraines, our own risk of migraines increases .

Genetic studies have not been able to find a single gene that causes migraine, but they have linked mutations in several different genes with a higher probability of suffering them. This turns the migraine into a possible multifactorial polygenic disease, or what is the same, that several genetic and environmental elements are guilty of its appearance.

Symptom

Although there are different types of migraine, which we will discuss later in the article, we can describe certain general characteristics of this disease. These do not have to happen in all cases , they are simply the most common symptoms, and usually last from a few hours to several days:

  • Severe headache
  • Sensitivity to light
  • Sickness
  • Vomiting
  • Lethargy

It is also common for migraine to present phases of evolution throughout its attacks. Again, given the wide variety of ways in which migraine manifests, one or more of these phases may not occur:

1. The warning phase, or prodromic

In this phase mild symptoms are described that “warn” of the proximity to the migraine attack , such as fatigue, the desire to eat sweet foods, strong emotional changes, thirst sensation or stiff neck. These sensations can last from an hour to a whole day, before the attack goes to the next phase.

2. The aural phase

Auras are described in the minority of migraine cases, depending on their type. They are neurological symptoms, which can last about an hour before the headache . Among others, the symptoms that are perceived during the aural phase can be visual, such as seeing points of darkness, light, colors or zigzagging lines. Dizziness, tiredness, speech and hearing disorders, memory disorders and emotions may also occur …

In adults the aural phase is prior to the headache, but in children it can occur simultaneously. It is also possible to experience aural symptoms without the typical migraine headache occurring.

3. The main phase, the headache

This is the phase whose symptoms we have previously described as the most common in the different types of migraine. The affected experience an intense headache, of variable severity, that worsens with movement. This pain in the head is usually located on one side of the head, but it is not uncommon that as this phase evolves, the pain extends to both sides .

In this phase you can also experience nausea, vomiting and sensitivity to noise or light.

4. The resolution of the attack

Most migraine attacks disappear slowly without a climax, but sometimes the end of the headache is preceded by episodes of vomiting or heavy crying. Sleeping can end the migrainous attack in some cases, especially in children.

5. The postdromatic or recovery phase

After ending the episode of pain, patients may suffer symptoms similar to those of an alcoholic hangover, which may last up to two days .

The symptoms of this phase may be opposite to those in the warning phase (for example, if we feel very tired, we may feel full of energy, or if we lose our appetite, we may find ourselves hungry). They usually consist of nausea, difficulty concentrating, fatigue and muscle pain.

Types of migraine

Some of the types of migraine, but not all, are:

1. Migraines without aura

The most common migraine, which represents between 70 and 90% of cases. This type of migraine does not experience the aural phase, and may last between 4 and 72 hours. The usual experience with this type of migraine is that of a headache located in the middle of the head, of a pulsating type that worsens with physical exercise. The frequency of these attacks is between a single attack per year and several weekly attacks.

2. Migraines with aura

Migraines that present auras constitute between 10 and 30% of cases. Nowadays it is believed that auras are caused by a disruption in the cerebral cortex, caused by vascular problems in the brain .

This process is known as disseminated cortical depression (English CSD for “cortical spreading depression”) and its study is giving hope to those affected by migraine because it also seems that this process is related to the typical migraine headaches , being able to give an explanation and then find a cure or relief from the disease.

3. Menstrual migraines

Although menstruation is usually one of the triggers of migraine, there are people whose migraine attacks are strongly linked to menstruation . This is thought to be due to the lowering of the levels of the hormone estrogen during the period, or the rise in levels of the hormone prostaglandin, also during the period.

Currently, hormone control therapies are undergoing to alleviate or eliminate the symptoms of menstrual migraines.

4. Hemiplegic migraine

A rare type of migraine, where the symptoms mainly affect one half of the body. Those who suffer from it can experience symptoms very similar to those of the rest of migraines, but being located only in one of the halves of the body, it is usually alarmed by its resemblance to the effects of the heart attack.

Possible causes

Currently, it is not known what is the cause of migraine, although there are known factors that make us more vulnerable to suffer from it. Some of these factors, as we have said before, are genetic. But there have also been studies that conclude that there are socioeconomic factors that make us more susceptible to suffering from migraines , according to which being in lower classes socioeconomically speaking, would make us more prone.

Regardless of the underlying cause, multiple triggers of migraine attacks have been described. These will vary from person to person, but include, among others:

  • Stress
  • Lack of sleep
  • Excessive coffee consumption
  • Interruption of coffee consumption
  • Hormonal changes
  • Environmental changes (sound, light, humidity …)
  • The chocolate
  • The alcohol
  • The cheese.

Migraines are also associated with cardiovascular diseases and psychiatric disorders, such as depression, anxiety or bipolar disorder. While there is no cure, we can relieve symptoms with sound and visual isolation, rest, correct hydration and analgesics .

There are also indications that an active life and a healthy diet can decrease the frequency and intensity of migraine attacks.

Bibliographic references

  • Kowalska, Marta et al. “Molecular factors in migraine.” Oncotarget.
  • A. Zabala, H. (2019). Epidemiology and economic impact of migraine.
  • Piane, Maria et al. (2007) “Genetics of migraine and pharmacogenomics: some considerations.” The journal of headache and pain vol. 8.6
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