CONDITIONS

Migraine

What Is Migraine

A migraine is a headache that involves throbbing or pulsing on one side of the head. It is very different from other headaches, which are typically characterized by duller, more widespread pain. The International Headache distinguishes a migraine by the length of the attacks (at least five over a period of time that depends on the individual, plus pain that lasts from four to 72 hours.) Experts have named four distinct stages of migraine, though not every migraine sufferer goes through them all. The stages are:

  • Prodrome occurs one to two days before the migraine itself. Patients may experience mood changes, sleepiness with frequent yawning, thirst, and an increased need to urinate.
  • Aura, or visual disturbance, occurs 30 minutes before the attack. Patients may experience partial vision loss, language problems, and tingling sensations.
  • The attack itself, which lasts from four to 72 hours. During the attack period, patients experience intense, throbbing pain, typically on one side of the head above the head, though it may occur in the entire head. Pain may worsen with physical activity or movement and is often accompanied by light, sound, and smell sensitivity, fainting, and nausea/vomiting.
  • Postdrome begins when the attack period finishes, and is characterized by an exhausted, hangover-like feeling which lasts for one to two.

According to the National Library of Medicine, Migraines usually appear for the first time between the ages of 10 and 45. They are three times more common among women than men, according to the Migraine Research Foundation. (Estrogen may be a culprit.) Occasionally, the NLM says, they may become less frequent during pregnancy. According to the National Headache Foundation, 37 million Americans suffer from migraines.

What Causes Migraine

According to the National Institutes of Health (NIH), a migraine headache is caused by abnormal brain activity. Most experts believe that the attack involves constriction/dilation of blood vessels, neural pathways, and brain chemicals, and that changes in those areas affect blood flow in the brain. The exact chain of events leading to migraine still isn’t entirely clear, and the brain activity can be triggered by a number of causes.

Experts believe that there are a number of triggers for migraine, including caffeine withdrawal, the hormonal changes that accompany menstruation or the use of birth control pills; loud noises or bright lights; odors (including perfumes); stress, anxiety, and drinking alcohol.

Migraines can also be triggered by certain foods. The most common food triggers include chocolate; food with monosodium glutamate (MSG); foods with tyramine (red wine, aged cheese, smoked fish); fruit (avocado, banana, citrus); meats with nitrates, including bacon and cured meats; and pickled or marinated foods.

Risk Factors For Migraine

The following are risk factors for migraines:

  • Family History. According to the Mayo Clinic, up to 90 percent of migraine sufferers have a family history of the ailment. Being the child of a migraine sufferer means that you have a good chance of being one, too.
  • Sex. Women are three times likelier than men to have migraines, and hormonal changes have linked to migraines in women. Migraines often begin around the onset of menstruation and it is not uncommon for them to grow less frequent after menopause.

Diagnosing Migraine

A physician can often diagnose migraines through a review of symptoms and family history. If migraines suddenly become worse, doctors may perform the following tests to rule out a more serious cause for the pain such as bleeding in the brain, tumors, and other serious conditions:

  • Blood tests, which can check for abnormalities in cell counts, blood sugars, and blood proteins.
  • CT scans, which use X-rays to obtain an image of the brain.
  • MRI scans, which uses radio waves to obtain an image of the brain
  • Spinal tap, in which the doctor inserts a thin needle between two of your vertebrae to get a sample of spinal fluid.

Symptoms of Migraine

Because everybody experiences migraines differently, symptoms may not be the same for all patients. Some patients experience limited symptoms surrounding the attack and extreme pain during the attack, and others experience noticeable symptoms leading up to the attack and after the attack, but experience less intense pain during the attack period.

