A migraine is a recurring, throbbing headache. It usually occurs on one side of your head. Migraine is a biological disorder. It often runs in families.
Migraine affects about 28 million Americans. It can strike anyone, at any age. It is most common in young women. If you have a close relative with migraines, you are more likely to have them.
Too many people do not seek adequate care for their migraines. You may be suffering needlessly. Research has led to many advances in recent years. Doctors can now diagnose and treat migraine with success. Most people are able to live with much less pain. Some are free of pain.
About 10-20 % of migraine suffers experience a warning before the migraine attack. This warning is referred to as an aura which is thought to be a temporary disruption of the brain function that occurs 20-30 minutes before the attack. Characteristics of an aura include: visual disturbances such as flashing lights, zigzagging lines, blurred or lost vision, a tingling feeling around the lips or hands, hallucinations or loss of speech.
Other migraine suffers get a prodrome. This is a warning of the oncoming migraine and can occur several hours or days before the actual attack. Symptoms of prodrome include: yawning, fatigue, mood swings, food cravings, sensitivity to light and sound, touch or odors.
Some causes or triggers of migraine attacks include: seasonal changes, smoking, stress, foods such as red wine, aged cheeses, chocolate, and nuts, changes in sleep patterns, or hormonal changes like those during pregnancy or menstruation or menopause.
- Moderate to severe headache that lasts 4 to 72 hours
- Throbbing pain, often on one side of the head
- Increased pain after exercise or movement
- Sensitivity to bright light, sound, and/or odors
- Nausea or vomiting with the headache
Each person with migraine may not experience all of these symptoms. If you have any of these symptoms, you may have migraine.
One in five people with migraine have a warning before the headache. This warning is called an aura. You may see flashing lights, temporarily lose your sight, or go numb on one side of your body. An aura usually lasts 5 to 30 minutes. It can happen without a headache.
Migraines are diagnosed from a medical history and symptom assessment. It is helpful to keep a headache diary that notes the date, onset and duration of each migraine as well as observing if some of the possible triggers precipitated the migraine attack.
No medical test can tell you if you have migraine. You must carefully tell your doctor about your headache and your symptoms. Your doctor will also do a neurological exam. This is the most important information your doctor needs to diagnose migraine. In general, if your headache history is consistent with migraine and your neurological exam is normal, no further testing is needed.
There are many treatments available for migraines. Pain relievers can be prescribed as well as specific medications aimed at migraine relief that focus on various neurological pathways. Each person responds to various treatments differently.
To give you the best chance for success, you and your doctor must work as a team. A diary is a valuable tool. It can help identify migraine triggers and track how drugs are working. It can also track the results of treatment and lifestyle changes. Regular follow-up visits and proper drug use are also vital.
Many people know and can avoid their migraine triggers, which may include:
- Diet: Missed meals, alcohol (especially red wine), foods with monosodium glutamate (MSG), excessive caffeine, preserved meats with nitrates and nitrites, and foods that contain tyramine- such as aged cheeses- may trigger migraine.
- Sleep: Too much or too little sleep can trigger a migraine attack.
- Stress: Stress and release from stress may be a factor in triggering migraine.
- Environmental factors: Weather change, glaring or fluorescent lights, strong odors, and high altitude can trigger migraine.
Many women have attacks linked to their menstrual cycles. Menstrual migraines can be more severe than other migraines. They can also be more difficult to treat. Migraine often changes during pregnancy. Women usually have fewer migraines as they age.
Acute treatments are used to stop an attack when it occurs or to treat its symptoms. If you have frequent attacks, you can take a preventive treatment. This can help migraines strike less often and end sooner. However, daily use of a headache medication may make your headaches worse.
Pain-relieving drugs include:
- Nonprescription (over-the-counter) medications, such as aspirin, ibuprofen, or acetaminophen combined with aspirin and caffeine
- Prescription nonsteroidal anti-inflammatory drugs and analgesics, including narcotics and non-narcotics
- Specific drugs used to stop migraine attacks include: Triptans, such as sumatriptan, zolmitriptan, naratriptan, and rizatriptan
- Drugs used in hospital emergency rooms include: Dihydroergotamine, anti-emetics (anti-nausea drugs), narcotic and non-narcotic analgesics
Such treatment is especially helpful if you are experiencing frequent headaches. They can also help if your treatment is not working or is causing side effects. Although these drugs may not prevent all migraines, they can reduce the frequency, pain, and length of attacks.
Preventive treatments include:
- Antidepressants, such as amitriptyline
- Beta-blockers, such as propranolol or timolol
- Calcium channel blockers, such as verapamil
- Anticonvulsants, such as divalproex sodium, and topiramate
- Alternative treatments, such as vitamin B2, magnesium, and feverfew
- Botulinum Toxin injections
Contact your doctor if your treatment is not working as well or if you need to use more acute medication. Overuse of acute drugs can lead to daily rebound headache.
Cognitive and behavioural treatments
Research has shown that some cognitive and behavioral treatments can help prevent migraine. These include:
- Relaxation training
- Thermal biofeedback with relaxation training
- Electromyographic biofeedback
- Cognitive-behavioral therapy (also called stress-management training)
Guidelines for doctors on the diagnosis, treatment, and prevention of migraine were developed by the US Headache Consortium, a group of migraine experts. The guidelines are available at www.aan.com.
You may find taking part in clinical research trials to be rewarding. Benefits include taking a more active role in your health care and gaining access to expert medical care.
Many strategies can be used to help prevent migraine.