Migraine

Migraine (from the Greek words hemi, meaning half, and kranion, meaning skull[) is a debilitating condition characterized by moderate to severe headaches, and nausea. It is about three times more common in women than in men.

A migraine is a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head.

Some people who get migraines have warning symptoms, called an aura, before the actual headache begins. An aura is a group of symptoms, including vision disturbances, that are a warning sign that a bad headache is coming.

Causes, incidence, and risk factors

Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes they may begin later in life.

  • Migraines occur more often in women than men,
  • Migraines may run in families.
  • Some women, but not all, may have fewer migraines when they are pregnant.

A migraine is caused by abnormal brain activity, which is triggered by stress, certain foods, environmental factors, or something else. However, the exact chain of events remains unclear. Today, most medical experts believe the attack begins in the brain, and involves various nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues.

Migraine attacks may be triggered by:

  • Alcohol
  • Allergic reactions
  • Bright lights
  • Certain odors or perfumes
  • Changes in hormone levels (which can occur during a woman’s menstrual cycle or with the use of birth control pills)
  • Changes in sleep patterns
  • Exercise
  • Loud noises
  • Missed meals
  • Physical or emotional stress
  • Smoking or exposure to smoke

Certain foods and preservatives in foods may trigger migraines in some people. Food-related triggers may include:

  • Any processed, fermented, pickled, or marinated foods
  • Baked goods
  • Chocolate
  • Dairy products
  • Foods containing monosodium glutamate (MSG)
  • Foods containing tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans
  • Fruits (avocado, banana, citrus fruit)
  • Meats containing nitrates (bacon, hot dogs, salami, cured meats)
  • Nuts
  • Onions
  • Peanut butter

This list may not include all triggers.

True migraine headaches are not a result of a brain tumor or other serious medical problem. However, only an experienced health care provider can determine whether your symptoms are due to a migraine or another condition.

Symptoms

Vision disturbances, or aura, are considered a “warning sign” that a migraine is coming. The aura occurs in both eyes and may involve any or all of the following:

  • A temporary blind spot
  • Blurred vision
  • Eye pain
  • Seeing stars or zigzag lines
  • Tunnel vision

Not every person with migraines has an aura. Those who do usually develop one about 10 – 15 minutes before the headache. However, it may occur just a few minutes to 24 hours beforehand. A headache may not always follow an aura.

Migraine headaches can be dull or severe. The pain may be felt behind the eye or in the back of the head and neck. For many patients, the headaches start on the same side each time. The headaches usually:

  • Feel throbbing, pounding, or pulsating
  • Are worse on one side of the head
  • Start as a dull ache and get worse within minutes to hours
  • Last 6 to 48 hours

Other symptoms that may occur with the headache include:

  • Chills
  • Increased urination
  • Fatigue
  • Loss of appetite
  • Nausea and vomiting
  • Numbness, tingling, or weakness
  • Problems concentrating, trouble finding words
  • Sensitivity to light or sound
  • Sweating

Symptoms may linger even after the migraine has gone away. Patients with migraine sometimes call this a migraine “hangover.” Symptoms can include:

  • Feeling mentally dull, like your thinking is not clear or sharp
  • Increased need for sleep
  • Neck pain

Treatment

There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or changing your triggers.

A good way to identify triggers is to keep a headache diary. Write down:

  • When your headaches occur
  • How severe they are
  • What you’ve eaten
  • How much sleep you had
  • Other symptoms
  • Other possible factors (women should note where they are in their menstrual cycle)

For example, the diary may reveal that your headaches tend to occur more often on days when you wake up earlier than usual. Changing your sleep schedule may result in fewer migraine attacks.

