What Is a
Migraine?
A migraine is a
throbbing painful headache, usually on one side of the head, that is often
initiated or "triggered" by specific compounds or situations
(environment, stress, hormones, and many others). They occur more often in
women (75%, approximately) and may affect a person’s ability to do common
tasks.
Migraine Symptoms
Migraine
symptoms, throbbing pain, usually on one side of a person's head, can be
intense enough to cause a person to be unable to do simple tasks or to work.
The headache pain may radiate toward the eyes, forehead, or temple and make a
person develop nausea, vomiting, vision problems, and sensitivity to normal
light or mild exertion.
Migraine With Aura
"Classic"
migraines begin with an aura such as seeing visual field changes (dots, wavy
lines, blurriness) about an hour or less before the pain begins. Approximately
20% of people with migraines have this "classic" type.
Migraine Warning Signs
"Classic"
auras do not occur in all patients, but about 25% of migraine patients can have
a prodromal phase. The prodromal phase occurs as long as 24 hours before
migraine pain develops; the prodromal phase consists of mood changes
(depressed, excited, irritable) and sensations of odd smells or tastes, while
others may feel tired or tense.
What Causes a Migraine?
The
neurological causes of migraines are not understood but researchers speculate
something may initiate a mix of blood vessel permeation and brain chemicals to
interact with brain cells to cause the migraine
Trigger: Flashing Lights
Migraine
headaches are often triggered to occur when the person is exposed to a specific
set of circumstances. One of the most common triggers is strong flickering
light. For example, faulty fluorescent lights, a television picture rapidly
going on and off, or sunlight reflected off of waves in a lake or the ocean are
all potential triggers.
Trigger: Anxiety and Stress
As
mentioned, stress is sometimes a trigger for migraines. While it is unlikely
that people can live stress-free lives, many people can reduce their stress and
avoid triggering migraines by using relaxation techniques, deep breathing, and
other biofeedback techniques.
Trigger: Lack of Food or Sleep
Regular
daily patterns of meals and sleep work well for some individuals to avoid
migraines. Sleep interruptions and lack of adequate fluid and/or food intake
and even some food binges may trigger a migraine.
Trigger: Hormonal Changes
Many
women's migraines are linked to their menstrual cycle. The hormonal increases
and decreases are thought to be responsible for triggering migraines in some
women. However, patterns differ from person to person so one type of hormonal
therapy may benefit one woman, but it may be unhelpful or even increase
migraine symptoms in other women.
Trigger: Headache Foods
Although
studies have not proven that any food is a migraine trigger, patients often
suggest certain foods trigger their migraines. Common food or food ingredients
cited by patients are red wine, cheese, chocolate, soy sauce, processed meat,
and MSG.
Trigger: Tyramine
Tyramine, produced from the amino acid tyrosine, may be a trigger
for migraines because it can cause blood vessel constriction and expansion.
Many aged and fermented foods that are associated with migraines like cheeses,
soy sauce, pickles, or aged meats like pepperoni contain tyramineCaffeine: Help or Hindrance?
The
caffeine in coffee may help relieve migraines when used with some medications.
However, when the caffeine levels drop, the patient may then be prone to
develop headaches. Consequently, it may be both a help and a hindrance for
people with migraines.
Tracking Personal Triggers
Individuals
should keep a diary or list of things that act as warning signs or triggers of
an oncoming migraine. This information may help migraine sufferers to avoid
future migraines.
Who Gets Migraines?
Migraines
occur in women about three times more often than in men; people with relatives
who get migraines are more likely to get them. In addition, migraines more
often occur in people with epilepsy, depression, stroke, asthma, anxiety, and
in individuals with neurologic and hereditary (genetic) disorders.
Migraines in Children
Migraines
occur in children about equally until puberty when migraines become more common
in girls. However, in children, migraine symptoms are somewhat different than
those in adults; children may experience stomach pains (abdominal migraine),
frequent and forceful vomiting, or benign paroxysmal vertigo where the symptoms
are unsteady balance, involuntary eye movements, vomiting, and behavioral
changes.
Diagnosing Migraines
Migraines
are usually diagnosed by the clinical history of symptoms; however, most
doctors will do a CT or MRI brain scan to determine if other causes of
headaches (brain tumor or bleeding into the brain, for example) are presen
Calculating Your Headache Burden
Some
doctors like to estimate how much migraines disrupt normal activities before
treatment begins. A questionnaire is given to the patient to estimate how often
they miss various functions (school, work, family activities) because of
migraines.
Treatment: Over-the-Counter Drugs
There
are many types of over-the-counter (OTC) medicines for headache pain. Some of
the most common are aspirin, naproxen sodium, ibuprofen, and acetaminophen;
some OTCs are marketed as treatments for migraines. Although all of these OTCs
may be helpful, people should not overuse them to avoid toxicity, ulcers, and
other gastrointestinal problems. In addition, overuse may make migraines worse.
Treatment: Triptans
Triptans
(Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Treximet, and Zomig) are the
most commonly prescribed medication for the treatment of migraines. However,
people with hypertension, heart disease, stroke, and those who take certain
medications may not be able to take triptans; your doctor can help with
medication choices. Unfortunately, side effects of nausea, dizziness, chest
pain, and paresthesia may occur with triptans.
Treatment: Ergotamines
Ergotamines
(Cafergot, Migergot, or Migranal) are used to treat migraines although they are
usually not as effective as triptans. However, they have side effects such as
nausea, dizziness, muscle pain, or an unusual or bad taste in the mouth and may
interact with other drugs. These side effects and drug interactions may limit
the patient’s use of the drug.
Is Your Treatment Working?
Sometimes
the initial treatments for migraines either do not reduce the symptoms or only
marginally reduce them. If, after trying the prescribed treatment(s) about two
or three times and getting little or no relief, you should ask your doctor to
change the treatment. However, patients are urged to treat the migraines early
(within about 2 hours) to get full benefit of treatments.
Limits of Medication Use
Some
chronic headaches are due to overuse of medicine; avoid using migraine
prescribed medicines more than twice per week. Using and tapering medicine for
migraines should proceed under your doctor’s supervision. Narcotics are used as
a last resort for migraines because they can be addictive.
Treatment: Preventive Medicines
If
your migraines are frequent and severe, your doctor may prescribe medication(s)
to lessen the frequency or to prevent the headaches. Medicines that are used in
this manner include Timolol (Blocadren), divalproex sodium (Depakote),
propranolol (Inderal), and topiramate (Topamax), although the drugs were
designed to reduce hypertension or prevent seizures.
Alternative Therapy: Biofeedback
Other
methods that may reduce or prevent migraines include biofeedback techniques to
reduce migraine triggers like stress and early symptoms such as muscle tension.
Alternative Therapy: Acupuncture
Although
studies on acupuncture are not definitive, some patients may respond well to
this Chinese method of inserting needles into specific body locations to reduce
or stop pain. Because the results are so variable, some doctors do not
recommend this treatment; but because some patients benefit, it is another
treatment method to consider
An Advantage of Aging
The
peak intensity and frequency of migraines occur between ages of about 20 to 60
years of age. As you age past 60, migraine intensity and frequency decrease and
in some patients, migraines cease.
When You Need Quick Care
Most
people know the pattern of their migraines (triggers, auras, and pain
intensity). However, new headaches, in people with or without
a migraine history, that last about 2 or more days should be checked by a
doctor. However, if a headache develops with other symptoms such as fever, stiff
neck, confusion, or paralysis, the person or their relative, friend, or
caretaker should be examined emergently.
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