Headache - migraine
A migraine is a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head.
Some people who get migraines have warning symptoms, called an aura, before the actual headache begins. An aura is a group of symptoms, including vision disturbances, that are a warning sign that a bad headache is coming.
Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes they may begin later in life.
A migraine is caused by abnormal brain activity, which is triggered by stress, certain foods, environmental factors, or something else. However, the exact chain of events remains unclear. Today, most medical experts believe the attack begins in the brain, and involves various nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues.
Migraine attacks may be triggered by:
Certain foods and preservatives in foods may trigger migraines in some people. Food-related triggers may include:
This list may not include all triggers.
True migraine headaches are not a result of a brain tumor or other serious medical problem. However, only an experienced health care provider can determine whether your symptoms are due to a migraine or another condition.
Vision disturbances, or aura, are considered a "warning sign" that a migraine is coming. The aura occurs in both eyes and may involve any or all of the following:
Not every person with migraines has an aura. Those who do usually develop one about 10 - 15 minutes before the headache. However, it may occur just a few minutes to 24 hours beforehand. A headache may not always follow an aura.
Migraine headaches can be dull or severe. The pain may be felt behind the eye or in the back of the head and neck. For many patients, the headaches start on the same side each time. The headaches usually:
Other symptoms that may occur with the headache include:
Symptoms may linger even after the migraine has gone away. Patients with migraine sometimes call this a migraine "hangover." Symptoms can include:
Your doctor can diagnose this type of headache by asking questions about your symptoms and family history of migraines. A complete physical exam will be done to determine if your headaches are due to muscle tension, sinus problems, or a serious brain disorder.
There is no specific test to prove that your headache is actually a migraine. However, your doctor may order a brain MRI or CT scan if you have never had one before or if you have unusual symptoms with your migraine, including weakness, memory problems, or loss of alertness.
An EEG may be needed to rule out seizures. A lumbar puncture (spinal tap) might be done.
There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or changing your triggers.
A good way to identify triggers is to keep a headache diary. Write down:
For example, the diary may reveal that your headaches tend to occur more often on days when you wake up earlier than usual. Changing your sleep schedule may result in fewer migraine attacks.
When you do get migraine symptoms, try to treat them right away. The headache may be less severe. When migraine symptoms begin:
Many different medications are available for people with migraines. Medicines are used to:
If you have frequent migraines, your doctor may prescribe medicine to reduce the number of attacks. Such medicine needs to be taken every day in order to be effective. Such medications may include:
Botulinum toxin (Botox) injections may also help reduce migraine attacks.
STOPPING AN ATTACK
Other medicines are taken at the first sign of a migraine attack. Over-the-counter pain medications such as acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. If these don't help, ask your doctor about prescription medications. (Be aware, however, that overuse or misuse of such pain medications may result in rebound headaches.Chronic rebound headaches typically occur in people who take pain medications more than 3 days a week on an ongoing basis.)
Your doctor can select from several different types of medications, including:
These medications come in different forms. Patients who have nausea and vomiting with their migraines may be prescribed a nasal spray, suppository, or injection instead of pills.
Some migraine medicines narrow your blood vessels and should not be used if you are at risk for heart attacks or have heart disease, unless otherwise instructed by your health care provider. Ergots should not be taken if you are pregnant or planning to become pregnant, because they can cause serious side effects to an unborn baby.
Other medications are primarily given to treat the symptoms of migraine. Used alone or in combinations, these drugs can reduce your pain, nausea, or emotional distress. Medications in this group include:
If you wish to consider an alternative, feverfew is a popular herb for migraines. Several studies, but not all, support using feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, know that herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.
American Council for Headache Education -
The National Migraine Association -
National Headache Foundation -
Every person responds differently to treatment. Some people have rare headaches that require little to no treatment. Others require the use of several medications or even occasional hospitalization.
Migraine headache is a risk factor for stroke in both men and women.
Migraine headaches generally represent no significant threat to your overall health. However, they can be a long-term (chronic) problem and may interfere with your day-to-day life.
Call 911 if:
Also, call your doctor if:
See the general article on headaches for more information on emergency symptoms
Understanding your headache triggers can help you avoid foods and situations that cause your migraines. Keep a headache diary to help identify the source or trigger of your symptoms. Then modify your environment or habits to avoid future headaches.
Other tips for preventing migraines include:
Wilson JF. In the clinic: migraine. Ann Intern Med. 2007;147(9):ITC11-1-ITC11-16.
Ebell MH. Diagnosis of migraine headache. Am Fam Physician. 2006;74(12):2087-2088.
Detsky ME, McDonald DR, et al. Does this patient with headache have a migraine or need neuroimaging? JAMA. 2006;296(10):1274-1283.
Loder E. Triptan therapy in migraine. N Engl J Med. 2010 Jul 1;363(1): 63-70.
Silberstein SD, Young WB. Headache and facial pain. In: Goetz CG. Textbook of Clinical Neurology. 3rd ed. St. Louis, Mo: WB Saunders; 2007:chap. 53.
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