Face / Head / Neck

Migraine

What is migraine?

After tension headache, migraine is the most common type of headache. It comes in episodes, which are a severe burden for the patient and those around them.

Cause

The cause of migraine is unclear. In some cases, it is possible to identify factors that trigger an attack, such as sleeping too long or not long enough, working night shifts, certain foodstuffs or stress. Hereditary factors are also thought to be involved, as migraine often runs in the family. Experts think that migraine is caused by a temporary disturbance of the coordination between the blood vessels and the nerve tracts in the brain.

Signs and symptoms

The signs and symptoms can vary greatly between patients. The most typical form is that of episodes of severe throbbing headache that usually starts suddenly, often on one side of the head. Patients may be woken up by an attack in the middle of the night. The headache may become worse when patients exert themselves. In most cases the patients are nauseous and may vomit; they sometimes also have diarrhoea. During the attack, which may last from 4 to as much as 72 hours, patients prefer to lie down in a darkened room without any noise. About one third of the patients see a visual 'aura' before the pain starts. This aura may consist of brief (10 to 60 minutes) disturbances of vision (for instance flashes of light) or a partial loss of the visual fields, disturbed speech, sensory disturbances (tingling) and paralysis. The number of attacks also varies greatly between patients.

How is migraine diagnosed?

Physical examination

The diagnosis is based on the patient's pattern of complaints. Neurological examination does not show any abnormalities in the periods between attacks.

Do I need additional examinations?

  • Diagnostic examination for other non-physical factors important for your pain, have already been done by yourself trough filling out your pain questionnaires.
  • An MRI scan of the brain is only required in exceptional cases.

What are my treatment possibilities?

Multidisciplinary Treatment

Depending on the cause of your pain, your pain specialist will decide whether or not to embark on physical treatment. Based on the results of the completed pain questionnaire, additional examinations can be carried out and, apart from physical treatment, other methods of treatment will be suggested.

 

Non-physical Treatments

If the results of your pain questionnaire are abnormal, your pain specialist will offer you one of the non-physical treatments listed below:

Physical Treatments

Medication

Treatment of attacks

  • General analgesics
  • Paracetamol, NSAIDs, in combination with anti-emetics
  • Specific anti-migraine medication
  • Sumatriptan

Preventive treatment

  • Beta-blockers
  • Propranolol