Everyone has a headache from time to time. However, did you know that migraine affects up to 15-18% of women and 6% of men? In addition, it is more common in adolescents and young adults. This health problem therefore deserves some attention.

moments in order in particular to distinguish between a banal headache and migraine.

Migraine or headache?

First, although the concepts of headache and migraine seem at first glance similar, it is important to differentiate them. Migraine is part of the large family of headaches (headaches). However, not all headaches meet the criteria for

migraine.

Migraine is one of the vascular headaches

We also find the category of headaches due to muscle contraction, the origin of which may be

postural or post-traumatic. Subsequently, we find tension headaches. These very common headaches can be linked to stress, fatigue, anxiety or depression. They usually start before the age of 40 and affect women more than men. An interesting fact to note is that there is a family history in about 40% of people with these headaches.

Finally, the last category is that of headaches due to inflammation. It is also possible to find chronic headaches which are by definition present more than fifteen days per month for at least

at least three months. These headaches can include headaches of all categories

set out above.

In addition, headaches from drug overuse can sometimes be observed. They can be caused by overconsumption of ergot derivatives, triptans, analgesics, opiates as well as combinations. It then develops a tolerance leading to ineffectiveness of the treatment. Usually, the headache decreases or goes away when the offending drug is stopped.

By definition, migraine is characterized by repetitive headache attacks which may or may not be accompanied by visual, digestive or neurological disturbances. There are several sub-categories of migraine headaches. However, the two most important are classic migraine (or ophthalmic) and simple migraine which is the most common.

The main hallmark of migraine is a throbbing pain affecting only one side of the head. This pain is usually moderate to severe and is made worse by physical activity. It is sometimes accompanied by nausea and

vomiting, sensitivity to light, smells and sounds. 30% of migraines are preceded by warning symptoms called aura. These symptoms usually appear ten to sixty minutes before the headache. The aura is characterized by reversible visual disturbances manifested by a fuzzy area or a black spot

in the visual field, uniform flashes of light or loss of vision. There may also be

numbness and tingling. It is still difficult to understand the cause of migraine.

Among those raised, we note environmental and genetic factors. There is indeed a family history in about 60% of migraine sufferers. These factors would cause changes in the neurotransmitters in the brain, including serotonin, leading to an alteration in cerebral circulation. The currently popular hypothesis concerns a dilation of the cranial blood vessels, thereby causing pain via hypersensitivity of the nerves.

In the same vein, several triggers have been identified including stress, fatigue, dazzling light, hypoglycemia, temperature changes, relaxation, menstruation, ovulation, oral contraceptives, odors , alcohol and certain foods (cheese, chocolate, drinks containing caffeine, cold meats, foods containing monosodium glutamate or aspartame). In order to explain the fact that three times more women than men suffer from migraine, the hypothesis of estrogen levels has been stated. Indeed, it is possible to observe menstrual migraines which seem to be related to the drop in estrogen levels just before the onset of menstruation. However, estrogens appear to have varying effects on the frequency and severity of migraines. The future will tell us whether the identification of these risk factors is linked or not to the causal mechanism of migraines.

Finally, it is important to note that the sensitivity of the brain to these triggers is likely to vary from day to day. In the majority of people, headaches and migraines can be well controlled with different agents as well as complementary therapies. The first step is to take simple steps that are effective not only in preventing headaches and migraines, but also in treating them. Thus, the cornerstone of treatment lies in improving lifestyle habits. Regular exercise, relaxation, stress management, ice application, avoiding trigger foods, and physical therapy can be of great help.  

Keeping a headache diary can be of great help in determining the type of headache you have so that you can treat it properly.

As for pharmacological treatments, it is possible to distinguish two main types of treatment: symptomatic treatment which aims to put an end to the headache when it occurs and preventive treatment.

In the first place, symptomatic treatment is especially effective in people with infrequent migraines lasting less than twelve hours. This type of treatment seems more effective when it is used at the first symptoms of a migraine, during the aura for example. In these treatment categories, we find several agents: light analgesics (ibuprofen, acetaminophen), the class of triptans and ergot derivatives. Note first, that mild pain relievers are especially useful in the presence of mild to moderate migraine attacks. These agents are generally well tolerated apart from gastrointestinal irritation with ibuprofen. Subsequently, we find the class of triptans. This class includes six drugs available only under prescription: sumatriptan (Imitrex MD), rizatriptan (Maxalt®), zomitriptan (Zomig®), naratriptan (Amerge MD), almotriptan (Axert MD) and eletriptan (Relpax MD) ). Unlike mild pain relievers, these agents can be used for moderate to severe attacks.

Another class of drugs available under prescription, that of ergot derivatives, can be used in the niche of severe to very severe attacks and includes dihydroergotamine (Migranal spray MD) and ergotamine combinations (Cafergot®, Gravergol®). The most commonly used agent, dihydroergotamine, is an effective agent available as a nasal spray as well as in other forms. Ergot derivatives, like triptans, act at the level of serotonin, a neurotransmitter pointed out in migraine. In addition, an antinausea agent can be used to relieve nausea and vomiting that may be associated with migraine.

Finally, aromatherapy, especially peppermint, appears to provide effective relief. In people with frequent migraine attacks or in whom treatment is ineffective, preventive treatment may be started. Many drugs used for this purpose were not originally intended for this use.

Consider in particular antihypertensive drugs such as propanolol (Inderal®) and verapamil (Isoptin MD). Anticonvulsants like divalproex (Epival®) and tricyclic antidepressants like amitriptyline (Elavil®) are also good examples and are commonly used in the first line. In refractory cases, pizotylin (Sandomigran ®) and methysergide (Sansert ®) are worth trying, although their use should be done with caution given the many contraindications and associated side effects.  

As for alternative approaches, matricaria (or feverfew) has been shown to be effective in preventing migraine. The effectiveness would come from the leaves and more particularly from parthenolide, a substance which is extracted from them. You can get a standardized parnetholide extract called Tanacet. However, it is recommended to consult your pharmacist before consuming this product if you are already taking medication, because this product has several interactions, especially with anticoagulants such as warfarin (Coumadin®). This product is contraindicated during pregnancy because of its stimulating properties for the uterus. In addition, individuals allergic to ragweed, chrysanthemums, and daisies may react to matricaria. Another product believed to have some effectiveness in preventing migraine is coenzyme Q10, a powerful antioxidant. However, there is currently too little documentation for the use of this product to be recommended for preventing migraine. In addition, the presence of many drug interactions complicates the taking of this product. Magnesium is also a product often used to prevent migraines. Its use is based on the assumption that up to 50% of migraine sufferers suffer from magnesium deficiency. However, the veracity of this hypothesis remains to be proven.  

All in all, it’s important not to downplay the importance of migraines and other headaches for people who suffer from them. Indeed, these headaches, which inconvenience a good part of the population, seriously affect the quality of life, in addition to causing a significant consumption of drugs which can sometimes lead to rebound headaches. However, there are many treatments available to alleviate these ailments, whether mild or even very severe, all this while keeping in mind that you must first change your lifestyle. Fortunately, the treatments are generally effective and provide good relief, as are the drugs used for prevention. Also, encouragingly, the frequency of migraines seems to decrease with age. We will therefore be able, in a future that we hope to bring closer, to further elucidate the mechanisms involved in migraine and other headaches and who knows, to discover new avenues of treatment.