What causes migraines and how can they be treated? If you have never had migraine before and now get one regularly is there any cause for concern?

Answer

Migraine, or vascular headache, refers to periodic, usually one sided, throbbing headaches which are often accompanied by nausea and visual disturbances. They tend to begin in childhood or early adulthood and are common, affecting 20 to 30 percent of the population. Women are more often affected than men. In 60 percent of cases there is a strong family history of migraine. There are four main patterns: classic migraine, common migraine, complicated migraine and cluster headaches.

Classic migraine generally has a so-called prodrome of neurological symptoms such as visual disturbances, classically zigzag lines, photophobia and blocking of one part of the visual field. Some people also experience dizzyness and tinnitus. People who have this type of migraine are often aware some hours before that they are about to get a migraine, often due to feelings of elation, excess energy, thirst or drowsiness.

In common migraine the headache occurs suddenly without any of the preceding symptoms, but with nausea and vomiting.

In complicated migraine the headaches are accompanied by severe neurologic symptoms such as numbness and tingling of the lips, face, hand and leg on one hand. Sometimes the arm or leg may become paralysed, mimicking a stroke. The numbness or weakness slowly spreads from one part of the body to another over minutes. There is usually full recovery within a short time.

Interestingly, in some people the neurological symptoms occur without the headache. In children cyclical abdominal pain and vomiting without headache may be caused by migraine. Older people not previously known to have migraine may develop the classic neurological accompaniments, know as transient migranous accompaniments.

Cluster headache is more common in men than in women and tends to occur during sleep. There is a constant, one sided pain in the eye, along with a blocked nostril, tearing of the affected eye and the nose may also run. The cheek may become swollen and flushed. The attacks tend to occur every night for a few weeks or months, and then disappear for months, or even years, at a time.

Migraine is thought to be caused by changes in cerebral blood flow, but exactly what those changes are and what causes them are still unknown. Many people find that they have specific precipitating factors such as certain foods, or a sudden release in tension.

Treatment is aimed at prevention where at all possible. Classic and common migraine can generally be prevented early in the attack by ergot preparations such as ergotamine (Migril®, Cafergot®, Deseril®) Pizotifen (Sandomigran®) is often effective for preventing migraines occurring, but must be taken regularly. Some people find that a low dose of a beta-blocker is effective. Sumatriptan (Imigran®) is a selective serotonin agonist which is very effective in stopping an acute migraine and is available as tablets or an injection.

If you have only recently developed migraine late in life it is probably worth consulting your GP to check that your symptoms are in fact due to migraine. However, late onset migraine is not that uncommon.