Definition

Migraine is a type of recurring headache. It involves nerves and brain chemicals. Other sensations, such as auras, may come before a migraine headache.

There are 2 types of migraines:

    
  • Occurring with an aura—formerly called a classic migraine
  • Occurring without an aura—formerly called a common migraine
  • Migraine may happen several times a week or once every couple of years. They can be so severe that they interfere with the ability to work and carry on normal activities.

    Causes

    While the precise cause is not known, many potential triggers have been identified. Common triggers include:

        
  • Environmental triggers, such as odors and bright lights
  • Dietary triggers, such as alcohol
  • Certain medications
  • Changes in sleep patterns
  • Stress
  • Physiologic changes, such as menstruation and puberty
  • Weather changes
  • A trigger sets the process in motion. It is possible that the nervous system reacts to the trigger by conducting electrical activity. This spreads across the brain. It leads to the release of brain chemicals, which help regulate pain.

    Risk Factors

    Migraines are more common in women, especially before the age of 40. Other factors that increase your risk for migraines may include:

        
  • Family history of migraines
  • Menstruation
  • Obesity
  • Presence of patent foramen ovale—a congenital heart defect
  • Symptoms

    Migraines occur in phases that may include:

    Warning

    A warning may come before a migraine. In the hours or days before the headache, symptoms may include:

        
  • Changes in mood, behavior, and/or activity level
  • Fatigue
  • Yawning
  • Food craving or decreased appetite
  • Nausea
  • Diarrhea
  • Sensitivity to light
  • Aura

    The most common aura is visual. The aura lasts about 15-30 minutes. It 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
  • Confusion
  • Lightheadedness
  • Speech disturbances
  • It is important to seek medical attention to make sure the symptoms are not due to a more serious cause. This can include stroke or seizure .

    Headache

    Migraine pain starts within an hour of the aura ending. Symptoms include:

        
  • A headache (usually on one side but may involve both sides) that often feels:     
  • Moderate or severe in intensity
  • Throbbing or pulsating
  • More severe with bright light, loud sound, or movement
  • Nausea or vomiting
  • Diarrhea
  • Lightheadedness
  • Post-Headache Period

    Migraines usually last from 4-72 hours. They often go away with sleep. After the headache, you may experience:

        
  • Trouble concentrating
  • Fatigue
  • Sore muscles
  • Irritability
  • Mood changes
  • Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. You may also be given a neurological exam.

    Your body fluids may be tested. This can be done with blood tests.

    Images may be taken of your body structures. This can be done with:

        
  • CT scan
  • MRI scan
  • CT Scan of the Head

    Breast self-exam, step 5

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    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 needed to ease or stop the pain. Over-the-counter pain pills may ease mild symptoms.

    Warning: Regular use of some over-the-counter medications may cause a rebound headache.

    Some prescription medications act directly to stop the cause of the migraine headache. These include drugs that:

        
  • Quiet nerve pathways
  • Reduce inflammation
  • Bind receptors for serotonin, a brain chemical
  • These drugs can be taken by mouth. They may act more quickly in forms that dissolve in the mouth, are inhaled through the nose, or injected. They are more likely to be helpful if taken as soon as possible at the start of a migraine. Your doctor can help you choose the medication best for you.

    Medications that can help stop a migraine once it has begun include:

        
  • Triptans
  • Steroids
  • Acetaminophen
  • Non-steroidal anti-inflammatory drugs (NSAIDS)
  • Medications for nausea
  • Ergots
  • Combination medication that contains caffeine
  • Other drugs can help prevent migraines for people with frequent migraines. Preventive drugs are taken every day. Classes of preventive medications include:

        
  • Beta-blockers
  • Calcium channel blockers
  • Tricyclic antidepressants
  • Anticonvulsants
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blockers (ARBs)
  • Therapy

    Therapy may also be used to reduce the length and frequency of migraine headaches. It may be used with or without medication and may include cognitive behavioral therapy, biofeedback, or relaxation methods.

    Procedures

    Botulinum Toxin Injections

    Botulinum toxin injections may be used as a way to prevent migraines and to reduce the duration and intensity of the headaches in people who have headaches often.

    Surgery

    In some people, migraines are triggered when a nerve in the head is stimulated. With this type of surgery, the nerve trigger point is located in the head and is deactivated. This surgery may reduce the number of migraines or completely eliminate them in sufferers who do not respond to conventional treatments. Most migraines are not treated with surgery.

    Transcranial magnetic stimulation surgery may also be used in patients with migraine with aura who have not responded to other treatments.

    Self-Care During the Migraine

        
  • Apply cold compresses to painful areas of your head.
  • Lie in a dark, quiet room.
  • Try to fall asleep.
  • Lifestyle Changes

        
  • Keep a diary. It will help identify what triggers your migraines and what helps relieve them.
  • Learn stress management and relaxation techniques.
  • Consider talking with a counselo to learn new coping skills and relaxation techniques.
  • Exercise regularly .
  • If you are a smoker, talk to your doctor about ways to quit . Smoking may worsen a migraine.
  • Avoid foods that trigger migraines.
  • Eat regular meals.
  • Maintain your regular sleep pattern even during the weekend or on vacation.
  • Prevention

    Methods for preventing migraine include:

        
  • Avoiding those things that trigger the headache
  • Following your doctor's recommendations—The doctor may consider using medications to prevent headaches such as:     
  • Antidepressant
  • Antiseizure
  • Medications that lower blood pressure
  • Butterbur extract
  • Healthy lifestyle habits that may help prevent migraines include:

        
  • Maintain regular sleep patterns.
  • Learn stress management techniques.
  • Do not skip meals.
  • Avoid alcohol.
  • Exercise regularly. Consider yoga as one type of activity.
  • Ask your doctor if acupuncture is right for you. It may help you to have more headache-free days, as well as lessen the intensity of headaches when they do occur.
  • Therapy that may decrease migraine or migraine pain include:

        
  • Mind-body therapies such as:     
  • Biofeedback
  • Cognitive behavioral therapy
  • Guided imagery—may improve pain coping
  • Massage therapy
  • Foods are not proven to trigger migraine. But consider keeping a diary of migraine and diet to identify foods that may trigger migraines for you. Foods suspected to trigger migraine include:

        
  • Nuts and peanut butter
  • Beans
  • Aged or cured meats
  • Aged cheese
  • Processed or canned meat
  • Caffeine—intake or withdrawal
  • Canned soup
  • Buttermilk or sour cream
  • Meat tenderizer
  • Brewer's yeast
  • Avocados
  • Onions
  • Pickles
  • Red plums
  • Sauerkraut
  • Snow peas
  • Soy sauce
  • Anything with MSG (monosodium glutamate), tyramine, or nitrates