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Migraine

Migraine

Wednesday, April 17, 2013 - 13:44

Contributing Author: Guy Slowik FRCS

What is Migraine? What are the symptoms of migraine? How is it treated?

A migraine is a severe headache that lasts from three hours to a few days. Often, migraines are accompanied by disturbances of vision, nausea, and vomiting. Migraine sufferers tend to experience repeated attacks. The frequency of attacks ranges from less than once a month to four or more attacks a month.

The National Headache Foundations estimates that 28 million Americans experience migraines each year. Migraines are slightly more common in women than in men. About 25 percent of women, and 10 percent of men, will experience migraine headaches at some point during their lives. Migraines can affect infants and children, as well. Typically, migraines begin during young adult life, but anyone can experience migraines for the first time at any age.

There are two types of migraine: with and without aura.

Migraine with aura (previously called classical migraine). People who experience migraine with aura usually have a clear set of indicators that a migraine is about to begin. The person may feel dizzy or faint, see flashes of light, have blind spots in the vision, or feel tingling or muscle weakness in the arm (these are the ‘aura’). Hearing, taste, and smell can also be affected. These signs usually last from five to 30 minutes but can last for hours before the headache begins.

Migraine without aura (previously called “common migraine”) is the most common type of migraine. Headache pain usually begins without warning and is often felt on one side of the head. During the headache, the person may experience blurred vision, confusion, nausea, changes in mood, fatigue, and increased sensitivity to light and noise.

Symptoms of Migraine

Symptoms of migraine may include a throbbing or aching headache, nausea, vomiting, sensitivity to light and sound. Most commonly, the person will feel fatigued and miserable, a condition calledmalaise. The person will likely wish to lie down, often in a darkened, quiet room. Some people may experience severe stabbing pain, lasting a minute or two, referred to as “ice-pick” headaches. Pain may be felt in all part of the head and face; typically, one side is worse than the other.

Migraines usually occur in four stages:

  1. Premonitory symptoms begin up to a day before a migraine develops. The person may experience food cravings, experience mood swings, yawn uncontrollably, and be mildly confused or “spacey.” Fluid retention or increased urination are also common.

  2. Aura. People who experience migraine with aura often “see” flashing or bright lights immediately before or during the migraine. Others may experience muscle weakness or feel as if they are being touched or grabbed.

  3. Headache. A migraine headache usually starts gradually and worsens before it gets better. Migraine can occur without a headache

  4. Postdrome (after the headache). The person may be extremely tired or confused for up to a day after a migraine.

What Causes Migraine?

Experts do not know exactly what causes migraine headaches. However, recent research suggests that migraines are a type of vascular headache, in which blood vessels in the brain become inflamed. It is thought that the swollen blood vessels press on nearby nerves that are sensitive to pain, causing them to send pain signals to the brain.

Inflammation may begin in the nerve that supplies the face with most of its sensory information, called the trigeminal nerve . The trigeminal nerve may also send a signal for inflammation to blood vessels. Among the most troublesome blood vessels is the temporal artery, which is located on the outside of the skull on the side of the head at the same level as the eyes.

A small percentage of people who experience migraines can identify situations that lead to migraines, called migraine triggers. For these people, avoiding triggers is a general, but not foolproof, way to prevent migraines. Exposure to a migraine trigger may not always lead to a migraine; conversely, a migraine can develop even if they avoid triggers.

Heredity may play a role in determining who gets migraines. As many as 70 percent of people who experience migraines have a first-degree relative – mother, father, brother, or sister – who also have migraine episodes.

Potential migraine triggers include:

The Environment

  • Allergies and allergic reactions

  • Loud noises

  • Bright lights

  • Some odors or perfumes

  • Exposure to tobacco smoke or smoking

Foods

  • Alcoholic beverages or foods containing alcohol

  • Caffeine

  • Foods that contain:

    • Monosodium glutamate (MSG)

    • Tyramine (aged cheeses, smoked fish, red wine, figs, and some beans)

    • Nitrates (hot dogs, salami, and other processed meats)

  • Other common food culprits include dairy products, nuts, peanut butter, avocado, banana, citrus, onions, pickled foods, and chocolate.

Lifestyle

  • Physical or emotional stress

  • Changes in sleep patterns or irregular sleep, including sleeping too little and too much.

  • Skipping meals, fasting, or – conversely – overeating.

Hormones

  • Menstrual cycle : Some women get migraines around the time of their periods.

  • Hormonal changes that occur in women who are beginning the menopause

 

Treatment for Migraines

The goals of treatment for migraines are alleviating pain and other symptoms and preventing further attacks. First-line treatment consists of comfort, medications, and prevention. Alternative therapies may help some people.

Comfort and rest can often help to lessen migraine symptoms. In some cases, quick action can help prevent the migraine altogether. If you feel a migraine coming on, or if you are experiencing a migraine, take the following steps:

  • Nap or rest with your eyes closed in a dark, quiet room

  • Place a cool cloth or ice pack on your forehead

  • Drink plenty of fluids, especially water. Avoid beverages with added sugar or excessive caffeine.

  • Take small amounts of caffeine shortly after the migraine begins

Medications can help prevent and alleviate migraine pain. Medications to help stop an ongoing migraine – called “abortive” or “acute” medications – work by reducing inflammation and pain. They should be taken as early as possible during the migraine.

