Migraine

Migraine has four distinct phases: prodrome, aura, headache and postdrome.

Prodrome phase: this phase precedes the migraine attack by approximately 24 to 48 hours. Symptoms may include mood changes, irritability, sleep disturbances, fatigue, food cravings and increased sensitivity to light and sound.

Aura: around 20-30% of migraine sufferers experience this phase, which is characterised by sensory disturbances such as visual flickering, speech or motor difficulties.

Headache: the migraine attack itself can last from 4 to several days and is characterised by severe headaches, generally on one side of the head, accompanied by nausea, vomiting and hypersensitivity to sensory stimuli.

Postdrome phase: after the attack, patients often experience intense fatigue, muscle pain, difficulty concentrating, and mild sensitivity to light or noise.

Although the precise mechanisms behind migraines are not yet fully understood, several factors are involved. Migraines appear to result from a complex interaction between genetic and environmental factors and the brain. The release of certain neurotransmitters, such as CGRP (calcitonin gene-related peptide), is also involved in the propagation of pain.

Risk factors associated with migraines include:
Heredity: Up to 80% of migraine sufferers have a close relative affected by the condition.
Gender: Women are three times more likely than men to suffer from migraines, often due to hormonal fluctuations associated with menstrual cycles, pregnancy or the menopause.
Age: Migraines generally first occur in adolescence, peak in the thirties and then tend to diminish with age.

The diagnosis of migraine is based primarily on clinical examination and analysis of symptoms. There is no specific diagnostic test, and brain imaging is generally not necessary unless there are warning signs, such as a sudden or unusual headache, or neurological deficits. The main purpose of these tests is to rule out other potentially serious pathologies rather than to confirm the diagnosis of migraine. A headache calendar can help identify the triggers and severity of attacks.

Download the headache calendar 

The treatment of migraines involves both acute and background treatments.

• Treatment of attacks: Non-steroidal anti-inflammatory drugs (NSAIDs) and triptans are the first-line drugs used to treat acute attacks. They should be administered as soon as the first signs of migraine appear for optimum effectiveness.
• Background treatment: When migraines are frequent or severe, preventive background treatment may be prescribed to reduce the frequency and intensity of attacks. This generally includes anti-hypertensives, anti-epileptics or tricyclic antidepressants.

Migraines can develop into chronic forms in some patients, particularly if they overuse analgesics. This leads to resistant headaches, making it more difficult to manage the attacks.

Preventing migraine attacks is based on identifying and avoiding the factors that trigger them. The most common are :

Keeping a migraine diary can help to identify these specific triggers.

It is advisable to consult a doctor if migraines are frequent, severe or resistant to treatment, or if symptoms progress. Symptoms requiring urgent attention include sudden onset of severe headache, neurological symptoms such as paralysis or blurred vision, or headache following trauma.

Hôpital de La Tour provides care for migraine sufferers, with tailored treatments and personalised follow-up aimed at reducing the frequency and severity of attacks.

At Hôpital de La Tour, we offer our patients the Cefaly device, an innovative non-drug solution for the treatment of migraines. The device focuses on the trigeminal nerve, often implicated in headaches and migraines. Using an electrode, Cefaly delivers small electrical impulses that stimulate this nerve. These stimulations significantly reduce the frequency and intensity of migraine attacks, providing effective relief and improved quality of life for patients suffering from recurrent migraines.

1. What triggers a migraine?
Triggers can vary from person to person, but often include stress, hormonal fluctuations, certain foods, and environmental factors such as bright light or strong smells.

2. How can you tell the difference between a migraine and a simple headache?
Migraines are generally more intense and are accompanied by other symptoms such as nausea, vomiting and sensitivity to light and noise.

3. Are migraines hereditary?
Yes, there is a strong genetic component, with around 80% of migraine sufferers having a family history of migraines.

4. How long does a migraine attack typically last?
A migraine attack can last between 4 and 72 hours.

5. Are there natural treatments for migraines?
Certain methods such as acupuncture, yoga and magnesium or riboflavin supplements can help prevent attacks in some people.

6. What is a migraine aura?
An aura is a set of reversible neurological symptoms that precede or accompany a migraine attack, such as visual disturbances or tingling.

7. Can migraines get worse over time?
In some people, migraines can develop into a chronic form, especially if they are accompanied by medication abuse.

8. When should a migraine sufferer consult a neurologist?
It is advisable to consult a neurologist if migraines are frequent or severe, or if they are accompanied by unusual symptoms such as neurological deficits.