MIGRAINE: SYMPTOMS, CAUSES, TREATMENTS - NEUROPSYCHOLOGY - 2025

The migraine is a condition that affects the central nervous system; It presents in the form of an intense and recurrent headache or headache, usually throbbing and associated with different autonomic symptoms.

It is a medical condition that usually appears in the form of temporary crises, lasting hours or days. Within its clinical course, some of the signs and symptoms that accompany migraines are nausea, vomiting or sensitivity to light, among many others.

Specifically, migraines are one of the most common types of headache, along with tension headaches. Thus, more than 15% of the general population presents the diagnostic criteria for this pathology.

Migraine is a pathology that is within the group of diseases that are most prevalent or common among women. Furthermore, its prevalence tends to decrease with age.

Although the etiological cause of migraine is not exactly known, for several decades it has been associated with the dilation and / or constriction of the cerebral blood vessels. However, other positions are currently under investigation.

The diagnosis of migraine is usually made on the basis of clinical criteria. This pathology is a recurrent condition in emergency medical services, so the first phase of medical management consists of the precise identification of the signs and symptoms present in each case.

In the case of treatment, there are numerous medical interventions for the control of the clinical picture associated with migraine, pharmacological and non-pharmacological therapies. Furthermore, different interventions aimed at preventing migraine attacks or crises have also been described.

Characteristics of migraine

Pain that affects the brain or head “limb” is called a headache. This type of disorder is one of the problems that humans have historically worried about, for more than 3,000 years before Christ.

Headache is a medical condition that has been referenced at a clinical level in findings as old as Ebers' Papito, the writings of Hippocrates or Galen, among many others.

Currently, headaches or recurrent headaches are considered one of the most frequent pathologies that affect the central nervous system.

The World Health Organization points out that headache is a significantly painful and disabling medical condition, among which may be migraine, migraine, tension headache and cluster headache.

Headache can have a primary origin, without an etiological medical cause, or secondary in which an associated pathology can be identified. Specifically, most headaches of primary origin are due to suffering from a migraine.

As we have noted, migraine is a type of headache. It is considered a complex neurological disorder that can affect the entire body in a systematic way, leading to a wide variety of symptoms.

It is a pathology that can occur differently among those affected, so its signs and symptoms can be overlooked or confused with other types of diseases.

Although the clinical features of migraine have been precisely described, it remains a poorly understood disease. Furthermore, in most of the people who suffer from it, it remains undiagnosed and consequently untreated.

Migraine presents with severe and intense headache, accompanied by symptoms such as nausea, vomiting, eye pain, vision of spots or spots, sensitivity to light / sound, etc.

Normally, it appears in the form of a temporary attack or crisis, however, migraine is considered a public health problem with significant social and economic costs.

Statistics

Most headaches have a primary origin, that is, without an explicit cause or associated medical pathology. Specifically, numerous investigations have indicated that more than 90% of all headache or primary headache cases are due to migraines and / or tension headaches.

Migraine is the third most common disease in the world. In the United States, it has been estimated that approximately 18% of women, 6% of men, and 10% of children suffer from migraines.

Despite the fact that the figures on the prevalence and incidence of this pathology are not very precise, it has been pointed out that approximately 15% of the population worldwide can meet the criteria for establishing a migraine diagnosis. Thus, different institutions have indicated that this neurological disease has a worldwide frequency of approximately 38 million affected.

Regarding the distribution by sex, migraine is more frequent in women than in men, around double or triple, mainly due to hormonal influences.

On the other hand, in relation to the typical age of presentation, it usually appears in the stage between puberty and adolescence. In addition, it tends to especially affect people who are between 35 and 45 years old. In addition, it is a pathology whose frequency tends to decrease as age advances, more significantly after 50 years of age.

Health records indicate that, in the United States, every 10 seconds a person visits the emergency department with a severe or persistent headache.

In addition, despite the fact that those affected by migraine usually present these attacks once or twice a month, approximately 4 million suffer from it chronically, presenting signs and symptoms at least 15 days a month.

Signs and symptoms

Migraine is usually associated with a throbbing, intense and recurring headache, restricted to one side of the head.

