Migraine is a nerve-related disorder with multiple symptoms. Some common ones include debilitating and intense headaches, vomiting, nausea, tingling or numbness, difficulty speaking, and sensitivity to sound and light. 

This condition often runs in families and may affect anyone regardless of their age. However, it is more common in women than in men.

The most common migraine types are one with aura and those without aura (more on that below).

But medicines are available that can prevent migraines or make them less painful. One such medicine is Amitriptyline.

The right medicine, along with self-help remedies and lifestyle changes, may help.

In this article, you will get to know about migraine, its types, causes, symptoms, how to get quick relief from it, treatment options, and how Amitriptyline can help.

Migraine- Causes and Symptoms

Migraine is a medical condition that causes recurring, severe headaches and other symptoms such as nausea and vomiting.

Before the headache, there may be sensory changes, known as aura.

So, before we go ahead, let’s have a quick look at the types of migraines.

Migraine types

While there are many types of migraines, the most common ones are with and without aura. It is also possible for you to have both these types.

Here are some common types with their characteristics:

  • Migraine without aura: As most people with migraines do not have an aura, it was also known as common migraine. Individuals with this type of headache have at least five of the mentioned characteristics: headache lasting for 4 to 72 hours, is unilateral, is throbbing or pulsating, and the pain is more when you move. The headache may also make you sensitive to sound or light and may also cause nausea or diarrhea.
  • Migraine with aura: This type of headache comes with an aura that goes away and may include sensory or visual problems, language or speech problems, or weakness. It may also include vertigo, difficulty in talking, vision problems, ringing in the ears, hearing problems, and decreased consciousness.
  • Chronic migraine: People with this type of headache have it for more than 15 days a month. Besides, eight of these headaches would be migraines with or without aura. People with chronic migraines have more severe headaches as compared to those with acute migraines. It may also be associated with depression, arthritis, a history of head or neck injuries, and other disorders such as hypertension.
  • Acute migraine: This type of headache involves a migraine that is not diagnosed as chronic. People with acute migraines may have headaches up to 14 days a month and fewer headaches than those with chronic migraines.
  • Vestibular migraine: This type of headache is associated with vertigo. People with this type of headache may also have vestibular symptoms such as dizziness and balance problems.
  • Optical migraine: It is also known as ocular or eye migraine. It is a rarer type of migraine with aura. The symptoms may include a blind spot, flashes of light, or partial loss of vision. 
  • Complex migraine: This type of headache may have stroke symptoms such as trouble speaking, weakness, and loss of vision.
  • Menstrual migraine: They are menstrual-related migraines that occur before, during, or after ovulation or menstruation. 
  • Acephalgic migraine: It is also known as migraine without headache or a silent headache. This type of headache is more common in people who get a migraine after 40 years of age.
  • Hormonal migraines: They are also known as exogenous withdrawal headaches or menstrual migraines. It usually occurs during ovulation, perimenopause, periods, or pregnancy.
  • Stress hormones: While this is not a recognized type of migraine, it is usually associated with stress. They are also known as tension-type headaches.

Symptoms

Migraine symptoms may appear a day or two before the headache, which is known as the prodrome stage.

Symptoms during stage may include:

  • Depression
  • Frequent yawning
  • Irritability
  • Food cravings
  • Hyperactivity
  • Fatigue
  • Neck stiffness

In migraine with aura, the aura stage occurs after the prodrome stage. During this stage, you may have problems with sensation, speech, vision, and movement.

Some common symptoms include:

  • Tingling or prickling sensation on your arms, face, or legs
  • Temporary loss of vision
  • Seeing light flashes, shapes, or bright spots
  • Difficulty in speaking clearly

The next comes the attack phase. This is the stage where actual migraine pain happens. Some common symptoms include:

  • Nausea
  • Vomiting
  • Pain in one side of your head
  • Increased sensitivity to sound or light
  • Dizziness
  • Throbbing or pulsing pain

After the attack, you may have a postdrome phase with changes in feelings and moods. These can range from being euphoric to depressed. You may also feel fatigued or apathetic. It is also possible to have a mild, dull headache.

