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Migraine

Alternate Names

  • migraine without aura
  • vascular headaches
  • Brain structures

Definition

A migraine is a moderate to severe headache affecting one or both sides of the head.

What is going on in the body?

Migraines are believed to be caused by changes in the blood flow in the vessels of the head. Changes in blood flow to different areas of the brain can produce a variety of symptoms.

Risks

What are the causes and risks of the condition?

The tendency for migraine headaches is probably inherited. Other factors that put a person at risk for migraines include:
  • bright lights
  • certain foods and drinks, such as caffeine, chocolate, or alcohol
  • head injury or neck injury
  • hormonal changes in women, especially during menstruation
  • stress
  • poor sleep habits
  • weather changes

Prevention

What can be done to prevent the condition?

A person can help prevent migraine headaches by:
  • avoiding his or her personal triggers
  • exercising regularly
  • limiting stress
A trigger is different from a symptom. A symptom is a condition that accompanies or results from a migraine headache. A trigger is actually something inside or outside the body that can cause or aggravate headache pain. It can be related to something the person does or eats. Other triggers include changes in the weather, fatigue, light, noise, and many other factors.
Triggers can include:
  • any type of medicine, including prescription medicines, over-the-counter medicines, and herbal remedies
  • bright or flickering lights
  • changes in the seasons
  • changes in the weather
  • excessive or repetitive noises
  • high altitudes
  • jet lag
  • specific smells
Sometimes a headache is triggered by a combination of food and drink. The National Headache Foundation Listing of Trigger Foods includes:
  • alcoholic beverages
  • any pickled, fermented, or marinated food
  • bananas
  • broad beans, lima beans, fava beans, and snow peas
  • caffeinated beverages, such as tea, coffee, and colas
  • chicken liver or pate
  • chocolate
  • citrus foods and drinks
  • figs, raisins, papayas, avocados, and red plums
  • foods or beverages that contain aspartame and phenylalanine
  • freshly baked yeast products
  • meats that may contain nitrates, such as bacon, sausage, bologna, salami, pepperoni, summer sausage, or hot dogs
  • monosodium glutamate, also known as MSG, which is found in meat tenderizers, seasoned salt, and soy sauces
  • nuts or nut butters
  • onions
  • pickled or dried herring
  • ripened or aged cheeses, including cheddar, Emmenthaler (Swiss), Stilton, Brie, and Camembert
  • sour cream
  • sourdough bread
For certain patients, medicines can be used to prevent migraines and include the following:
  • anticonvulsants, such as gabapentin (i.e., Neurontin),carbamazepine (i.e., Tegretol), topiramate (i.e., Topamax) and valproic acid (i.e., Depakote, Depakene)
  • beta-blockers, such as atenolol (i.e., Tenormin) and propranolol (i.e., Inderal, InnoPran)
  • calcium channel blockers, such as diltiazem (i.e., Cardizem, Tiazac, Dilacor) and verapamil (i.e., Calan, Covera, Verelan)
  • lithium carbonate
  • methysergide maleate (i.e., Sansert) and methylergonovine maleate (i.e., Methergine)
  • nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (i.e., Advil, Motrin) and naproxen sodium (i.e., Aleve, Anaprox, Naprosyn)
  • selective serotonin reuptake inhibitors (SSRIs), including paroxetine ( i.e., Paxil)and fluoxetine HCl (i.e., Prozac)
  • tricyclic antidepressants, such as amitriptyline (i.e., Elavil) and nortriptyline (i.e., Pamelor)
  • other antidepressants, such as trazodone (i.e., Desyrel) and venlafaxine ( i.e., Effexor)

Diagnosed

How is the condition diagnosed?

According to the International Headache Society, migraine is diagnosed when a person has the following:
  • at least five headache episodes, each lasting 4 to 72 hours
  • nausea or sensitivity to light and sounds
  • at least two of the following: one-sided pain, pulsing pain, moderate or severe pain, or pain aggravated by physical activity
There are no blood tests for migraine.
Usually a migraine headache can be diagnosed with a complete physical examination and a medical history that includes information about the person's headache experiences. Doctors seldom use tests to diagnose a migraine. They may order tests to rule out other possible causes of the headache. These tests may include:
  • biopsy of the arteries in the head. In this test, a doctor collects a small sample of the artery and examines it under a microscope.
  • a cranial CT scan, which is an examination of the head using a special three-dimensional X-ray
  • a cranial MRI, which is a special three-dimensional image made using a magnetic field
  • an electroencephalogram, also called an EEG, which is a recording of brain waves
  • an electromyogram, also called an EMG. This test is a recording of the electrical activity of selected muscle groups.
  • skull X-rays
  • a spinal tap, where a small amount of cerebrospinal fluid is removed from the spine using a thin needle
  • testing of levels of certain drugs or toxins in the blood

Long Term Effects

What are the long-term effects of the condition?

