This terrible headache that feels like your head is splitting... Do you have a (Migraine) too? Let's talk about this!

Do you sometimes have a severe headache that starts on one side and feels like it's going to burst? Do you feel like your head hurts more when you're outside, when you're exposed to loud noises or strong smells? Then you may have a migraine, which we're going to talk about. This is a very annoying thing that disrupts all your daily activities. So let's talk about this migraine in detail.

What is this ``(Migraine)''? Let's learn it slowly.

Simply put, a migraine is not just a regular headache. It is a severe headache that feels like someone is hitting you with a hammer or a vein is bursting. It is often felt on one side of the head.

These ``(Migraine)`` headaches can last for at least four hours, and sometimes even days. Imagine how painful it is when your head hurts like a split second for days. This pain increases even more:

• When you do some physical work (for example, walking, climbing stairs).
• When exposed to bright light (like sunlight, streetlights).
• When you hear a loud noise .
• When you smell strong smells (like certain scents, smoke).

Migraines can be a real life-threatening condition. They can disrupt your daily activities and social interactions. But the good news is that there are treatments that can help you manage them.

Are there types of migraines?

Yes, there are different types of migraines. The two main types that are seen are:

• Migraine with an Aura (Classic Migraine): In this type of migraine, a series of symptoms called an aura appear before the headache begins.
• Migraine without Aura (Common Migraine): In this case, the headache begins suddenly without the previously mentioned Aura symptoms.

Simply put, an ``aura'' is a warning sign that you feel before a headache. We'll talk about that in a bit.

In addition to these two main types, there are other types of migraines:

• Migraine in children (Abdominal Migraine): This is more like a stomach ache than a headache.
• Chronic Migraine: This may occur if you have headaches for more than 15 days a month.
• Migraine with paralytic symptoms (Hemiplegic Migraine): This can cause symptoms such as temporary paralysis on one side of the body.
• Menstrual Migraine: This occurs in women in association with their menstrual cycle.
• Migraine without a headache (Silent Migraine): In this, only the aura symptoms come and go without a headache.
• Retinal Migraine / Ocular Migraine: Symptoms include temporary loss of vision in one eye.
• Severe, long-lasting migraine (Status Migrainosus): This is a very severe condition that lasts for more than 72 hours.

How common is migraine?

Migraine is actually more common than you might think. Surveys show that a significant number of people around the world suffer from this condition. So if you have migraine, remember that you are not alone.

What are the stages of a migraine?

A migraine usually has four stages. However, not everyone experiences all four stages in every migraine. Some people may skip some stages.

1. Prodrome: This is the first stage. These symptoms can appear about 24 hours before the headache.

2. `(Aura)` phase: `(Aura)` is a group of symptoms that occur just before the headache, such as sensory, motor, or speech difficulties. This can last from 5 minutes to about an hour. Sometimes both the `(Aura)` and the headache can occur at the same time.

3. Headache stage: Migraine headaches can last from 4 hours to about 72 hours (3 days).

4. Postdrome: This phase usually lasts from a few hours to a couple of days. The symptoms are similar to the morning after a heavy drinker's hangover, so it is also called a migraine hangover.

It can take anywhere from 8 to 72 hours to complete all four stages.

What are the symptoms of `(Migraine)`?

Migraine symptoms vary depending on the stage. Also, not all migraines are the same. You may not experience all of these stages at the same time.

Characteristics of the prodrome stage:

• Changes in mood (just feeling angry, sad).
• Difficulty concentrating.
• Difficulty falling asleep.
• Feeling tired and fatigued.
• Nausea.
• Feeling more hungry or thirsty.
• Frequent urination.

Characteristics of the `(Aura)` stage:

• Muscle weakness.
• Vision changes (streaks before the eyes, seeing lights, things seem blurry).
• Sensation of ringing in the ears (`Tinnitus`).
• Sensitivity to touch (feeling like someone is touching your body).
• Numbness, tingling sensation.
• Difficulty speaking or concentrating.

Symptoms of the headache phase:

• The headache gradually gets worse. This can be on one side of the head or on both sides.
• Other symptoms may also occur:
• Nausea and vomiting.
• Sensitivity to light, sound, and smell.

Characteristics of the post-event stage (`Postdrome`):

• Tiredness, fatigue.
• Stiff neck.
• Sensitivity to light and sound.
• Difficulty concentrating.
• Nausea.
• Dizziness.

How does it feel when you have a migraine?

Migraine headache pain can be felt in different ways:

• Like a brain throbbing.
• Like a telegram (`Pulsing`).
• It feels like something is hitting your head (`Pounding`).
• Dull, heavy.

Migraines can affect everyone differently. They can range from mild to severe. The pain can start on one side of the head and move to the other. The pain can also spread to the eyes, forehead, and sometimes the face, sinuses, jaw, or neck.

How often can migraines occur?