Often, symptoms of migraines depend on the stage that the migraine is in. Not all migraine sufferers experience the same progression. If you are experiencing a combination of the following symptoms (even if they are out of order) you may be experiencing a migraine:


Prodrome. This is the period of time that occurs around 24 hours before a migraine. Symptoms may include:

  • Mood changes. Depression, irritability, etc.
  • Mental confusion. This may include difficulty finding words, or difficulty concentrating.
  • Hyperactivity
  • Food cravings
  • Fatigue
  • Sleepiness with excessive yawning
  • Constipation/diarrhea
  • Neck pain

Aura. This is the period right before the characteristic head pain of a migraine begins. Symptoms can include:

  • Hypersensitivity to touch and feel
  • Difficulty with language
  • Distorted sense of body image and reality (also known as Alice in Wonderland Syndrome; this symptoms is one of the most rare of the aura period)
  • Hearing loss
  • Visual, auditory, or olfactory hallucinations
  • Confusion
  • Dizziness
  • Tingling or prickling sensation in extremities
  • Vertigo
  • Partial vision loss, blurred vision, or appearance of lines, spots, or waves in line of vision

The attack. The actual migraine attack can last anywhere from four to 72 hours. Symptoms include:

  • Headache, frequently limited to one side of the head but can also occur in both simultaneously. Pain is severe, usually throbbing or pulsating, and can be worsened by physical activity.
  • Confusion
  • Dizziness
  • Vertigo
  • Dehydration
  • Diarrhea/Constipation
  • Hot flashes/chills
  • Nasal congestion/runny nose
  • Nausea/vomiting
  • Sensitivity to sound, light, and odors.

Postdrome. This is the “hang-over” phase of the migraine. Symptoms include:

  • Fatigue
  • Mental exhaustion
  • Depression

Prognosis

After a person has a number of migraines, the condition can build up to the point where he or she has a daily migraine. (The Migraine Research Foundation says that about 14 million people have headaches for at least 15 days per month). Health experts emphasize that medicine is important for controlling the condition. But the Migraine Research Foundation calls the condition “chronic,” and another organization, the Migraine Trust, says there is no cure. Steps can be taken to manage symptoms and occasionally prevent attacks.

Living With Migraine

Lifestyle changes can help migraine patients make their conditions less burdensome.

The following tips may help you reduce your migraine frequency:

  • Keep to a regular sleep schedule. Abrupt changes in sleep patterns – like sleeping in or staying up all night – can trigger migraines.
  • Exercise, but be careful not to overexert yourself. Moderate, regular exercise has been shown to decrease the frequency and severity of migraines. Overexertion, whether from working out or other physical activities like sex, can trigger migraines.
  • Eat regular meals. Don’t skip breakfast or eat all of your calories in one sitting. Migraines can be triggered by sharp changes in blood sugar levels, so it’s important to keep them as even as possible.
  • Watch your neck posture. Make sure you are sitting straight up at your computer and not bending your neck forward for long periods of time. Muscle strain in the neck may lead to migraines.
  • Try to reduce stress via such methods as yoga, tai chi, meditation, and spending time with loved ones. Stress can be a main factor in triggering and worsening migraines.
  • Do biofeedback therapy, in which you learn to control, through electronic monitoring, the reactions of your body so you can avoid headache pain.
  • Identify your triggers. Everyone is different. Some people may find that bright lights or sudden changes in weather may cause their migraines; others may find that migraines come from skipping a meal, or missing out on sleep. If needed, keep a daily journal to track things like mood, weather, energy level, and diet.

Screening

Some doctors choose to screen patients for migraines with a short questionnaire that asks if the patient experiences headaches, and if yes, how severe are they and how long do they last? This questionnaire has been proven to be effective in diagnosing migraines that would have otherwise gone unnoticed. If a doctor suspects a patient is suffering from migraines, he or she may conduct one or several diagnostic tests.

Prevention

If you have inherited a susceptibility to migraines, there aren’t too many things you can do to prevent migraines. But you can make lifestyle changes that will help. The most important one, according to the American College of Physicians (PCP), is to learn how to manage stress. They suggest getting enough sleep and exercise, as well as regular meals. Avoid environmental triggers that have caused you headaches, including bright light and smoke. You should also quit smoking.

