Migraine Headaches
Migraine is a type of headache. It affects about 6
out of 100 people. The World Health Organization ranks
in the top 20 most disabling disorders in the world.
Migraines most commonly occur in women and usually begin
between the ages of 10 and 46. They appear to run in
families in some cases.
Migraines are traditionally classified as classic migraine
(migraine with an aura), common migraine (migraine without
an aura) or mixed migraine (has features of both migraines).
Classic migraine is preceded by an aura, a group of
symptoms that indicates a pending migraine headache.
The most common aura is the visual symptoms such as
flashing light, zigzag lines, blind spots, and moving
spots. There may also be numbness or weakness on one
side of the body that marches up the arm, leg or face
over the course of minutes. Common migraine does not
have such aura. They are a common type of chronic headache.
They are more common than classic migraine. Classic
migraine accounts for only about one-sixth of all migraines.
Common migraine and other (rare) forms account for the
rest.
Migraines are sometimes triggered by lack of sleep,
MSG (monosodium glutamate), alcohol, stress, certain
food (chocolate), etc. Others may occur when blood vessels
of the head and neck spasm or constrict, which decreases
blood flow. In people who tend to have migraines, preventive
medications may reduce the number of incidences of headache.
In addition, it is usually recommended to avoid factors
that have triggered a migraine in the past.
The symptoms of migraine include headache, which has
the following characteristics: 1) throbbing, pulsating;
2) usually worst on the sides of the head; 3) may be
on only one side of the head; 4) may be severe or dull;
5) commonly lasts 4 to 36 hours; 6) may be associated
with nausea, vomiting, sensitivity to light and sound.
An aura may precede the headache (any of various symptoms
that indicate an impending migraine). Symptoms may be
present during the headache and disappear after the
headache is relieved (dizziness, tingling, or other
symptoms).
Migraine headache may be diagnosed by the health care
provider based on the pattern of symptoms, history of
migraines in the family, and the response to treatment.
In addition, a physical examination must show no detectable
abnormalities. Sometimes an MRI is obtained to rule
out other causes of headache, such as tumor, vascular
malformation or aneurysm, upon initial investigation.
Treatment of migraine includes multiple approaches.
Resting in a quiet, darkened room often reduces the
severity of symptoms. Drinking a lot of fluids is important
to maintain hydration especially if there is vomiting.
Several medications may be advised to relieve symptoms.
The response of migraine to medications is highly variable.
If a medication has been effective in relieving a previous
migraine, it may be tried before others. Over-the-counter
analgesics may reduce pain if they are taken early in
the development of the headache. If over-the-counter
analgesics are ineffective, vasoconstricting or other
medications may be helpful. Triptans (Imitrex, Zomig,
Amerge, Maxalt, Frova, etc) are very effective and relatively
safe medications. Ergotamine tartrate preparations constrict
the arteries of the head and may be used alone or in
combination with other drugs such as caffeine (Cafergot)
or fioricet. Ergonovine maleate may relieve symptoms.
Propoxyphene or other medications that relieve pain
and/or inflammation may provide relief for some people.
Nausea should be treated early with Reglan, Compazine,
or other antiemetics. Severe cases may need hospitalization
and steroids.
Preventive medications include propranolol, amitriptyline,
ergonovine, cyproheptadine, clonidine, methysergide,
calcium channel antagonists, valproic acid, and carbamazepine,
or other antidepressants. New anticonvulsant, Topamax,
has shown to be an effective prophylactic medication.
Others include new anticonvulsants such as trileptal,
lamictal, etc. Typically, several medications are tried
before an effective preventative medication is found.
Botox injection may also be effective.
The migraine will relieve with time. Treatment may
reduce discomfort and time away from work, improve quality
of life and may prevent future migraines. Rarely, people
with severe migraines may have a stroke.
A consultation with your health care provider is recommended
if this is the first time that you have had symptoms
of migraine; migraine symptoms are severe, persistent,
recurrent, or accompanied by other symptoms; if previously
effective treatments are no longer helpful, or if symptoms
indicating side effects of medications occur; or if
you are likely to become pregnant (many medications
should not be taken when pregnant).
If you are interested in scheduling an appointment
with one of CINN’s headache specialists, please
call 1-800-411-CINN.
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