Migraine is a type of recurring headache. It involves blood vessels, nerves, and brain chemicals. Sensations may come before a migraine. This can include visual changes, called auras.
There are two types of migraines:
- Migraine occurring with an aura (formerly called classic)
- Migraine occurring without an aura (formerly called common)
The precise cause is unknown. Among the suspected causes are:
- Environmental triggers
- Genetic predisposition
- Dietary triggers
- Physiologic (menstruation, puberty)
A trigger sets the process in motion. It is possible that the nervous system reacts to the trigger by conducting electrical activity. This spreads across the brain. It leads to the release of brain chemicals. These make blood vessels swell. It may be this inflammation that causes pain and other symptoms.
The risk of having a migraine over a lifetime is up to 20%-25%.
Factors that increase your chance for migraines may include:
- Sex: adult females, but more common in male children than female
- Family members with migraines
- Youth (90% occur by age 40)
- Hormone replacement therapy
- Drugs to dilate blood vessels
- Lack of sleep or changing sleep patterns
- Stress or relief from stress
- Skipping meals
- Alcohol, especially red wine
- Altitude or weather changes
- Time zone changes
- Exertion that is sustained
- Glaring or flashing light
- Perfumes or other odors
- Eating foods known to trigger migraines
Migraines occur in phases that may include:
A warning may come before a migraine. In the hours or days before the headache, symptoms may include:
- A change in mood
- A change in behavior
- A change in the level of activity
- Food craving or decreased appetite
- Nausea, diarrhea]]>
- Sensitivity to light
The most common aura is visual. The aura lasts about 15-30 minutes. It 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
- Dizziness, lightheadedness
- Speech disturbances
- Cognitive dysfunction
More rarely, an aura can occur by itself. In these cases, it is important to seek medical attention to make sure the symptoms are not due to a more serious cause. This can include ]]>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) that often feels:
- Moderate or severe intensity
- Throbbing or pulsating
- More severe with movement
- Nausea or vomiting
- Sensitivity to light or sound
- Lightheadedness or dizziness
A Post-Headache Period
Migraines usually last from 4-72 hours. They often go away with sleep. After the headache, you may experience:
- Trouble concentrating
- Sore muscles
- Mood changes
The doctor will ask about your symptoms and medical history. A physical exam will be done. You may also be given a neurological exam.
To rule out other conditions your doctor may order a:
Migraine therapy aims to:
- Prevent headaches
- Reduce headache severity and frequency
- Restore your ability to function
- Improve quality of life
Treatment options include:
Pain medications]]> are often needed to ease or stop the pain. Over-the-counter pain pills may ease mild symptoms.
Warning: Regular use of some over-the-counter medications may cause a rebound headache.
Some prescription medications act directly to stop the cause of the migraine headache. These include drugs that:
- Quiet nerve pathways
- Reduce inflammation
- Bind receptors for serotonin, a brain chemical
These drugs can be taken by mouth. 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 best for you.
Medications that can stop a migraine once it has begin include:
- ]]>Acetaminophen]]> (Tylenol)
- Medications for nausea
- Non-steroidal anti-inflammatory drugs (NSAIDS) (eg, aspirin, ibuprofen, naproxen)
Other drugs can help prevent migraines for people with frequent migraines. Preventive drugs are taken every day. Classes of preventative medications include:
- Calcium channel blockers
- Tricyclic antidepressants
In some people, migraines are triggered when a nerve in the head is stimulated. With this type of surgery, the doctor finds the nerve trigger point in the head and deactivates it. This surgery may reduce the number of migraines or completely eliminate them in sufferers who do not respond to conventional treatments.
Self-Care During the Migraine
- Apply cold compresses to painful areas of your head.
- Lie in a dark, quiet room.
- Apply constant pressure to your temples.
- Try to fall asleep.
- Keep a diary. It will help identify what triggers migraines and what helps relieve them.
- Learn stress management and relaxation techniques.
- Consider talking with a counselor. They can help you learn new coping skills and relaxation techniques.
- ]]>Exercise regularly]]> .
- If you are a smoker, ]]>quit]]> . Smoking may worsen a migraine. It probably also increases the rare chance of ]]>stroke]]> during a migraine attack. (especially true if you are a woman taking birth control pills or other hormone replacement therapy)
- Avoid foods that trigger migraines.
- Eat regular meals.
- Maintain your regular sleep pattern even during the weekend or on vacation.
If you are diagnosed with a migraine, follow your doctor's instructions .
Methods for preventing migraine include:
- Avoiding those things that trigger the headache.
- Establishing other healthy habits.
- Maintain regular sleep patterns.
- Learn stress management techniques.
- Do not skip meals.
- Avoid red wine and other alcohol.
- Exercise regularly.
Foods are not proven to trigger migraine, but consider keeping a diary of migraine and diet to identify foods that may trigger migraines for you. Foods suspected to trigger migraine include:
- 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
- Buttermilk or sour cream
- Meat tenderizer
- Brewer's yeast
- Red plums
- Snow peas
- Soy sauce
- Anything with MSG (monosodium glutamate), tyramine, or nitrates
- Ask your doctor if acupuncture]]> is right for you. It may help you to have more headache-free days, as well as lessen the intensity of headaches when they do occur.
American Headache Society
The National Migraine Association
The College of Family Physicians of Canada
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Cephalalgia: An International Journal of Headache . 2004;24(suppl 1).
Dambro MR. Griffith's 5-Minute Clinical Consult . Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
Gladstone JP. Migraine. Medlink website. Available at: http://www.medlink.com . Accessed February 23, 2008.
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Migraine in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 2009. Accessed February 3, 2009.
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12/16/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Jena S, Witt CM, Brinkhaus B, Wegscheider K, Willich SN. Acupuncture in patients with headache. Cephalalgia. 2008;28:969-979.
2/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White A. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009;CD001218.
11/10/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S. A placebo-controlled surgical trial of the treatment of migraine headaches. Plast Reconstr Surg. 2009;124(2):461-468.
Last reviewed October 2009 by ]]>Rimas Lukas, MD]]>
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