DEFINITION
Migraine headaches are a specific type of headaches. Although migraine headaches are often severe
and frequently debilitating, not all severe headaches are migraines.
Migraine headaches are vascular headaches. The headache and the associated symptoms are
the result of vessels pulsating.
Migraine headaches typically cause throbbing or pounding pain in one
region of the head, most commonly in one temple. Migraine headaches usually start on one side
of the head, but may progress to involve the entire head.
SYMPTOMS
- throbbing/pounding headache, usually on one side
- nausea (80%)
- vomiting (50%)
- extreme sensitivity to light, sound, and/or smells
- tend to get worse with physical exertion and in some cases any physical movement
The pain of a migraine can be
severe and last for hours, and sometimes even days, making the sufferer want to
lie perfectly still in a quiet, darkened room.
Aura
A migraine headache may be preceded by a warning
sign called an aura. At times, an aura can occur in isolation without subsequent development of a headache. Among the most
common auras, are visual disturbances, such as seeing spots, waving lines,
flashing lights, or a blind spot in one eye.
Numbness or weakness involving one side of the body may also be an aura
of a migraine.
The aura may last for
several minutes and resolve as the head pain begins or it may last until the
headache is completely resolve. An aura
can mimic signs of a stroke, and may be frightening. A migraine may be preceded by a prodromal
period preceding the aura by hours or days, during which a person may feel tired or depressed or a migraine can onset suddenly
without any warning.
PREDISPOSING FACTORS
Migraine headaches tend to
occur more commonly during times when a person is experiencing:
- emotional stress
- fatigue
- trouble sleeping
- dehydration
- fasting
- life adjustments
TRIGGERS
Exposure to certain things may cause the onset of a migraine
headache in a predisposed individual, these are known as migraine
triggers. Migraine triggers vary from
one person to another. Common migraine
triggers include:
- flickering or flashing lights
- bright lights
- strong smells
- loud noises
- abrupt changes in barometer pressure
- Consuming specific foods, such as:
- red wines
- aged cheeses
- smoked meats
- artificial sweeteners
- monosodium glutamate (MSG)
- soy sauce
- chocolate
- dairy products
TREATMENT
At times, over-the-counter medications such as
acetaminophen or ibuprofen may be adequate treatment for a migraine headache,
especially if the headache is caught early, and the person lays still in a quiet,
dark room.
Triptans
The development of a class of
medications known as triptans was a major breakthrough in the treatment of
migraines. Triptans are great
medications which are specific for migraine, and are helpful for other types of
headaches or pain.
There are now several triptans available,
sold under a variety of brand names, including:
- sumatriptan (Imitrex, Imigran, Cinie, Illument, Migriptan)
- rizatriptan (Maxalt)
- naratriptan (Amerge, Naramig)
- zolmitriptan (Zomig)
- eletriptan (Relpax)
- almotriptan (Axert, Almogran)
- frovatriptan (Frova, Migard, Frovamig)
Prior to the development of triptans, severe
migraines were often treated in emergency rooms with narcotics and antiemetics
(medications to treat nausea and vomiting).
Treatment with narcotics can result in worsening of the headache when
the narcotic wears off, this is known as rebound headache. People who suffered from frequent headaches
treated with narcotics were at high risk of developing tolerance, dependence,
and addiction to narcotics.
Unfortunately, not everyone can take triptans
safely. These medications should be
initiated under the direct supervision of a physician and be used with
caution.
Ergotamines
Other medications still used
to treat migraines include ergotamines (Cafergot, Migergot, or Migranal), although
this class of medication is not usually as effective as triptans.
Any medication used to treat headaches
frequently can result in what is known as overuse headache, continuous chronic
headaches that are not responsive to medication. For this reason, prescription medications for
migraines should not be taken more often than twice a week.
PREVENTION
There are variety medications and other
therapies which can be helpful in preventing migraine headaches. Response to preventive medications and
methods are very individual; what works well for one person may not work at all
for another. It is not uncommon for a
person to require therapeutic trials with several different medications
before finding what prevents their migraines.
Medications
Several different types of medication prevent migraines in some
individuals.
- Blood pressure medications
- calcium channel blockers
- verapamil
- beta-blockers
- propranolol
- Antiepileptic drugs (medications for seizures)
- divalproex sodium
- topiramate
- gabapentin
- Antidepressants
- tricyclic antidepressants
- amitriptyline (Elavil)
- nortriptyline
- selective serotonin reuptake inhibitors (SSRI
- sertraline
- selective serotonin and norepinephrine reuptake inhibitors (SSNRIs)
- venlafaxine (Effexor XR)
- Dietary supplements
- magnesium
- riboflavin
Feverfew is a natural herb used for the prevention of migraine for centuries that some people find very helpful. Botox injections have be found to be helpful in decreasing the number and severity of migraines in some people who suffer more than 15 headaches a month.
Lifestyle modifications
Maintaining a healthy lifestyle with a regular sleep schedule, and regular exercise has been shown to be helpful in preventing migraine headaches. Staying well hydrated by drinking lots of fluids (not containing caffeine or alcohol) is beneficial, as dehydration is a common migraine trigger. Relaxation techniques and meditation can reduce the frequency and severity of migraines. Keeping a headache diary, recording when migraines occur, and activities and exposures prior to the headache can help a person identify specific migraine triggers, and decrease their frequency of migraines by avoiding these triggers.