Understanding Migraine Headaches
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Understanding Migraine Headaches

Pounding, and throbbing are words used that describe headaches. Over 23 million Americans will experience the pain of a migraine headache. Three-quarters of that group will be women.

What Does a Migraine Feel Like?

The hallmark of a migraine headache is pulsating head pain. The pain is often localized to one side of the head and frequently occurs behind the eye or near the temple. You may also vomit or feel nauseated, become hypersensitive to light, sound, or smells, feel dizzy, or experience visual disturbances. Symptoms are aggravated by movement. Migraine intensity ranges from uncomfortable to completely disabling and can last anywhere from several hours to several days.

Some people experience an "aura" before a migraine strikes. An aura is an unexplained sensation that affects sight, taste, touch, hearing, or smell. Visual auras are the most common, characterized by flashing lights, jagged lines, blurred vision, or blind spots. Auras can affect other senses as well, causing temporary numbness of a body part, odd smells, ringing in the ears, or difficulty talking. Only 15% to 20% of migraine sufferers experience warning auras.

Other medical conditions can also cause these symptoms. Therefore, it's important to see your health care professional to determine whether your head pain and associated symptoms is, in fact, due to a migraine.

What Causes Migraines?

No one knows for sure. At one time doctors believed that migraines were caused by swelling and expansion of the blood vessels surrounding the head and neck. However, there are several problems with this theory. A new theory believes that migraine triggers initiate a wave of electrical activity across the brain. This wave eventually reaches a remote part of the brain called the trigeminal nerve. Substances called neuropeptides are released that cause blood vessels to swell and leak, causing inflammation and migraine headache.

But what causes the wave? Although it varies from one person to another, certain factors have been generally linked with the onset of migraines. The list of identified triggers includes:

  • Hunger
  • Menstruation
  • Hormone therapy
  • Alcohol
  • Strong odors such as perfumes or cigarettes
  • Excessive noise or bright lights
  • Stress
  • A change in sleep
  • Overuse of pain medicine
  • Sildenafil (ie Viagra)
Researchers report that the genes you inherited from your parents play a significant role too.

There seems to be a strong correlation between hormonal fluctuation and migraines in women. According to the National Headache Foundation, approximately 60% of females experience migraine-like headaches just before, during, or immediately after menstruation.

Taking birth control pills or hormone replacement therapy can trigger an increase in migraines. If this occurs consult with your provider. Post-menopausal women who take estrogen may benefit from a lower dose and route of administration that keeps hormone levels as steady as possible.

Eating foods that contain monosodium glutamate (MSG), or nitrites may also bring on an attack. MSG is a flavor enhancer often used in canned soups, Chinese foods, meat tenderizer, and seasonings. Nitrites are found in hot dogs and lunchmeats.

But don't scrutinize your eating habits too much when it comes to the connection between food and migraines. Research does not prove foods is a migraine trigger.

What Can I Do To Prevent Migraines?

Try to maintain a consistent bedtime and wake time. Avoid alcohol. Exercise.

Keep a journal of your headaches. Note when a migraine occurred, what you were doing at that time and shortly before, and what foods you ate in the 24 hours prior to the headache. Reviewing your entries may reveal a pattern linking migraine onset to certain foods or activities that you can then avoid.

Investigate biofeedback therapy or other relaxation techniques. Biofeedback is a relaxation technique that can address emotional triggers such as stress and anger. Electrodes that track changes in pulse or skin temperature are used to help you relax. The goal of biofeedback is to teach you how to release tension and increase blood flow on your own without using the machine.

Other relaxation techniques include stress management and relaxation training. In its recent guidelines, the U.S. Headache Consortium said that stress management, relaxation training, and biofeedback may benefit some migraine sufferers.

If you sense a migraine coming on, you may be able to stop it by taking medicine, lying down in a quiet, dark room, applying a cold pack to your head, and gentle pressure to your temple.

