Migraine

Description:A symptom complex occurring periodically and characterized by pain in the head (usually unilateral), vertigo, nausea and vomiting, photophobia, and scintillating appearances of light. Classified as classic migraine, common migraine, cluster headache, hemiplegic migraine, ophthalmoplegic migraine, and ophthalmic migraine.Alternative Name: Bilious headache, blind headache, sick headache, vascular headache, hemicrania.Terminology related with Migraine include abdominal migraine acephalgic migraine, basilar migraine, classic migraine, common migraine, complicated migraine, fulgurating migraine Harris migraine, hemiplegic migraine, migraine without headache, ocular migraine, ophthalmoplegic migraine, and retinal migraine.A migraine headache is a throbbing or pulsating headache that is often one sided (unilateral) and associated with nausea; vomiting; sensitivity to light, sound, and smells; sleep disruption; and depression. Attacks are often recurrent and tend to become less severe as the migraine sufferer ages.Migraines afflict about 30 million people in the United States. They may occur at any age, but usually begin between the ages of 10 and 45. Some people experience several migraines a month, while others have only a few migraines throughout their lifetime. Approximately 75% of migraine sufferers are women. Over 80% of migraineurs have family members who have migraines.A lot of people get migraines -- about 11 out of 100. The headaches tend to first appear between the ages of 10 and 46. Occasionally, migraines may occur later in life in a person with no history of such headaches. Migraines occur more often in women than men, and may run in families. Women may have fewer migraines when they are pregnant. Most women with such headaches have fewer attacks during the last two trimesters of pregnancy.The migraine headache can be dull or severe and depending on the severity of the migraine, this can be disabling to a person for the duration of the migraine headache. The pain is usually felt behind the eyes or in the back of the head or neck. The headache can start on either side of the head or both, which can be worse on one side of the head or both. A throbbing, pounding or pulsating pain across all areas of the head will be felt that could last up to 72 hours. The pain usually starts as a dull ache which can get worse within minutes and last for hours and even days.In some cases, patients eventually experience on-going and chronic headaches. Some doctors believe that, unless otherwise demonstrated, any chronic headache consisting of episodes of disabling pain that recur regularly over years should be considered as a migraine. Chronic migraines may occur from overuse of migraine medications (called a rebound headache) or may develop over time (called transformed migraine).Types:
  • An abdominal migraine is also called periodic syndrome. It occurs usually in children, and usually ones with a prior family history of migraine attacks. Abdominal migraines are characterized by bouts of pain in the abdomen lasting for around two hours. Other symptoms can include nausea, vomiting, flushing and pallor. Standard migraine medications usually work for abdominal migraines.
  • A basilar migraine is one affecting the circulation in the back of the neck or brain. This usually occurs in young women and can cause dizziness, loss of balance, double vision, confusion, fainting, slurred speech and disorientation. Some people will even lose consciousness during an acute headache. Often people are mistakenly believed to be suffering from some other condition.
  • A hemiplegic migraine is a rare type considered to be a severe variety. During an attack, the sufferer might experience temporary motor paralysis and some sensory disturbances on a single side of his or her body. These symptoms precede the headache itself. The symptoms will fade as the headache appears.
  • Nocturnal headaches refer to attacks experienced in the early hours of the morning, usually around 4:00 a.m. The person is often awakened by the pain. According to recent studies, these attacks are linked with changes in the person's adrenaline and similar substances. As the levels reach their peak, the headache is experienced.
  • Ophthalmoplegic migraines are considered rare forms of migraine. In this variety, the pain surrounds the person's eyeball and can last as long s several months. It's caused by a weakness of muscles which surround the eye. A person should get a doctor to confirm the diagnosis, as similar symptoms might also be produced by a pressure on the nerves directly behind the eye.
  • An occular migraine refers to a migraine in which the person experiences visual hints of an oncoming attack, usually the "aura" which produces flashing lights or spots or something related.
