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.