This also varies from person to person. Some people may have only one migraine a year. Others may have one a week. On average, most people have two to four migraines a month. Most often, they tend to come in the morning. It is not possible to say exactly when a migraine will come. But sometimes, for example, women may have a feeling that a migraine is coming before their period or after a major stressor.

What are the causes of migraine?

Researchers still haven't found the exact cause of migraines, but studies have shown that there is a genetic influence.

When you have a headache, certain nerves in your blood vessels send pain signals to your brain. This causes the nerves and blood vessels in your head to release substances that cause inflammation. It's not yet clear why these nerves do this.

What are the triggers for a migraine?

A `trigger` is something that causes symptoms to start. Here are some of the main things that trigger a `(Migraine)`:

• Stress. (Imagine that when you have an exam coming up, or when you feel a lot of pressure due to a problem at home, this `(Migraine)` increases. That means that your `(Migraine)` may be affected by stress.)
• Hormonal changes (especially in women).
• Some medications.
• Changes in sleep patterns (sleeping less, sleeping more).
• Changes in weather.
• Excessive physical exertion.
• Addictive substances (like caffeine, tobacco).
• Skipping a meal.
• Exposure to bright light, loud noises, or strong odors.

Your doctor can help you figure out what triggers your migraines. They may ask you to keep a migraine diary. In this diary, you can write down things like when your migraines started, how they felt, and how long they lasted.

What foods and drinks trigger migraines?

Your body may be sensitive to chemicals and preservatives in some foods. This sensitivity, especially when combined with other triggers, can increase the risk of a migraine.

Some of the most common migraine-triggering foods are:

• Aged cheeses.
• Alcoholic beverages.
• Chocolate.
• Food additives like nitrates and MSG.
• Processed or preserved meats (like hot dogs, pepperoni).
• Fermented or pickled foods (e.g. kimchi, soy sauce).

Is `(Migrate)` something that comes from generation?

Yes, migraines can be passed down from generation to generation. About 80% of people with migraines have a first-degree relative (mother, father, siblings) in their family who has the condition.

Who is at higher risk of developing migraines?

Migraine can affect anyone, be it a child or an adult. However , women are more likely to develop migraines than men.

Some other risk factors for developing migraines are:

• Someone in the family has migraines.
• Other underlying medical conditions (such as depression, anxiety, sleep disorders, epilepsy).
• Frequent use of tobacco products.

How to recognize `(Migraine)`?

A doctor will diagnose migraine by performing a physical exam and a neurological exam. He or she will also ask about your medical history and family health. To learn more about your symptoms, your doctor may ask questions such as:

• What symptoms are you experiencing?
• Can you describe how your headache feels and where it is located?
• How severe are your symptoms?
• How long have the symptoms been present?
• Were there any things that made the headache worse or worse?

The doctor may also order blood tests and imaging tests such as a CT scan or MRI to rule out other causes of the headache. An EEG (Electroencephalogram) may also be performed to rule out other medical conditions.

Who diagnoses `(Migraine)`?

If you think you have a migraine, first talk to your primary care physician (PCP). He or she can diagnose and treat your migraine. If necessary, he or she may refer you to a headache specialist or neurologist.

How to treat migraine?

There is no cure for migraines yet. But a doctor can help you manage your migraine symptoms. There are three main ways to do this:

• Use of medications.
• Avoiding things that trigger migraines.
• Using alternative treatments.

What are the medications given for migraine?

Your doctor may prescribe medications to treat migraines. There are two main types of medications:

1. Migraine prevention medications: These can be taken at the first sign of a migraine. These medications help stop or reduce migraine symptoms such as pain, nausea, and sensitivity.

• Commonly prescribed medications: `(Triptans - e.g. Sumatriptan)`, `(Lasmiditan - Ditans group of medications)`, `(Rimegepant, Ubrogepant - Gepants group of medications)`, `(Dihydroergotamine)`, `(Prochlorperazine)`, Antiemetic medications - e.g. Metoclopramide`.

2. Migraine Preventive Medication: If you have severe symptoms, such as those that interfere with your daily activities, or if you have frequent migraines, your doctor may prescribe these preventative medications. These medications reduce the frequency and severity of migraines. These are usually taken daily.

• Commonly prescribed medications: Antiseizure medications - e.g. Valproic acid, Topiramate), Beta-blockers - e.g. Atenolol, Propranolol, Nadolol), Calcium channel blockers - e.g. Verapamil), Monoclonal antibodies - e.g. Erenumab, Fremanezumab, Galcanezumab), some medications for depression (Tricyclic antidepressants - e.g. Amitriptyline, Nortriptyline, Doxepin; SNRIs - e.g. Venlafaxine, Duloxetine).

This medication can come in different forms:

• Subcutaneous injection.
• Oral medication.
• Nasal spray.
• Given into a vein (`Intravenously - IV`).
• Suppository.

You and your doctor can discuss the best medication, combination of medications, and dosage to manage your symptoms. All medications should be used under the supervision of a headache specialist or a general practitioner. As with any medication, it is important to take it exactly as your doctor tells you to.