The best way to prevent migraines is to learn what triggers (sets off) your migraines and then try to avoid these triggers. Take a break from activities that provoke a migraine, such as using the computer for a long time. If you know that certain foods trigger your migraines, try to avoid them. Some people find that cutting back on caffeine intake or drinking a lot of water can help prevent migraines.Make a plan for all the things you have to do — especially during stressful times like final exams — so you don't feel overwhelmed when things pile up. Regular exercise can also reduce stress and make you feel better. If your doctor has prescribed medication, always have a dose on hand. Then if you feel a migraine coming, take your medicine. You can also try lying down in a quiet, dark room until the pain starts to go away.Because migraines are so different for different people, it helps to keep a headache diary and get to know what provokes migraines in your own case. The more you understand your headaches, the better prepared you can be to fight them.Symptoms:General symptoms of migraines include:
  • Moderate to severe pain, usually confined to one side of the head, but switching in successive migraines.
  • Pulsing and throbbing head pain.
  • Increasing pain during physical activity.
  • Inability to perform regular activities due to pain.
  • Nausea and vomiting.
  • Increased sensitivity to light and sound and sweating.
Other symptoms are chills, increased urination, fatigue, loss of appetite, nausea and vomiting, numbness, tingling or weakness, problems concentrating or finding the right words, which can occur with a headache.Causes and Risk factors:The exact causes of migraine headaches remain something of a mystery and despite the fact that it was believed for many years that they resulted from a dilation of the blood vessels, recent research suggests that this may not be the cause of these attacks. Indeed, modern research tends towards the view that this may be a genetic disorder which affects the way in which certain brain chemicals (neurotransmitters such as serotonin) interact with the nerve cells.Not all scientists agree about what causes migraines. Many believe that a migraine is caused by narrowing and expanding of the blood vessels in the brain. There are also theories that the level of certain chemicals in the brain may affect the nerve system that regulates pain.Just what brings on a migraine is also a complex matter. An attack can for instance be brought on by both a lack of sleep and excess sleep. Attacks are also often linked to skipping meals or to eating certain foods, such as cheese. Hormonal factors are also thought to influence both the onset of an attack and its severity. In this regard, one explanation for the higher incidence of this condition in women lies in the fact that many women use birth control pills which affect their estrogen levels.Risk factors that trigger the migraine include:
  • Physical or emotional stress.
  • Skipping meals or fasting.
  • Allergies and allergic reactions.
  • Bright lights, loud noises, and certain odors or perfumes.
  • Changes in sleep patterns or irregular sleep.
  • Smoking or exposure to smoke.
  • Alcohol.
  • Menstrual cycle fluctuations, birth control pills, hormone fluctuations during menopause onset.
  • Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami). Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods.
Diagnosis:Anyone, including children, with recurring or persistent headaches should consult a doctor. There are no blood tests or imaging techniques that can be used to diagnose migraine headaches. A diagnosis will be made on the basis of history and physical exam. Tests may be necessary to rule out other diseases or conditions that may be causing the headaches. It is important to choose a doctor who is sensitive to the needs of headache sufferers and aware of the latest advances in treatment.In order to diagnose a chronic headache, the doctor will examine the head and neck and will usually perform a neurologic examination, which includes a series of simple exercises to test strength, reflexes, coordination, and sensation. The doctor may ask questions to test short-term memory and related aspects of mental function.The diagnosis of migraine is not always easy, especially when a patient's symptoms do not fall into an easily recognizable pattern.Many physicians order a series of blood tests to screen for thyroid disease, anemia or infections that could cause headaches. At times different types of brain scans like computed tomographic (CT) scans and/or magnetic resonance imaging (MRI) scans may be needed to rule out serious brain disorders. If a brain aneurysm is suspected, an angiogram may be ordered.Sometimes an electroencephalogram (EEG) may be