What About Medications?

The medicines currently used to treat migraines fall into two categories:

  • Preventive agents (prophylactics)
  • Abortive agents

If you find that your life is becoming unmanageable because of migraines, your doctor may prescribe a prophylactic medication. Their purpose is to ward off migraines, or at least reduce the frequency and severity. They are taken daily, whether or not you are experiencing symptoms. Prophylactic medications include:

  • Beta blockers, such as propanolol (ie, Inderal, Inderal LA)
  • Calcium-channel blockers, such as verapamil (ie Calan, Calan SR, Covera-HS, Isoptin SR, Verelan, Verelan PM) and flunarizine (ie Sibelium)
  • Antidepressants, such as amitriptyline (ie Elavil)
  • Some seizure medicines, such as valproic acid (ie Divalproex sodium, Depakene, Depakote, Depakote ER, Depakote Sprinkle) and topiramate (ie Topamax)

Standard pain relievers are the first line of abortive treatment for migraines. These are taken when the patient first feels a migraine coming on. These include:

  • Over-the-counter drugs, such as aspirin, acetaminophen, or ibuprofen.
  • Prescription medications such as ketorolac (Toradol), naproxen (ie Anaprox), or mefenamic (Ponstel)

To halt an acute migraine in progress that has not responded to standard pain relievers, doctors may prescribe ergotamine (ie, Cafergot, Wigraine). Ergotamines can be administered either nasally, orally, or by injection. Excessive amounts of ergotamines can actually induce headaches, so monitor your usage and review drug use with your physician.

Sumatriptan (ie, Imitrex) is an abortive-type medication. It can be taken nasally, orally, or given by injection. You can learn to do the injections yourself. Imitrex reportedly helps over 70 percent of the migraine sufferers who use it.

Medicines for nausea, such as metoclopramide or prochlorperazine, may also be prescribed.

Although there is currently no "cure" for migraines, there are ways to obtain significant relief. Both medications and lifestyle changes can significantly reduce the number and severity of your headaches. To initiate this relief, however, you need to visit your health care provider or a headache clinic to work out a treatment plan. You won't be alone. According to one Philadelphia headache center, head pain is one of the leading reasons people visit their doctor.

RESOURCES:

American Council for Headache Education (ACHE)
http://www.achenet.org

Migraine and Cluster Headaches Page
http://www.centerwatch.com/studies/CAT100.HTM

Migraine Classification and Diagnosis Criteria
http://www.pitt.edu/~elsst21/mcldi.html

National Headache Foundation
http://www.headaches.org/

CANADIAN RESOURCES:

The College of Family Physicians of Canada
http://www.cfpc.ca/

Sick Kids (The Hospital for Sick Children)
http://www.sickkids.ca/

References:

Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice: The Neurological Disorders. 4th ed. Boston, MA: Butterworth-Heinemann; 2004.

Diamond M. Special treatment situations: menstrual migraine and menstrually-related migraine. In: Standards of care for headache diagnosis and treatment. Chicago (IL): National Headache Foundation; 2004. p. 108-14.

Goadsby P. Pathophysiology of migraine. Continuum. 2006; 12(6):52-66.

Maizels M., Scott B., Cohen W., Chen W. "Intranasal Lidocaine for treatment of migraine," Journal of the American Medical Association. 1996; 276; 319-21.

Migraine. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed March 17, 2008.

Silberstein SD. Practice Parameter: Evidence-based guidelines for migraine headache. Neurology. 2000; 55: 754-762. Available at: http://www.aan.com/public/practiceguidelines/list.htm

Silberstein SD, Young WB. Preventive treatment. Continuum. 2006; 12(6):106-132.

Young WB, Silbertstein SD. Migraine: spectrum of symptoms and diagnosis. Continuum. 2006; 12(6):67-86.



Last reviewed March 2008 by J. L. Chang, MD, FAASM, D, ABSM

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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