Besides, migraine pain can be a different feeling for everyone. Some common types of pain are:

  • Throbbing
  • Pounding
  • Pulsating
  • Perforating
  • Debilitating
  • Dull and steady ache

Migraine pain is usually felt in the forehead area but may also be present on one side of the head. In most cases, the migraine pain lasts for four hours and can even extend up to 72 hours if left unattended or doesn’t respond to treatment.

Causes

While the exact cause for migraine pain is not known, environmental and genetic factors may appear to be responsible.

Experts believe that alteration in the brainstem and its interaction with the trigeminal nerve may be involved in migraine pain. Imbalances in brain chemicals, including serotonin, may also cause migraines.

Here are some triggers for a migraine attack:

  • Hormonal changes in women, including the menstrual cycle and menopause
  • Hormonal medicines such as hormonal replacement therapy and oral contraceptive pills
  • Drinks such as alcohol and too much coffee
  • Stress
  • Sensory stimuli such as sun glare and bright lights
  • Sleep changes such as too much or lack of sleep
  • Intense physical exertion
  • Change in weather or barometric pressure
  • Medicines including nitroglycerin and vasodilators
  • Foods such as salty and processed foods and aged cheese
  • Food additives

Risk factors

  • Family history
  • Being women
  • Hormonal changes
  • Being 30 years or above

Your doctor may advise you to maintain a migraine journal. This means noting down what you had, what you were doing, or medicines you had before you got this attack. It will help your doctor identify your migraine triggers.

Migraine Treatments- How to Get Relief Quickly?

Migraine Treatment

The primary goal is preventing future attacks and managing symptoms.

Medicines used to manage migraine are mainly classified into the mentioned two categories:

  • Preventive medicines: These medicines need to be taken regularly to reduce the frequency and severity of migraines.
  • Pain-reliving medicines: They are used to combat the symptoms during a migraine attack.

Medications for relief

  • Pain killers: The over-the-counter medicines include ibuprofen or aspirin. 
  • Triptans: They are prescription drugs such as rizatriptan and sumatriptan that block pain pathways in the brain. 
  • Dihydroergotamines: They are available as an injection or nasal spray and most effective when taken shortly after the appearance of migraine symptoms. They should be avoided by people suffering from kidney or liver diseases or high blood pressure.
  • Lasmiditan: This oral tablet is used to manage migraines with or without aura and relieves pain, nausea, and sensitivity to sound and light. As it is a sedative and may cause dizziness, it is advised not to drive or operate heavy machinery for at least 8 hours after taking medicine.
  • Ubrogepant: This medicine is usually used to manage acute migraine attacks with or without aura in adults. Side effects include nausea, dry mouth, and excessive sleepiness.
  • Opioid medicines: They are a good option for people who cannot take other migraine medicines. As they are addictive, they are used only when other medications fail to help.
  • Anti-nausea medicines: They help in migraines with an aura and are also associated with nausea and vomiting. Some common medications include metoclopramide, chlorpromazine, and prochlorperazine.

Preventive medications

Your doctor may prescribe these medicines if you have long-lasting, frequent headaches that do not respond to treatment.

Some common options include:

  • Antidepressants: Amitriptyline, a tricyclic antidepressant, is useful in managing migraines (more about this in the next section).
  • Antihypertensive medicines: Beta-blockers including metoprolol tartrate and propranolol and calcium channel blockers such as verapamil help prevent migraine with aura.
  • Botox injections: Taking Botox injections every 12 weeks may prevent migraines in some adults.
  • Anti-seizure drugs: Drugs such as Topiramate and Valproate may reduce the frequency of migraine attacks.

How to Get Relief Quickly?

Migraine headaches may occur often. Besides, it may also take some time for the medicine to show its effect.

