Migraine

Migraine is a type of headache. It occurs in 20% of women and 10% of men. It’s a complex genetic disease, meaning one can be genetically predisposed to migraine, but the environment has a large impact too. You can inherit migraine; 75% of migraineurs have migraineurs in their families. This could be a parent or a second or third-degree relative, such as cousins ​​or great aunts.

Migraine pains are:
• Usually unilateral (single sided)
• Pounding, throbbing, has a pulsing quality
• Recurrent
• Causes sensitivity to light, sound and smell
• Causes nausea, sometimes vomiting
• Increase with head movements, daily activity and strain
• Affect daily life negatively

Migraine pains consist of 4 phases: prodrome, aura, pain and post pain.

1. Prodrome
   Before the migraine pain starts, some patients may have a prodromal period (early signs of illness). The most common complaints before pain are fatigue, which may cause yawning and a desire to sleep. Symptoms such as sound and olfactory sensitivity, mood changes, anxiety, irritability, cheerfulness, a desire to eat, dizziness, diarrhea, constipation, and increased urination may be seen.
   In most patients, neck muscle stiffness accompanies pain.
2. Aura
   Auras can be seen in a third of the patients at the same time as the prodrome or shortly after. Auras sometimes occur without accompanying migraine pain (this is called silent migraine). Auras are transient neurological deficits (findings) resulting from the disruption of conduction at the cellular level in the brain, brain’s blood flow also effects the process. It might be scary to observe an aura in a patient for the first time, it can easily be mistaken for a stroke or similar neurological illness. There are many different aura findings – the main ones are the following:
   
   • Sparkling or flickering lights, dots, wavy lines, zig zags, arcs, camouflage patterns, or blurry areas – toward the periphery of vision
   • Half-quarter-complete visual field losses
   • Blurred vision
   • Speech problems
   • Concentration loss, brain fog
   • Dizziness
   • Double vision (diplopia)
   • Eyelid drooping
   • Numbness in the hands, arms, legs, whole body
   • Paleness
   • Sweating
   These findings last 10 to 40 minutes and then pain follows. An aura will not last more than 60 minutes.
   In migraine patients without aura, migraine pain may start directly after prodrome or without prodrome.
3. Pain
   Pain is usually unilateral, beginning on the right or on the left, staying on one half, or spreading all over the head. In some patients, pain can affect the entire head, starting from the neck or forehead area without any particular side.
   Along with pain, the findings of the autonomic nervous system involvement such as red eyes, runny nose, and diarrhea can be seen.
   Pain levels can increase especially when climbing stairs, bending or lifting objects.
   Sleeping or resting for 10-15 minutes in a dark and cool room will alleviate the pain.
   Pain can last 2-72 hours.
4. Post pain
   There may be complaints such as fatigue, fatigue, burning sensation of the scalpfollowing the attack.

Migraine is a neurovascular headache resulting from the changes in the blood vessels and nerve cells in the brain. In individuals with a susceptible genetic background, hypothalamus-induced stimuli are thought to cause pain by triggering pain centers in the brain stem. With the stimulation of pain centers, secretion of inflammatory neuropeptides (substances that cause chemical changes in the brain) affects the trigeminal nerve, resulting in an increase/decrease of blood circulation in some regions of the brain. Secreted chemical substances cause inflammation and allergy cells (mast cells) are recruited. Mast cells further the inflammation of the meninges (brain membranes). This process results in pain.
Migraine pain often starts in adolescence. Hormonal changes, weight gain and a stressful lifestyle can cause migraine headaches to start in adults.

In susceptible people, some external and internal factors can bring the migraine attack or worsen an ongoing attack. These are called triggers.
Migraine triggers (factors that cause pain to develop or occur)

• Stress
• Insomnia
• Hunger; low blood sugar
• Thirst (dehydration)
• Magnesium deficiency
• Bright light (sun, white snow, fluorescent)
• Computer screens
• Detergents; cleaning agents
• Excess insulin secretion and/or insulin resistance
• Weight gain/obesity
• Smoking cigarettes, cigarette stench, cigarette smoke (secondhand smoke)
• Hormonal fluctuations before and after menstruation, before and after menopause and during the first trimester of a pregnancy
• Birth control pills (especially high in estrogen content)
• Bad posture
• Pressure changes in the air, especially southwestern wind.
• Flight travel (especially combined with insomnia and stress)
• Fake or strong perfumes; room sprays/scents; some flowers
• Sick building syndrome (new buildings and/or poorly ventilated buildings, pathogenic bacteria and viruses in the aeration, chemicals used within or around, wall to wall carpet or flooring, poor lighting, humidity, mold, ozone and carbon monoxide accumulation)
• Workplace environment, colleagues, managers
• Tying hair very tightly
• Foods and drinks
– Sugar and sweets
– Gluten-containing flour products, breads, pastries, biscuits
– Milk and dairy products, especially products made from cow’s milk and mature cheeses
– Processed products, especially delicatessen and processed meats
– Alcoholic beverages, especially beer and red wine
– Excessive coffee
– Chocolate
– Citrus
– Soy beans and soy products
– Foods containing artificial food additives such as monosodium glutamate (MSG), stabilizers/thickeners, and/or food coloring
• Aspartame and other artificial sweeteners
• Sulphite
• Tyramine (cheeses)
• Foods containing histamine (white/red wine, fermented meats, some fish (anchovies, sardines), some fruits (bananas, grapes, citrus fruits, pineapples, strawberries) green tea, pickles, spinach)
• Foods that increase histamine release (egg whites, cocoa/chocolate, tomatoes, nuts, shellfish, coriander)

Migraine rarely occurs in a patient by itself. Diseases that are co-morbid with migraine are:
• Fibromyalgia
• Depression
• Adverse childhood experiences
• Sleep disorders
• Tension type headache
• Jaw joint disorders
• Metabolic syndrome
• Asthma
• Allergies
• Irritable bowel syndrome
• Increased intestinal permeability
• Dysbiosis
• Thyroid diseases
• Patent foramen ovale (PFO)
• Mitral valve prolapse
• Obstructive sleep apnea syndrome
• Restless legs syndrome

The diagnosis of migraine is made by a neurologist after taking the patients history and a neurological examination. There is no specific test that can be performed to reach a diagnosis. If a problem is found during the examination, further investigations may be required if the physician deems it necessary, i.e. advanced imaging exams and laboratory tests. Deficiency of vitamin B12, folic acid, vitamin D, iron and biotin, as well as thyroid dysfunction must be kept in mind.