Migraine

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Migraine
Definition
Migraine is a type of recurring headache that involves blood vessels, nerves, and brain chemicals. Sensations such as visual changes, called auras, may precede a migraine.
The International Headache Society developed a system that classifies migraines as one of two types: migraine occurring with an aura (formerly called “classic”) and migraine occurring without an aura (formerly called “common"). Patients may experience a migraine several times a week or once every couple of years. Migraines may be so severe that they interfere with a patient's ability to work and carry on normal activities.
Migraine

Causes
The precise cause of migraines is unknown. Among the suspected causes are:
• Environmental triggers
• Genetic predisposition
• Dietary triggers
• Physiologic (menstruation, puberty)
An internal or external trigger sets the process in motion. It is possible that the nervous system reacts to the trigger by conducting electrical activity that spreads across the brain. This electrical activity leads to the release of brain chemicals that make blood vessels swell and become leaky. Scientists think that it is this inflammatory process that causes the pain and other symptoms of a migraine headache.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for migraines include:
• Sex: female
• Family members with migraines
• Youth
• Medications including:
o Birth control pills
o Hormone replacement therapy
o Drugs to dilate blood vessels
• Menstruation
• Fatigue
• Lack of sleep or changing sleep patterns
• Stress or relief from stress
• Skipping meals
• Alcohol, especially red wine
• Altitude or weather changes
• Time zone changes
• Exertion that is sustained or excessive
• Glaring or flashing light
• Perfumes or other odors
• Eating foods known to trigger migraines
Symptoms
Migraines occur in phases that may include:
A Warning
A warning may precede a migraine. In the hours or days before the headache, symptoms may include:
• A change in mood
• A change in behavior
• A change in the level of activity
• Fatigue
• Bloating
• Tense muscles
• Yawning
• Food craving or decreased appetite
• Nausea, vomiting, diarrhea
• Sensitivity to sound or light
An Aura
Some migraines are preceded by an aura. The most common aura is visual. The aura lasts about 15-30 minutes and may produce the following sensations:
• Flashing lights, spots, or zig zag lines
• Temporary, partial loss of vision
• Speech difficulties
• Weakness in an arm or leg
• Numbness or tingling in the face and hands
• Restlessness
• Confusion
• Dizziness, lightheadedness
• Speech disturbances
• Cognitive dysfunction
The Migraine Headache
Migraine pain starts within an hour of the aura ending. Symptoms include:
• A headache, usually on one side but may involve both sides. Typically, the headache feels:
o Intense
o Throbbing or pulsating
o More severe with movement
• Nausea or vomiting
• Diarrhea
• Sensitivity to light or sound
• Sore or achy muscles
• Lightheadedness or dizziness
A Post-headache Period
Migraines usually last from 4-72 hours. They often go away with sleep. After the headache, you may experience:
• Food intolerances or cravings
• Trouble concentrating
• Fatigue
• Sore muscles
• Irritability
• Restlessness
• Mood changes
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. You may also be given a neurological exam. In some situations, a CT scan or magnetic resonance imaging (MRI) scan may be performed to rule out other conditions. The doctor may order blood tests or other tests before starting treatment.
Treatment
Migraine therapy aims to:
• Prevent headaches
• Reduce headache severity and frequency
• Restore your ability to function
• Improve quality of life
Treatment options include:
Medications
Pain medications are often required to ease or stop the pain. Over-the-counter pain pills may ease mild symptoms.
Warning: Continuous use of some over-the-counter medications may cause what is called a "rebound headache" when you stop taking the medication.
Some prescription medications act directly to stop the cause of the migraine headache. These include drugs that:
• Quiet nerve pathways
• Reduce inflammation
• Stimulate receptors for serotonin, a brain hormone
These drugs can be taken by mouth (swallowed), but they may act more quickly in forms that dissolve in the mouth, are inhaled through the nose, or injected. Your doctor can help you choose the medication and route of administration most effective for you. Abortive medications include ergots, triptans, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDS).
Two recent studies involving 3,413 adult men and women with 2-6 migraine attacks per month found that combining a triptan (sumatriptan [Imitrex] 85 mg) with a NSAID (naproxen sodium [eg, Aleve] 500 mg) may be more effective than either medication taken separately. *
Other drugs can help prevent migraines for people suffering from frequent migraines. Preventive drugs are taken every day, even if you do not have a headache. Classes of preventative medications include beta-blockers, calcium channel blockers, tricyclics, and anticonvulsants.
Self-care During the Migraine
• Apply cold compresses to painful areas of your head.
• Lie in a dark, quiet room.
• Massage your scalp and temples.
• Try to fall asleep.
Lifestyle Changes
• Keep a diary to help identify what triggers migraines and what helps relieve them.
• Learn stress management and relaxation techniques.
• Consider talking with a counselor to learn new coping skills and relaxation techniques.
• Exercise regularly.
• If you are a smoker, quit. Smoking may worsen a migraine, and it probably also increases the rare chance of stroke occurring during a migraine attack.
• Avoid foods that trigger migraines.
• If low blood sugar precedes your migraines, eat small meals more often.
• Do not change your regular sleep pattern during the weekend or during vacation.
Prevention
Methods for preventing migraine include avoiding those things that trigger the headache and establishing other healthy habits. Suggestions include:
• Maintain regular sleep patterns.
• Learn stress management techniques.
• Do not skip meals.
• Avoid red wine and other alcohol.
• Exercise regularly.
• Avoid foods known to trigger migraines. These may include:
o Yogurt
o Nuts and peanut butter
o Beans (eg, lima, navy, pinto, and others)
o Aged or cured meats
o Aged cheese
o Processed or canned meat
o Caffeine (intake or withdrawal)
o Canned soup
o Chocolate
o Buttermilk or sour cream
o Meat tenderizer
o Brewer's yeast
o Avocados
o Onions
o Pickles
o Red plums
o Sauerkraut
o Snow peas
o Soy sauce
o Anything with MSG (monosodium glutamate), tyramine, or nitrates