Severe and frequent migraine headaches can greatly affect a person's ability to function. A migraine may rarely be linked with a stroke caused by blockage of blood flow in blood vessels.

Other Risks

What are the risks to others?

Although migraines are not contagious, 70% of migraine sufferers do have a family history of migraine.

Treatments

What are the treatments for the condition?

Healthcare professionals use one set of medications to prevent migraines from starting, and another to treat attacks once they occur.
Medicines used to prevent a migraine headache include:
  • anticonvulsants such as valproic acid (i.e., Depakene), divalproex (i.e., Depakote) and topiramate (i.e., Topamax)
  • beta-blockers such as propranolol (i.e., Inderal), atenolol (i.e., Tenormin), timolol (i.e., Blocadren), metoprolol (i.e., Lopressor) and nadolol (i.e., Corgard)
  • calcium channel blockers such as verapamil (i.e., Calan, Isoptin)
  • cyproheptadine (i.e., Periactin)
  • tricyclic antidepressants such as amitriptyline (i.e., Elavil) and nortriptyline (i.e., Pamelor)

Treatment for acute migraine attacks includes:
  • nonsteroidal anti-inflammatory drugs called NSAIDs, such as ibuprofen (i.e., Advil, Motrin) and naproxen (i.e., Aleve, Anaprox, Naprosyn)
  • barbiturate combinations, such as butalbital with caffeine and acetaminophen (i.e., Fiorcet)
  • ergot alkaloids and derivatives, such as ergotamine (i.e., Ergomar, Cafergot, Bellamine) and dihydroergotamine mesylate as a shot (i.e., DHE 45) or nasal spray (i.e., Migranal)
  • isometheptene agents, with combinations of isometheptene (i.e., Midrin, Duradin, Migquin)
  • narcotic analgesics, such as codeine and butorphanol (i.e., Stadol)
  • pain medicines, such as ibuprofen (Advil®, Motrin®) and acetaminophen (Tylenol®)
  • 5-HT-1 agonists (called triptans), such as sumatriptan (i.e., Imitrex as tablets, nasal spray or self-administered injection), zolmitriptan (i.e., Zomig), naratriptan (i.e., Amerge), rizatriptan (i.e., Maxalt), almotriptan (i.e., Axert), frovatriptan (i.e., Frova) or eletriptan (i.e., Relpax)
Alternative and complementary therapies for migraine with aura include:
  • acupuncture, a therapy used to relieve pain by inserting thin needles into certain parts of the body
  • aromatherapy, which uses oils to stimulate pleasant sensations and relieve stress
  • biofeedback, a process in which a person is taught how to relax when the body starts to show the signs of a headache
  • chiropractic, which involves manipulation of the spinal bones
  • cognitive-behavioral therapy, which helps a person change perceptions and behaviors related to the headache
  • exercise
  • herbal remedies (see list below)
  • hypnosis, which uses suggestion to influence the person's subconscious
  • relaxation training, which reduces stress and eases emotional strain
  • stress management
  • transcutaneous electrical nerve stimulation, or TENS, which relieves pain by stimulating nerves
The Natural Medicines Comprehensive Database evaluates the studies published from around the world on herbs, vitamins and supplements. They rate caffeine as "effective" for treating migraine headache and list as "possibly effective" butterbur, coenzyme q-10, feverfew, magnesium, and riboflavin (vitamin B2). They list fish oil (omega 3 fatty acids) as "possibly ineffective" and have concluded there is "insufficient evidence" for capsicum, ginger, and melatonin.
It is thought that in an individual with a persistent opening between chambers of the heart (patent foramen ovale), tiny blood clots (emboli) may travel through the opening, up the arterial circulation and into the brain. While not large enough to cause a stroke, these tiny clots could possibly trigger a migraine.
Other than avoiding one's triggers, the non-medicine treatments listed above may or may not be effective. A person should always talk with the doctor first before trying any of these treatments for migraine headache.

Side Effects

What are the side effects of the treatments?

Side effects of medicines used to treat migraines include stomach upset, drowsiness, and allergic reactions. Treatments other than medicines generally have few or no side effects.
Rarely, ergot alkaloids and triptans can cause constriction of arteries in the heart and limbs resulting in blocked blood flow. This occurs mainly in persons with peripheral arterial disease (PAD) or coronary artery disease (CAD) and should not be taken by patients with these conditions.

After Treatment

What happens after treatment for the condition?

After an effective treatment for migraine is in place, the person will usually feel like resuming normal activities. Rarely, complicated migraines can cause a stroke.

Monitor

How is the condition monitored?

A person with migraines may be asked to keep a headache diary. Any new or worsening symptoms should be reported to the doctor.

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