In such cases, the mentioned tips may help you to get relief quickly.

  • Cold pack: Apply it on your forehead when you have severe migraine pain. You can use ice cubes or cold vegetables wrapped in a cloth. Sometimes, a cold shower can also help. Use it for 15 minutes, followed by a 15-minute break.
  • Hot compress or a heating pad: If you have a tension headache, you can place a heating pad on the back of your head or your neck.
  • Ease pressure: If you are wearing a tight ponytail, remove the headband. External compressions such as wearing a hat or swimming goggles can trigger a headache.
  • Dim to shut down the lights: Bright light is a triggering factor for migraine pain. So, cover windows with curtains and wear sunglasses outdoors. You can also use anti-glare screens.
  • Avoid chewing: Chewing may hurt your jaw as well as cause headache. Avoid sticky and crunchy foods and take small bites. Also, avoid biting your nails or handy objects such as pens. If you grind your teeth at night, ask your dentist about mouth guards.
  • Drink enough fluids: This can include water, juices, or any non-alcoholic drinks.

You can also try the following tips:

  • Drink coffee
  • Try massage
  • Practice relaxation
  • Take some ginger
  • Use medicines in moderation

However, you should consult your doctor immediately in the following cases:

  • A headache of sudden onset
  • A headache followed after a head injury
  • A severe headache
  • A headache that worsens despite taking medicines

How Does Amitriptyline Help Treat Migraine and Other Tension Headaches?

Amitriptyline is a tricyclic antidepressant often prescribed as preventive medicine for migraine headaches. Various studies have shown the efficacy of this medicine in preventing migraine attacks.

According to the 2012 guidelines for preventing episodic migraines recognized by the American Headache Society and the American Academy of Neurology, Amitriptyline is a level B medication for migraine prevention, which means it is probably effective.

Amitriptyline improves the level of neurotransmitters serotonin and norepinephrine that regulate well-being and mood. Besides, serotonin aids in regulating blood vessels during a migraine, and both these chemical plays a role in processing the pain signals by your brain.

These effects of the chemicals are seen to prevent tension-type and migraine headaches.

When the brain cells pass signals to one another, they also release the chemicals to deliver the message. They have to take back the chemical so that they can pass the next message. This process of taking the chemical back is known as “reuptake.”

Amitriptyline prevents the reabsorption of neurotransmitters serotonin and norepinephrine. 

By preventing reuptake, Amitriptyline increases the levels of these chemicals, preventing migraine and tension headaches.

Use and Dosage

Read the patient information leaflet carefully and follow all the instructions given by your doctor.

Here are some instructions on its use:

  • Take it once a day before bedtime as it may cause sleepiness. If you feel it makes you drowsy in the morning, try taking it in the evening.
  • It may be possible that your doctor may advise taking low doses twice or thrice a day to avoid the risk of side effects.
  • It usually does not upset digestion, and thus you can take it with or without food.
  • The tablet is to be taken orally with water.
  • Try and take medicine at the same time every day.
  • If you happen to miss a dose, take the missed dose as soon as you remember. However, if it is almost time for the next dose, do not take the missed dose and continue with your next scheduled dose. 
  • Do not take a double dose to compensate for the missed dose. 

Dose

Amitriptyline tablets are available in the strengths of 10mg, 25mg, or 50mg.

Amitriptyline liquid is available in different strengths containing 10mg, 25mg, or 50mg of Amitriptyline.

The usual dose of Amitriptyline in adults is 50mg to 100mg a day. In some cases, it can go up to 150mg to 200mg a day.

In children between the age of 16-17, the usual dose is 25 mg to 50 mg a day.

Symptoms of Overdose

Here are some common symptoms:

  • Seizures
  • Confusion
  • Hallucinations
  • Drowsiness
  • Vomiting
  • Cold body temperature
  • Irregular heartbeat
  • Difficulty in concentration
  • Rigid muscles
  • Fever
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