Medications for acute migraines include both over-the-counter (OTC) and prescription medications :

  • Over-the-Counter medications: Many people find relief from migraine pain with OTC pain relief medications such as asipirin, acetaminophen (Tylenol), or non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil), naproxyn (Aleeve), or aspirin. These medications work best for people experiencing mild migraine pain.

 

What you Need to Know about Asprin

Aspirin is one of the most commonly used analgesic drugs. It is widely available as an over-the-counter drug, cheap, and effective in relieving pain and fever. Like any other drug, however, it is not without side effects. Aspirin (or its herbal equivalent, willow bark) can cause serious problems in children, teens, and young adults, as well as pregnant women and adults who are sensitive to the drug.

Always take the following precautions when using aspirin:

  • Never give aspirin to children or teens less than 20 years of age, as it can cause Reye’s Syndrome , a devastating liver disease.

  • Because aspirin affects the body’s ability to excrete uric acid, beople with kidney disease , gout , or hyperuricemia should also avoid aspirin.

  • Aspirin and other NSAIDS also increase the risk of bleeding in the stomach. People with peptic ulcers, , diabetes, or other gastrointestinal problems should consult their doctors before using aspirin.

  • People who are taking other medications to thin the blood, such as warfarin (Coumadin) should use aspirin only with a doctor’s supervision.

  • Generally, pregnant women should not take aspirin, especially during the third trimester of their pregnancies.

 

 

  • Prescription medications: If your migraine pain is moderate to severe, your doctor may prescribe one or more medications to help you handle the pain and nausea of acute attacks. Prescription medications used for migraine attacks include:

    • Triptan drugs, which increase levels of the neurotransmitter serotonin in the brain. Serotonin lowers the pain threshold, making it easier for you to handle pain, and causes blood vessels to constrict, lessening the pain signals in the head. Triptans are the preferred treatment for moderate to severe migraine pain.

    • Ergot derivative drugs, which work by binding to serotonin receptors on nerve cells, thus lessening the transmission of pain signals along nerve fibers.

    • Combination analgesics, which contain a “cocktail” of drugs such as acetaminophen, caffeine, and a narcotic. These medications may help people whose pain is not relieved by simple analgesics.

    • Narcotics, which work by interfering with pain receptors on nerve cells. A short course of narcotics may be prescribed for people who do not find relief with other medications. Narcotics generally should not be used to treat chronic headaches.

    • Anti-nausea drugs can lessen queasiness and vomiting.

 

Medications may also be prescribed to help prevent or reduce the severity of migraine attacks. Only some people need these medications, which are taken daily. Preventive medications are recommended for people whose migraines occur more than one or more times per week or if migraines of any frequency are disabling. People who take medications for headaches more than three times per week should also take preventive medications.

Preventive medications include:

  • Anticonvulsants increase levels of some neurotransmitters and dampen pain signals. They are useful for people who have other types of headache in addition to migraine.

  • Beta-blockers may help lessen migraines by helping to control blood pressure

  • Calcium channel blockers help stop blood vessels from either narrowing or widening, thus controlling blood flow to the brain and reducing pain signals. They are generally used to treat high blood pressure.

Antidepressants affect different chemicals in the brain and may help migraine sufferers. Antidepressants work by they increasing the production of serotonin and may also affect levels of other chemicals, such as norepinephrine and dopamine. Antidepressants used for migraine treatment include selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants (which are also used to treat tension-type headaches).

 

Alternative Treatments for Migraines

Some people have found that vitamins, supplements, and herbal remedies help to relieve migraine symptoms. Effective natural remedies include:

  • Riboflavin (vitamin B2)

  • Magnesium

  • Coenzyme Q10

  • Butterbur

Always check with your doctor before taking any natural remedies. Many natural remedies may interact with prescription medications, either increasing or negating their effects.

Other alternative therapies and lifestyle changes may also help prevent migraine and reduce the severity of attacks:

  • Biofeedback and relaxation training both help people cope with or control pain and the body's response to stress.

  • Acupuncture – or even acupressure – treatment is also sometimes helpful in controlling pain.

  • Exercise regularly

  • Avoid known migraine triggers, especially foods, beverages, and tobacco smoke

  • Eat regularly scheduled, well-balanced meals

  • Drink plenty of non-caffeinated, low-sugar fluids

  • Adhere to a consistent sleep schedule

  • Lose weight if you are overweight or obese

  • Ask your doctor to review your medications with you. Some medications can trigger migraines

 

 

Whats's the difference between a migraine and a tension headache?

 

Many people are unclear about which symptoms constitute a migraine and which a tension headache. People sometimes mistake a severe tension headache for migraine headache. However, a severe tension headache can lead to migraine. The following chart can help you to differentiate.

 

Symptom

Tension

Migraine

How bad is your pain?

     Mild to moderate

X

X

     Moderate to severe

X

 

     Intense pounding or throbbing
     and/or debilitating

 

X

     Distracting , but not debilitating

X

 

     Steady ache

X

X

Where is your pain?

     One side of head

 

X

     Both sides of head

X

X

Other symptoms

     Nausea, vomiting

 

X

     Sensitivity to light and/or sounds

Rare

X

     Aura before headache begins

 

X