Understanding Migraine Headaches
Pounding, and throbbing are words used that describe headaches. Over 23 million Americans will experience the pain of a migraine headache. Three-quarters of that group will be women.
What Does a Migraine Feel Like?
The hallmark of a migraine headache is pulsating head pain. The pain is often localized to one side of the head and frequently occurs behind the eye or near the temple. You may also vomit or feel nauseated, become hypersensitive to light, sound, or smells, feel dizzy, or experience visual disturbances. Symptoms are aggravated by movement. Migraine intensity ranges from uncomfortable to completely disabling and can last anywhere from several hours to several days.
Some people experience an "aura" before a migraine strikes. An aura is an unexplained sensation that affects sight, taste, touch, hearing, or smell. Visual auras are the most common, characterized by flashing lights, jagged lines, blurred vision, or blind spots. Auras can affect other senses as well, causing temporary numbness of a body part, odd smells, ringing in the ears, or difficulty talking. Only 15% to 20% of migraine sufferers experience warning auras.
Other medical conditions can also cause these symptoms. Therefore, it's important to see your health care professional to determine whether your head pain and associated symptoms is, in fact, due to a migraine.
What Causes Migraines?
No one knows for sure. At one time doctors believed that migraines were caused by swelling and expansion of the blood vessels surrounding the head and neck. However, there are several problems with this theory. A new theory believes that migraine triggers initiate a wave of electrical activity across the brain. This wave eventually reaches a remote part of the brain called the trigeminal nerve. Substances called neuropeptides are released that cause blood vessels to swell and leak, causing inflammation and migraine headache.
But what causes the wave? Although it varies from one person to another, certain factors have been generally linked with the onset of migraines. The list of identified triggers includes:
- Hormone therapy
- Strong odors such as perfumes or cigarettes
- Excessive noise or bright lights
- A change in sleep
- Overuse of pain medicine
- Sildenafil (ie Viagra)
There seems to be a strong correlation between hormonal fluctuation and migraines in women. According to the National Headache Foundation, approximately 60% of females experience migraine-like headaches just before, during, or immediately after menstruation.
Taking birth control pills or hormone replacement therapy can trigger an increase in migraines. If this occurs consult with your provider. Post-menopausal women who take estrogen may benefit from a lower dose and route of administration that keeps hormone levels as steady as possible.
Eating foods that contain monosodium glutamate (MSG), or nitrites may also bring on an attack. MSG is a flavor enhancer often used in canned soups, Chinese foods, meat tenderizer, and seasonings. Nitrites are found in hot dogs and lunchmeats.
But don't scrutinize your eating habits too much when it comes to the connection between food and migraines. Research does not prove foods is a migraine trigger.
What Can I Do To Prevent Migraines?
Try to maintain a consistent bedtime and wake time. Avoid alcohol. Exercise.
Keep a journal of your headaches. Note when a migraine occurred, what you were doing at that time and shortly before, and what foods you ate in the 24 hours prior to the headache. Reviewing your entries may reveal a pattern linking migraine onset to certain foods or activities that you can then avoid.
Investigate biofeedback therapy or other relaxation techniques. ]]>Biofeedback]]> is a relaxation technique that can address emotional triggers such as stress and ]]>anger]]>. Electrodes that track changes in pulse or skin temperature are used to help you relax. The goal of biofeedback is to teach you how to release tension and increase blood flow on your own without using the machine.
Other relaxation techniques include stress management and relaxation training. In its recent guidelines, the U.S. Headache Consortium said that stress management, relaxation training, and biofeedback may benefit some migraine sufferers.
If you sense a migraine coming on, you may be able to stop it by taking medicine, lying down in a quiet, dark room, applying a cold pack to your head, and gentle pressure to your temple.
What About Medications?
The medicines currently used to treat migraines fall into two categories:
- Preventive agents (prophylactics)
- Abortive agents
If you find that your life is becoming unmanageable because of migraines, your doctor may prescribe a prophylactic medication. Their purpose is to ward off migraines, or at least reduce the frequency and severity. They are taken daily, whether or not you are experiencing symptoms. Prophylactic medications include:
- Beta blockers, such as ]]>propanolol ]]>(ie, Inderal, Inderal LA)
- Calcium-channel blockers, such as ]]>verapamil]]> (ie Calan, Calan SR, Covera-HS, Isoptin SR, Verelan, Verelan PM) and ]]>flunarizine]]> (ie Sibelium)
- Antidepressants, such as ]]>amitriptyline]]> (ie Elavil)
- Some seizure medicines, such as ]]>valproic acid]]> (ie Divalproex sodium, Depakene, Depakote, Depakote ER, Depakote Sprinkle) and ]]>topiramate ]]>(ie Topamax)
Standard pain relievers are the first line of abortive treatment for migraines. These are taken when the patient first feels a migraine coming on. These include:
- Over-the-counter drugs, such as ]]>aspirin]]>, ]]>acetaminophen]]>, or ]]>ibuprofen]]>.
- Prescription medications such as ]]>ketorolac]]> (Toradol), ]]>naproxen ]]>(ie Anaprox), or ]]>mefenamic]]> (Ponstel)
To halt an acute migraine in progress that has not responded to standard pain relievers, doctors may prescribe ]]>ergotamine]]> (ie, Cafergot, Wigraine). Ergotamines can be administered either nasally, orally, or by injection. Excessive amounts of ergotamines can actually induce headaches, so monitor your usage and review drug use with your physician.
]]>Sumatriptan]]> (ie, Imitrex) is an abortive-type medication. It can be taken nasally, orally, or given by injection. You can learn to do the injections yourself. Imitrex reportedly helps over 70 percent of the migraine sufferers who use it.
Medicines for nausea, such as metoclopramide or prochlorperazine, may also be prescribed.
Although there is currently no "cure" for migraines, there are ways to obtain significant relief. Both medications and lifestyle changes can significantly reduce the number and severity of your headaches. To initiate this relief, however, you need to visit your health care provider or a headache clinic to work out a treatment plan. You won't be alone. According to one Philadelphia headache center, head pain is one of the leading reasons people visit their doctor.
American Council for Headache Education (ACHE)
Migraine and Cluster Headaches Page
Migraine Classification and Diagnosis Criteria
National Headache Foundation
The College of Family Physicians of Canada
Sick Kids (The Hospital for Sick Children)
Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice: The Neurological Disorders. 4th ed. Boston, MA: Butterworth-Heinemann; 2004.
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Last reviewed March 2008 by ]]>J. L. Chang, MD, FAASM, D, ABSM]]>
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