Despite the fact that the characteristic signs of this pathology are described in different clinical classifications, the symptoms can appear in innumerable forms, varying significantly among all affected people.

Thus, although the common factor is pain, alterations restricted to other areas such as sensory and sensory, cognitive, affective, autonomic or motor manifestations have been described:

Headache

Headache is defined as discomfort or pain that can be located in any part of the head. In this way, the headache or headache constitutes the central symptom of migraine. Normally, this symptom is described as pulsatile, however, not all patients perceive it in the same way.

In the emergency medical services, many patients report feelings of pressure, weight, tearing or tension in the head, especially in the initial moments.

The intensity of this discomfort is variable, between episodes and between those affected, as well as its duration, which varies depending on whether or not the appropriate treatment is administered.

Normally, the episodes of pain have a temporality of hours or days and usually appear unilaterally, that is, it is more frequent that they affect one side of the head.

Regarding its precise location, a higher prevalence of fronto-temporal pain has been observed, that is, behind the eye or around it.

In addition, another important aspect is the association of increased pain with movement, which is why patients tend to be quiet and seek rest situations.

Autonomic manifestations

Autonomic alterations and changes can occur both in the course of an episodic and in their resolution. Usually, the headache is accompanied by paleness, sweating, tachycardia, cold hands, hypo or hypertension or bradycardia.

Gratrointestinal discomfort is another of the most common findings in migraines. Nausea and vomiting can appear before or after pain, however, they are much more frequent at the end of the crisis.

Other less common gastrointestinal signs and symptoms are constipation, bloating, or diarrhea. In addition, fluid retention and weight gain is a frequent situation in the moments prior to the development of a migraine episode, especially in women.

On the other hand, it is also common for patients to report a feeling of dizziness during seizures, fundamentally associated with the intensity of pain and the presence of other symptoms such as vertigo.

Sensory manifestations

Although some of the sensory manifestations may be overshadowed by the headache, these may be visual, somato-sensory, olfactory, auditory and / or taste.

Specifically, in about 80% of affected people, excessive sensitivity or intolerance to intense light, brightness or glare usually appears. The same happens with loud sounds, or those typical of a conversation between several people.

Regarding olfactory manifestations, in some cases the presence of osmophobia has been observed, that is, aversion to certain odors, as well as hyperosmia or increased general sensitivity to odors.

The presence of positive symptoms, especially in the visual area, has also been described. Many patients report that they see bright spots or spots, especially in the most intense stages of pain.

On the other hand, in the case of the somatosensory sphere, the development of tingling sensations and paresthesia in the extremities is possible.

Cognitive manifestations

The alterations related to the psychological and cognitive sphere of the affected people are varied and can appear in any of the phases of the episodes or migraine attacks.

The main cognitive changes have been related to the presence of spatio-temporal disorientation, confusion and / or executive dysfunction.

In the most disabling stages of migraine attacks, those affected may show alterations related to language, specifically there is significant difficulty in articulating words and / or simple phrases.

On the other hand, regarding the manifestations related to the psychological sphere, the presence of anxiety, hostility, anguish, feelings of depression, irritability, a tendency to isolation, a feeling of fatigue, etc. have been observed.

Motor manifestations

As we have indicated previously, the increase in the severity and intensity of pain can be associated with the performance of activities and motor acts, for this reason it is common to observe motor inactivity or akinesia in the crisis phases.

Furthermore, in severe cases, the development of temporary muscle paralysis, especially in the extremities, has been described.

Phases

Migraine is a headache that varies from moderate to severe, occurs in a throbbing form, and usually affects only one side of the head.

Migraine is usually temporary, so attacks or episodes usually last a period of 4 to 72 hours.

Regarding the moment of appearance, it has been observed that this type of headache is more frequent during the morning, in the first moments of the day, especially when waking up.

In addition, in many people who suffer from migraine, the moment of presentation is predictable, since they are associated with specific events or circumstances that we will describe later.

On the other hand, migraine is a medical condition that appears in the form of an episode or crisis, so that, during its clinical course, several phases may be differentiated.

