A migraine is a moderate to severe headache affecting one or both sides of the head.
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.
Signs and symptoms of migraine can include: confusiondepressiondifficulty swallowingdrowsinessheadache that can last for hours or days on one or both sides of the headirritabilityloss of coordinationnauseanumbness or tingling in hands and feetparalysis anywhere in the bodyringing in the earsensitivity to sound, light, or smellsensory loss, such as loss of smell or tastetrouble remembering thingsvomitingweakness
A migraine headache may be preceded by an aura. An aura begins 5 to 30 minutes before the headache pain and consists of strange sensations of vision, smell, or feeling.
The tendency for migraine headaches is probably inherited. Other factors that put a person at risk for migraines include: bright lightscertain foods and drinks, such as caffeine, chocolate, or alcoholhead injury or neck injuryhormonal changes in women, especially during menstruationstresspoor sleep habitsweather changes
A person can help prevent migraine headaches by: avoiding his or her personal triggersexercising regularlylimiting 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 remediesbright or flickering lightschanges in the seasonschanges in the weatherexcessive or repetitive noiseshigh altitudesjet lagspecific smells
Sometimes a headache is triggered by a combination of food and drink. The National Headache Foundation Listing of Trigger Foods includes: alcoholic beveragesany pickled, fermented, or marinated foodbananasbroad beans, lima beans, fava beans, and snow peascaffeinated beverages, such as tea, coffee, and colaschicken liver or patechocolatecitrus foods and drinksfigs, raisins, papayas, avocados, and red plumsfoods or beverages that contain aspartame and phenylalaninefreshly baked yeast productsmeats that may contain nitrates, such as bacon, sausage, bologna, salami, pepperoni, summer sausage, or hot dogsmonosodium glutamate, also known as MSG, which is found in meat tenderizers, seasoned salt, and soy saucesnuts or nut buttersonionspickled or dried herringripened or aged cheeses, including cheddar, Emmenthaler (Swiss), Stilton, Brie, and Camembertsour creamsourdough 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 carbonatemethysergide 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)
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 hoursnausea or sensitivity to light and soundsat 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-raya cranial MRI, which is a special three-dimensional image made using a magnetic fieldan electroencephalogram, also called an EEG, which is a recording of brain wavesan electromyogram, also called an EMG. This test is a recording of the electrical activity of selected muscle groups.skull X-raysa spinal tap, where a small amount of cerebrospinal fluid is removed from the spine using a thin needletesting of levels of certain drugs or toxins in the blood
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.
Although migraines are not contagious, 70% of migraine sufferers do have a family history of migraine.
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 bodyaromatherapy, which uses oils to stimulate pleasant sensations and relieve stressbiofeedback, a process in which a person is taught how to relax when the body starts to show the signs of a headachechiropractic, which involves manipulation of the spinal bonescognitive-behavioral therapy, which helps a person change perceptions and behaviors related to the headacheexerciseherbal remedies (see list below)hypnosis, which uses suggestion to influence the person's subconsciousrelaxation training, which reduces stress and eases emotional strainstress managementtranscutaneous 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 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 an effective treatment for migraine is in place, the person will usually feel like resuming normal activities. Rarely, complicated migraines can cause a stroke.
A person with migraines may be asked to keep a headache diary. Any new or worsening symptoms should be reported to the doctor.
