Migraine is a type of recurring headache that involves blood vessels, nerves, and brain chemicals. Sensations such as visual changes, called auras, may precede a migraine.
The International Headache Society developed a system that classifies migraines as one of two types: migraine occurring with an aura (formerly called "classic") and migraine occurring without an aura (formerly called "common"). Patients may experience a migraine several times a week or once every couple of years. Migraines may be so severe that they interfere with a patient's ability to work and carry on normal activities.
An internal or external trigger sets the process in motion. It is possible that the nervous system reacts to the trigger by conducting electrical activity that spreads across the brain. This electrical activity leads to the release of brain chemicals that make blood vessels swell and become leaky. Scientists think that it is this inflammatory process that causes the pain and other symptoms of a migraine headache.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
About 11% of the population is reported to experience a migraine over the course of a given year. The risk of having a migraine diagnosis over a lifetime increases to nearly 20%.
Risk factors for migraines include:
Sex: adult females, but about equal gender risk in pre-adolescents
Family members with migraines
Youth (50% of cases occur before adulthood, 90% occur before age 40)
Some migraines are preceded by an aura. The most common aura is visual. The aura lasts about 15-30 minutes and may produce the following sensations:
Flashing lights, spots, or zig zag lines
Temporary, partial loss of vision
Speech difficulties
Weakness in an arm or leg
Numbness or tingling in the face and hands
Restlessness
Confusion
Dizziness, lightheadedness
Speech disturbances
Cognitive dysfunction
Very rarely, an aura can occur by itself, with no subsequent headache. In these cases, it is important to seek medical attention to make sure the symptoms are not due to a more serious cause such as
stroke
or seizure.
The Migraine Headache
Migraine pain starts within an hour of the aura ending. Symptoms include:
A headache, usually on one side but may involve both sides. Typically, the headache feels:
Migraines usually last from 4 to 72 hours. They often go away with sleep. After the headache, you may experience:
Food intolerances or cravings
Trouble concentrating
Fatigue
Sore muscles
Irritability
Restlessness
Mood changes
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. You may also be given a neurological exam. In some situations, a
CT scan
or
magnetic resonance imaging (MRI) scan
may be performed to rule out other conditions. The doctor may order blood tests or other tests before starting treatment.
Treatment
Migraine therapy aims to:
Prevent headaches
Reduce headache severity and frequency
Restore your ability to function
Improve quality of life
Treatment options include:
Medications
Pain medications are often required to ease or stop the pain. Over-the-counter pain pills may ease mild symptoms.
Warning:
Continuous use of some over-the-counter medications may cause what is called a "rebound headache" when you stop taking the medication.
Some prescription medications act directly to stop the cause of the migraine headache. These include drugs that:
Quiet nerve pathways
Reduce inflammation
Stimulate receptors for serotonin, a brain hormone
These drugs can be taken by mouth (swallowed), but they may act more quickly in forms that dissolve in the mouth, are inhaled through the nose, or injected. Your doctor can help you choose the medication and route of administration most effective for you. Abortive medications include ergots, triptans, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDS).
Other drugs can help prevent migraines for people suffering from frequent migraines. Preventive drugs are taken every day, even if you do not have a headache. Classes of preventative medications include beta-blockers, calcium channel blockers, tricyclics, and anticonvulsants.
Self-care During the Migraine
Apply cold compresses to painful areas of your head
Lie in a dark, quiet room
Massage your scalp and temples
Try to fall asleep
Lifestyle Changes
Keep a diary to help identify what triggers migraines and what helps relieve them.
Learn stress management and relaxation techniques.
Consider talking with a counselor to learn new coping skills and relaxation techniques.
Exercise regularly.
If you are a smoker, quit. Smoking may worsen a migraine, and it probably also increases the rare chance of
stroke
occurring during a migraine attack.
This is especially true if you are a women taking birth control pills or other hormone replacement therapy.
Avoid foods that trigger migraines.
If low blood sugar precedes your migraines, eat small meals more often.
Do not change your regular sleep pattern during the weekend or during vacation.
Prevention
Methods for preventing migraine include avoiding those things that trigger the headache and establishing other healthy habits. Suggestions include:
Maintain regular sleep patterns.
Learn stress management techniques.
Do not skip meals.
Avoid red wine and other alcohol.
Exercise regularly.
Avoid foods known to trigger migraines. These may include:
Yogurt
Nuts and peanut butter
Beans (eg, lima, navy, pinto, and others)
Aged or cured meats
Aged cheese
Processed or canned meat
Caffeine (intake or withdrawal)
Canned soup
Chocolate
Buttermilk or sour cream
Meat tenderizer
Brewer's yeast
Avocados
Onions
Pickles
Red plums
Sauerkraut
Snow peas
Soy sauce
Anything with MSG (monosodium glutamate), tyramine, or nitrates
Food triggers are often very dependent on the individual. Using a food diet can help you identify migraine triggers that are specific to your migraine disorder.
RESOURCES:
American Council for Headache Education http://www.achenet.org
American Headache Society http://ahsnet.org
The National Migraine Association http://www.migraines.org
CANADIAN RESOURCES:
The College of Family Physicians of Canada http://www.cfpc.ca
The Migraine Clinic http://www.migraineclinic.ca/
References:
American Academy of Family Physicians website. Available at:
http://www.aafp.org/online/en/home.html
.
American Academy of Neurology website. Available at:
http://www.aan.com/professionals/index.cfm?a=0&fc=1
#
.
Cephalalgia: An International Journal of Headache
. 2004; 24(suppl 1). Available at:
http://216.25.100.131/ihscommon/guidelines/pdfs/ihc_II_main_no_print.pdf
. Accessed November 15, 2004.
Gladstone JP. Migraine In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation. Available at:
http://www.medlink.com
. Accessed February 23, 2008.
Griffith's 5-Minute Clinical Consult
. Lippincott Williams & Wilkins; 1999.
The International Headache Society.
International Classification of Headache Disorders
. 2nd ed. 2003.
National Institute of Neurological Disorders and Stroke website. Available at:
http://www.ninds.nih.gov/
.
Silberstein SD, Lipton RB.
Headache in Clinical Practice
. London, England: Martin Dunitz Ltd; 2002.
Textbook of Clinical Neurology
. WB Saunders Co; 1999.
The Vestibular Disorders Association
website.
Available at:
http://www.vestibular.org/migraine.html
. Accessed November 15, 2004.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