In this way, migraine attacks are fundamentally composed of 3 main phases: a) prodromal, b) aura and c) headache (Riesco, García-Cabo & Pascual, 2016).

to)

The prodromal phase is the one that precedes the symptoms and / or characteristic of migraine and can last for a period ranging from a few hours to 2 days.

Normally, the most common symptoms in the prodromal phase include inhibitory and excitatory changes:

• Inhibitory disorders: reduced processing speed, attention difficulties, generalized mental slowness, asthenia (weakness, fatigue or tiredness) or anorexia (lack of appetite or lack of appetite).
• Excitatory disturbances: irritability, recurrent yawning, feeling of euphoria or aversion to certain foods.

b)

The aura phase occurs in approximately one third of people with migraine episodes. This phase is characterized by a focal symptomatology that immediately precedes the headache or coincides with its appearance.

The symptoms of the aura phase are usually transitory and progressive, lasting approximately 60 minutes. As in the previous phase, it is possible to distinguish negative and positive symptoms:

• Positive symptoms: perception of spots or flashes, zigzag colored images, photopsies, tingling, paresthesia, etc.
• Negative symptoms: light sensitivity, ataxia, muscle weakness, altered level of consciousness, etc.

c)

This is the phase, in which the headache develops completely. Normally, this symptom tends to last approximately 4 hours when there is a treatment, while it can last up to 72 hours if no type of therapeutic intervention is performed.

Apart from this, other authors such as Blau (1987) carry out other types of classifications of the stages of migraine attacks, in this case, one characterized by 5 fundamental phases:

• Prodrome: phase characterized by the appearance of premonitory signs and symptoms. The characteristic courses of this phase can include systemic, physical, psychological findings, etc., they tend to appear temporarily, several days before the development of the migraine attack.
• Aura: this phase has an abrupt presentation and its characteristic signs and symptoms usually settle in just minutes. Specifically, it is defined as an episode of brain dysfunction that occurs in the moments before the onset of the headache or in the initial phases.
• Headache: headache is the cardinal symptom of this pathology and, as we have indicated previously, the duration of this phase will vary depending on the therapeutic measures adopted.
• Resolution: this is the phase, in which the most intense symptoms begin to subside, reducing the severity significantly.
• Postdrome or final phase: the last phase of a sight crisis can last brief moments or reach several hours. In most cases, patients feel tired and / or exhausted, unable to carry out their usual work and personal activities. In other cases, patients may suffer from various body aches, euphoria, anxiety, or symptoms of anorexia.

Types of migraine

The National Institute of Neurological Disorders and Stroke notes that migraine attacks are usually classified into two main types:

• Migraine with aura: in this type of migraine, formerly known as the classic migraine, the headache is accompanied by predecessor sensory disturbances, especially visual ones.
• Migraine without aura: This type is the most common form of migraine. The headache presents without predecessor symptoms, suddenly and abruptly. In this way, the intensity of the pain usually appears accompanied by nausea, vomiting, light sensitivity, etc.

In addition to these basic types of migraine, others such as abdominal migraine, basilar-type migraine, hemiplegic migraine, menstruation-associated migraine, migraine without headache, ophthalmoplegic migraine, retinal migraine, and migraine status.

Causes

Current research has indicated that this medical condition, migraine, has a strong genetic and / or hereditary component.

At least 3 genes related to a particular variant, familial hemiplegic migraine, have been identified. Specifically, the existence of mutations in these genes implies the intracellular and extracellular increase of different substances (calcium, potassium and glutamate), which gives rise to a stage of cellular hyperexcitability and, therefore, to the development of the signs and symptoms characteristic of the different phases of migraine.

In general, specialists and researchers point out that it is possible that migraine is an entity with a multiple character, that is, that its expression is due to the presence of various genetic changes that interact reciprocally with certain environmental factors.

Most common triggers of migraine

As we have indicated in the previous section, the exact causes of migraine attacks are not precisely known, however, their occurrence has been associated in many cases with the presence of certain events or events.

In most cases, migraine attacks or episodes tend to appear in the first moments of the day, in the morning upon waking. However, this is not the only predictable moment, since many other affected people point to the occurrence of headache attacks associated with menstruation or stressful work.

