A migraine headache is a form of vascular headache. Migraine headache is caused by vasodilatation (enlargement of blood vessels) that causes the release of chemicals from nerve fibers that coil around the large arteries of the brain. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the arteries magnifies the pain. People who get migraines often describe the pain as pulsing or throbbing in one area of the head. During migraines, people are very sensitive to light and sound.

Although much about the cause of migraines isn't understood, genetics and environmental factors seem to both play a role. Migraines may be caused by changes in the trigeminal nerve, a major pain pathway. Imbalances in brain chemicals, including serotonin — which helps regulate pain in your nervous system — also may be involved.

Serotonin levels drop during migraines. This may trigger your trigeminal system to release substances called neuropeptides, which travel to your brain's outer covering (meninges). The result is headache pain.

Migraine is a chronic condition with recurrent attacks. Most (but not all) migraine attacks are associated with headaches.

• Migraine headaches usually are described as an intense, throbbing or pounding pain that involves one temple. (Sometimes the pain is located in the forehead, around the eye, or at the back of the head).
• The pain usually is unilateral (on one side of the head); although about a third of the time the pain is bilateral (on both sides of the head).
• The unilateral headaches typically change sides from one attack to the next. (In fact, unilateral headaches that always occur on the same side should alert the doctor to consider a secondary headache, for example, one caused by a brain tumor).
• A migraine headache usually is aggravated by daily activities such as walking upstairs.
• Nausea, vomiting, diarrhea, facial pallor, cold hands, cold feet, and sensitivity to light and sound commonly accompany migraine headaches. As a result of this sensitivity to light and sound, migraine sufferers usually prefer to lie in a quiet, dark room during an attack. A typical attack lasts between 4 and 72 hours.

An estimated 40%-60% of migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days. The symptoms may include:

• Sleepiness,
• Irritability,
• Fatigue,
• Depression or euphoria,
• Yawning, and
• Cravings for sweet or salty foods.

If you have typical migraines or a family history of migraines, your doctor will likely diagnose the condition on the basis of your medical history and a physical exam. But if your headaches are unusual, severe or sudden, your doctor may recommend a variety of tests to rule out other possible causes for your pain.

• Computerized tomography (CT): This imaging procedure helps doctors diagnose tumors, infections and other possible medical problems that may be causing your headaches.
• Magnetic resonance imaging (MRI): MRI scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.
• Spinal tap (lumbar puncture): If your doctor suspects an underlying condition, such as meningitis — an inflammation of the membranes (meninges) and cerebrospinal fluid surrounding your brain and spinal cord — he or she may recommend a spinal tap (lumbar puncture). In this procedure, a thin needle is inserted between two vertebrae in your lower back to extract a sample of cerebrospinal fluid (CSF) for laboratory analysis.

For patients who have been diagnosed with recurring migraines, early medication should start as the attack increase the patient’s sufferings. The possible medications are

Analgesic

• Paracetamol (Napa)
• Paracetamol with caffeine (Napa Extra)

NSAIDs

• Naproxen

Triptans

• Sumatriptan
• Zolmitriptan

There are two ways to prevent migraine headaches:
1) By avoiding factors ("triggers") that cause the headaches. Migraine triggers are

• Stress,
• sleep disturbances
• Fasting
• Hormones
• Bright or flickering lights
• Odors
• Cigarette smoke
• Alcohol
• Aged cheeses
• Chocolate

2) By preventing headaches with medications (prophylactic medications).