done to measure brain activity. EEGs can indicate a malfunction in the brain, but they cannot usually pinpoint a problem that might be causing a headache. Thermography, an experimental technique for diagnosing headache, promises to become a useful clinical tool. In thermography, an infrared camera converts skin temperature into a color picture, or thermogram, with different degrees of heat appearing as different colors. Skin temperature is affected primarily by blood flow. Research scientists have found that thermograms of headache patients show strikingly different heat patterns from those of people who never or rarely get headaches.There are six questions that a doctor might ask the patient to determine if headaches are migraines are regular tension headaches. 1) Does the patient experience nausea in conjunction with the headaches? 2) Does he experience sensitivity to light? 3) Does he experience sensitivity to sound? 4) Does physical activity make the headache worse? 5) Is the headache restricted to one side of the head? 6) Is the pain a pounding /throbbing pain?Treatment:Preventive strategies for migraine include both drug treatment and behavioral therapy or lifestyle adjustments.It is best to treat a migraine attack as soon as symptoms first occur. Doctors generally recommend starting with nonprescription pain relievers for mild-to-moderate attacks. If migraine pain is severe, a prescription version of an NSAID may be recommended. A triptan is generally the next drug of choice. Ergotamine drugs tend to be less effective than triptans, but are helpful for some patients. Depending on the severity of the attacks, and accompanying symptoms, the doctor may recommend taking a triptan or ergotamine drug in tablet, injection, or suppository form. The doctor may also prescribe specific medications for treating symptoms such as nausea.The most commonly used preventive drugs—used to avoid or reduce the frequency of migraine attacks—include:
  • Beta-blockers, which relax blood vessels.
  • Calcium channel blockers, which reduce the amount of narrowing (constriction) of the blood vessels.
  • Antidepressants, such as amitriptyline, a tricyclic antidepressant, which has been shown to be effective in preventing migraines.5
  • Anticonvulsants, such as topiramate, which is approved by the U.S. Food and Drug Administration (FDA) for preventing migraines.
In severe cases, prescription medicines such as NSAIDS (Non-steroidal Anti-inflammatory Drugs) may be used. Many patients who wish to avoid dependence on medicines make use of alternative treatment methods to relieve migraine pain.Most children with migraines may need only mild pain relievers such as for children age 6 years and older, ibuprofen (Advil) is recommended. Acetaminophen (Tylenol) may also be effective. Acetaminophen works faster than ibuprofen, but the effects of ibuprofen last longer. For adolescents age 12 years and older, sumaptriptan (Imitrex) nasal spray is recommended.For Immediate Relief:
  • Have a bath or shower.
  • Lie down to rest in a dark room. Avoid bright or flashing light.
  • Put something cold on the back of your neck, such as a cold, wet cloth; or alternate hot and cold cloths where the pain is.
  • Put a cold compress on your forehead and your feet in a container of warm water.
  • Have a drink of water or natural juice, especially tomato juice. Have some food, or a nutritious drink, if you haven't eaten for a while.
  • Massage your own face, head, neck and shoulders, or get someone else to do those and your back. Relax your muscles.
  • Press on two pressure points at the back of the neck. These points are about two inches apart, just below the base of the skull. Press for a minute or two. This releases endorphins that help against pain.
Complementary therapies may be added to drug treatment to reduce or prevent migraine symptoms. Be sure to ask your doctor before you try these therapies—to make sure they are safe for you.
  • Acupuncture, which involves putting very thin needles into the skin at certain points on the body to produce energy flow along the body's meridians. Current evidence suggests that acupuncture can help with headaches. But more research is needed.
  • Relaxation techniques such as biofeedback, a relaxation method for learning to control a body function that is not normally under conscious control, such as muscle tension.
Medicine and medications:Acetaminophen, Tylenol, Ibuprofen, Advil, Motrin, Naproxen, Naprelan, Naprosyn, Aleve, Anaprox, Sumatriptan, Imitrex, Frovatriptan, Relpax, Neurontin, Naratriptan, Zomig, Almotriptan, Maxalt, Amitriptyline, Elavil, Inderal, Depakote, Gabapentin, Topamax, Reglan, Riboflavin, Phenergan.Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care. 

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