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, 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.
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 tyramine.
Caffeine: 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.
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 present.
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.
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.
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.
More Reading on Headaches and Migraines
Reviewed by Joseph Carcione, DO on Wednesday, May 11, 2016
Slideshow: A Visual Guide to Migraine Headaches
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