When you do get migraine symptoms, try to treat them right away. The headache may be less severe. When migraine symptoms begin:

  • Drink water to avoid dehydration, especially if you have vomited
  • Rest in a quiet, darkened room
  • Place a cool cloth on your head

Many different medications are available for people with migraines. Medicines are used to:

  • Reduce the number of attacks
  • Stop the migraine once early symptoms occur
  • Treat the pain and other symptoms

REDUCING ATTACKS

If you have frequent migraines, your doctor may prescribe medicine to reduce the number of attacks. Such medicine needs to be taken every day in order to be effective. Such medications may include:

  • Antidepressants such as amitriptyline
  • Blood pressure medicines such as beta blockers (propanolol) or calcium channel blockers (verapamil)
  • Seizure medication such as valproic acid, gabapentin, and topiramate
  • Selective norepinephrine uptake inhibitor (SNRIs) such as venlafaxine

Botulinum toxin (Botox) injections may also help reduce migraine attacks.

STOPPING AN ATTACK

Other medicines are taken at the first sign of a migraine attack. Over-the-counter pain medications such as acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. If these don’t help, ask your doctor about prescription medications. (Be aware, however, that overuse or misuse of such pain medications may result in rebound headaches.Chronic rebound headaches typically occur in people who take pain medications more than 3 days a week on an ongoing basis.)

Your doctor can select from several different types of medications, including:

  • Triptans — the most frequently prescribed medicines for stopping migraine attacks — such as almotriptan (Axert), frovatriptan (Frova), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
  • Ergots such as dihydroergotamine or ergotamine with caffeine (Cafergot)
  • Isometheptene (Midrin)

These medications come in different forms. Patients who have nausea and vomiting with their migraines may be prescribed a nasal spray, suppository, or injection instead of pills.

Some migraine medicines narrow your blood vessels and should not be used if you are at risk for heart attacks or have heart disease, unless otherwise instructed by your health care provider. Ergots should not be taken if you are pregnant or planning to become pregnant, because they can cause serious side effects to an unborn baby.

TREATING SYMPTOMS

Other medications are primarily given to treat the symptoms of migraine. Used alone or in combinations, these drugs can reduce your pain, nausea, or emotional distress. Medications in this group include:

  • Nausea medicines such as prochlorperazine
  • Over-the-counter pain relievers such as acetaminophen (Tylenol)
  • Sedatives such as butalbital
  • Narcotic pain relievers such as meperidine
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen

If you wish to consider an alternative, feverfew is a popular herb for migraines. Several studies, but not all, support using feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, know that herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.

Expectations (prognosis)

Every person responds differently to treatment. Some people have rare headaches that require little to no treatment. Others require the use of several medications or even occasional hospitalization.

Complications

Migraine headache is a risk factor for stroke in both men and women.

Migraine headaches generally represent no significant threat to your overall health. However, they can be a long-term (chronic) problem and may interfere with your day-to-day life.

Prevention

Understanding your headache triggers can help you avoid foods and situations that cause your migraines. Keep a headache diary to help identify the source or trigger of your symptoms. Then modify your environment or habits to avoid future headaches.

Other tips for preventing migraines include:

  • Avoid smoking
  • Avoid alcohol
  • Avoid artificial sweeteners and other known food-related triggers
  • Get regular exercise
  • Get plenty of sleep each night
  • Learn to relax and reduce stress — some patients have found that biofeedback and self-hypnosis helps reduce the number of migraine attacks

References : ncbi.nlm.nih.gov/pubmedhealth/PMH0001728/

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About mdmedicine

Medical student. Interested in learning and promoting medical field.
This entry was posted in Clinical Cases and tagged , , , , , , , . Bookmark the permalink.

One Response to Migraine

  1. Kerry says:

    Very nice basic overview of migraines. However, I think that it should be stressed that a regular sleep routine is very important rather than getting plenty of sleep. Change in sleeping patterns is a recognized problem, as is too much sleep.

    I’d recommend that any medically-oriented person look at Robert A. Davidoff’s book Migraine: Manifestations, Pathogenesis, and Management. I’ve read entirely too much over the years in an attempt to understand things.

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