Let's also learn about painkillers that can be purchased at the pharmacy!

If you have mild migraine symptoms, over-the-counter medications can be helpful. These medications include ibuprofen, aspirin, acetaminophen, naproxen, and caffeine.

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But you need to be very careful when taking these painkillers. Sometimes, if you take too much of them, you can get a headache called ``Analgesic-rebound headaches'', or you can become addicted to them. If you take these types of painkillers more than two to three times a week, be sure to tell your doctor. He or she can then prescribe a more effective, prescription medication.

Avoiding things that trigger migraines

Your doctor can help you find out what triggers your migraines. He or she may ask you to keep a migraine diary. This diary can help you write down things like when your migraines started, how you felt, and how long they lasted. You can also add details about what you ate, drank, and did to help you identify any triggers.

Nowadays, there are even smartphone apps that help you keep a migraine diary like this.

Once you have identified your `Trigger`, you can take steps to avoid it. This is not always possible, but being aware of your `Triggers` can be very helpful in identifying and treating a `(Migraine)` when it starts.

For example, if your trigger is stress, you can talk to a mental health counselor and get help managing it. If you get migraine symptoms when you miss a meal, you can set an alarm on your phone to remind you to eat at the right time.

Alternative treatments for migraines

There are several alternative treatments that can help control migraines. These include:

• Taking vitamins, minerals or herbs (e.g. `(Riboflavin - Vitamin B2)`, `(Magnesium)`, `(Feverfew)`, `(Butterbur)` or `(Co-enzyme Q10)`).
• Relaxation techniques (e.g., Yoga).
• Acupuncture.
• Biofeedback.
• `(Botulinum toxin type A - Botox®)` injection.

The most important thing is to talk to your doctor before starting any alternative treatment for migraines.

What to do for migraines during pregnancy?

If you are pregnant or planning to become pregnant and have migraines, be sure to talk to your doctor. Your doctor may advise you to avoid taking migraine medications while you are pregnant or think you may be pregnant, as some medications can affect the development of your unborn baby.

Your doctor may recommend alternative treatments for migraines, such as a pain reliever like acetaminophen.

What do you do when you get a migraine?

There are a few things you can do to get some relief when you have a migraine:

• Rest in a dark, quiet, cool room.
• Place a cloth soaked in cold or warm water (a `compress`) on your forehead or the back of your neck.
• Give yourself a head massage regularly.
• Apply gentle pressure to the tight circles on both sides of the forehead.
• Keep your mind calm (do something like meditation).

What is the outlook for `(Migraine)`?

Migraines vary from person to person. They are temporary, but can recur throughout life. There is no cure for migraines. But your doctor can help you manage them quickly and reduce their severity. It may take some time to find the right treatment for you. Be sure to tell your doctor how your symptoms are getting better and worse.

Can migraines be prevented?

You can't prevent every migraine. But you can reduce the frequency and severity of migraines by taking preventive medications as prescribed by your doctor. You can also learn about your triggers and work with your doctor to avoid them.

When should I see a doctor?

In such a case, you should definitely see a doctor:

• If new symptoms appear.
• If symptoms worsen.
• If there are side effects from the treatment .

This is an emergency! Go to the nearest hospital right now!

* If you get the worst headache you've ever had in your life (`Thunderclap headache`).

* If you develop new neurological symptoms that you never had before (such as difficulty speaking, difficulty walking, vision problems, memory loss, seizures, numbness/tingling).

* If you get a headache after a head injury.

At times like this, don't forget to call 1990 (Sri Lanka's emergency ambulance service) or go to a hospital immediately!

What questions should you ask the doctor?

When you see your doctor, you can ask questions like these:

• Will this migraine go away with time?
• What medications do you recommend?
• How can I prevent migraines?
• What type of migraine do I have?
• Is my migraine considered chronic?

You may have had headaches before, but a migraine is something different. It can feel like the world is ending and there's nothing you can do to make it go away. Even though your symptoms are temporary, you may feel like time is running out and working against you during a migraine. But when a migraine strikes, there are treatments that can help you manage it and stop it from disrupting your day. A doctor can help you with this, so that your migraine doesn't control your life.

The most important things we need to remember from this story (`Take-Home Message`)

Okay, so we've talked a lot about `(Migraine)` now. In short,

• A migraine is not just a headache , it can be severe and life-threatening.
• There are many different causes, triggers, and symptoms . It's important to find out what your triggers are.
• There are effective medications and other treatments to control migraines. It is best to seek medical advice.
• Be aware of the warning signs of an emergency . If you experience any of these, seek medical attention immediately.
• You are not alone, many people suffer from this condition. With the right knowledge and support, you can live with migraines.

So, if you have these symptoms, don't be afraid to see a doctor and get advice. Then you too can get rid of this annoying `(Migraine)` and stay healthy!

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