Although the factors that can trigger a migraine episode can vary considerably between affected people, some of the most common have been recorded:

• Sudden climatic and meteorological changes.
• Lack or excess hours of sleep.
• Presence of strong odors, chemicals, gases, or fumes.
• Sudden emotional changes.
• Episodes of high tension and stress.
• Excessive or unusual physical or mental exertion.
• Presence of loud, constant or sudden noises.
• Episodes of dizziness and temporary loss of consciousness.
• Low blood glucose levels.
• Hormonal alterations and changes.
• Lack of nutrition.
• Drug use / abuse.
• Presence of bright or flashing lights.
• Substance withdrawal (tobacco, caffeine, alcohol, etc.).
• Consumption of certain foods (cheeses, nuts, chocolate, fermented products, pickles, cured or processed meats, etc.

Regarding statistical data, approximately 50% of people who suffer from migraines associate their episodes with the consumption of some foods or the presence of certain odors.

Diagnosis

Currently, there are no tests or laboratory tests that indicate the unequivocal existence of migraine.

Typically, the healthcare provider diagnoses migraine based on clinical findings. Thus, the completion of the family and individual medical history, the questionnaire about the presence and development of symptoms and the physical examination is essential.

Thus, the objective of these initial interventions will be to determine the presence / absence of a series of defined clinical criteria for the medical diagnosis of migraine. These criteria include episodes of headaches lasting between 4 and 72 hours, nausea, vomiting or sensitivity to light.

In addition to meeting these diagnostic criteria, it is possible to use various laboratory tests to rule out the presence of other types of pathologies: computerized tomography, magnetic resonance imaging or electroencephalogram.

On the other hand, the use of a specific neuropsychological is also common to determine the presence of other types of complications such as memory problems, attention, problem solving, orientation, etc.

Treatment

There is no type of curative treatment for migraine, however, a wide variety of specific therapeutic interventions have been designed to treat its attacks.

Generally, the treatments used in migraine are based on the prescription of drugs to relieve pain or to prevent the occurrence of attacks.

The specific choice of therapy depends fundamentally on the characteristics of the affected person and the migraine episodes. In addition, it will be essential to consider the presence of other medical conditions.

Thus, the Mayo Clinic makes a description of the most used therapeutic measures:

Drugs for pain management

Medications used to treat pain are usually used during the migraine attack phase and the main objective is to alleviate and stop the progression of symptoms that are already present.

Some of the most widely used drugs are analgesics (aspirin or anti-inflammatories), triptans, ergotamine, anti-nausea drugs, opioid drugs or glucocorticoids.

Drugs for crisis prevention

In this case, the medications used for the prevention of attacks are usually prescribed for regular consumption, usually taken daily to reduce the frequency of migraine in the most severe cases.

Some of the most commonly used drugs include cardiovascular medication, antidepressants or antiepileptic medication, among others.

In addition to pharmacological treatments, other types of therapeutic interventions have also been described with the fundamental objective of modifying various lifestyle habits and, furthermore, avoiding exposure to triggering events.

Normally, experts recommend performing muscle or respiratory relaxation exercises, getting enough restful sleep, avoiding stressful situations, avoiding the consumption of harmful substances, etc.

The preparation of a crisis diary is also recommended, in which the symptoms, intensity and frequency of migraine attacks are recorded, since they will be useful for the preparation of an individualized therapeutic intervention and as effective as possible.

References

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2. Cleveland Clinic. (2015). Migraine. Obtained from Cleveland Clinic.
3. Mayo Clinic. (2013). Migraine. Obtained from Mayo Clinic.
4. Migraine Action. (2016). Migraine Information. Obtained from Migraine Action.
5. Migraine Research Foundation. (2016). What is Migraine? Obtained from Migraine Research Foundation.
6. Nall, R. (2015). What Is a Migraine? Obtained from HealthLine.
7. NIH. (2014). Migraine. Retrieved from MedlinePlus.
8. NIH. (2015). Headache: Hope Through Research. Obtained from National Institute of Neurological Disorders and Stroke.
9. WHO. (2016). Headaches Obtained from World Health Organization.
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