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Migraine With Aura

Alternate Names

  • classical migraine
  • classic migraine
  • Brain structures

Definition

A migraine is a moderate-to-severe headache affecting one or both sides of the head. An aura is an abnormal sensation which warns that a migraine is coming on.

What is going on in the body?

A migraine begins when, for unknown reasons, cells in the central part of the brain become oversensitive to stimulation. A migraine trigger causes these cells to suddenly begin firing electrical impulses. These impulses travel through the brain in a wave, similar to the way ripples spread across the water when a stone is thrown into a pond.
This spreading electrical impulse causes the release of serotonin and other brain chemicals. Serotonin causes changes in blood flow to different areas of the brain. When an impulse reaches the outermost part of the brain, it triggers the release of substance P and other chemicals. These chemicals contribute to the throbbing pain, inflammation, and increased sensitivity to sensory stimuli.

Risks

What are the causes and risks of the disease?

A migraine occurs when cells in the center of the brain become overly sensitive to stimulation. Factors that may trigger a migraine include the following:
  • alcohol
  • certain foods, including chocolate and some cheeses
  • change in hormone levels
  • fatigue
  • food additives
  • foods containing tyramine, such as red wine and organ meats
  • light or noise
  • too much or too little sleep
  • weather changes

Prevention

What can be done to prevent the disease?

An individual can lower the risk for migraine with aura by identifying and avoiding triggers. People who are sensitive to tyramine, for example, should not drink red wine.
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 disease diagnosed?

Diagnosis of a migraine with aura begins with a medical history and physical exam. Rarely, the healthcare provider may order tests to rule out other problems.

Long Term Effects

What are the long-term effects of the disease?

If the migraines are infrequent and mild, there are few long-term effects. If they are frequent and severe, they can greatly impair a person's ability to function or work. Rarely, a migraine can cause a stroke.

Other Risks

What are the risks to others?

Migraines with aura are not contagious and pose no risk to others.

Treatments

What are the treatments for the disease?

Medicines used to relieve the symptoms of migraine with aura include:
  • 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 (i.e., Advil, Motrin) and acetaminophen (i.e., 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.
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.

Side Effects

What are the side effects of the treatments?

Medicines used to treat migraine with aura may cause drowsiness, allergic reactions, or rebound headache. Rebound headaches are caused by regular use of pain medicines.
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.

Monitor

How is the disease monitored?

The individual may be asked to keep a headache diary to identify triggers and track the success of treatment. Any new or worsening symptoms should be reported to the healthcare provider.

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