According to the American College of Physicians (ACP), you should keep a headache journal. This journal, the ACP says, should detail the date of your migraine, how long it lasts, an intensity of pain scale from 1-10, preceding symptoms, triggers, relief measures and relief (whether it’s complete or moderate, and how much time it takes to get relief). This will help you get a handle on your migraine patterns and enable you to manage any preceding symptoms. For example, you could avoid red wine if you realize that’s a trigger for you. Share the information from your journal with your doctor so he or she can tailor your medication to your patterns.

Additionally, migraine sufferers should figure out their food triggers. The headache journal mentioned above can help you, although it may take a while to discover which foods are at fault. For example, the ACP cites the case of a patient thinking that having a chocolate bar might be a food trigger. But merely the desire for it might be a signal that a migraine is imminent. Chocolate isn’t a trigger for everyone, the ACP points out. Some sufferers actually benefit from the caffeine in it, the ACP says.

Medication And Treatment

Certain medications can help reduce migraine frequency and severity. These include:


Propanol (Inderal) This beta blocker medication can help prevent attacks in some patients who are having frequent migraines or severe, long-lasting attacks. Propranolol is a beta blocker medication, which is helpful in preventing migraine attacks in some patients. If a patient is having frequent attacks or severe, long-lasting attacks, it may be of help in cutting down the frequency of the attacks. As with all prescription drugs, this should be taken only under a doctor’s supervision.

Side effects of propanol include:

  • Dizziness or lightheadedness
  • Difficulty sleeping
  • Excessive tiredness
  • Upset stomach
  • Vomiting
  • Rash
  • Diarrhea
  • Constipation

Timolol (Blocadren) is a beta blocker that affects the blood flow through arteries and veins. Experts believe that some migraines are caused by the narrowing of veins and arteries, restricting blood flow and causing the condition.

Side effects include:

  • Fatigue
  • Trouble sleeping
  • Slowed heartbeat
  • Cold extremities

Selective serotonin receptor antagonists. This is a class of medications that works by reducing pain transmission signals to the brain and by stimulating serotonin receptors in the brain that can affect blood flow. Many selective serotonin receptor antagonists come in injectable forms.

  • Imitrex (Sumatriptan)
  • Naratriptan (Amerge)
  • Zolmitriptan (Zomig)
  • Rizatriptan (Maxalt)
  • Frovatriptan (Frova)
  • Eletriptan (Relpax)
  • Almotriptan (Axert)

Side effects of selective serotonin receptor antagonists vary from medication to medication, and may include:

  • Hypertension
  • Sexual Disorder
  • Depression
  • Suicidal thoughts

Botox (botulinum toxin), though primarily known as a cosmetic treatment, has been in use for years as a treatment for chronic migraine. It works by temporarily deadening nerve endings. Doing so makes the muscles too weak to contract and cause the headache.

Side effects of Botox include:

  • Pain and tenderness at the injection site
  • Headaches
  • Weakness
  • Pain and tenderness at the injection site
  • Drooping of the eyelid
  • Difficulty swallowing
  • Rash
  • Neck pain

Cefaly. In March 2014, the FDA approved the first electronic device to prevent migraines. A statement from the FDA said that Cefaly is a small, portable, battery-powered, prescription device that resembles a plastic headband worn across the forehead and atop the ears. The device applies an electric current to the skin and underlying body tissues to stimulate branches of the trigeminal nerve, which has been associated with migraine headaches. The FDA said that the device should be used just once a day for 20 minutes.

Less than 5% of patients experience side effects during Cefaly treatment. These include:

  • Intolerance to the feeling of Cefaly on the forehead
  • Fatigue
  • Headache
  • Skin irritation (allergic reaction to electrode)

In some cases, a surgical procedure that uses an endoscope (a slim tube) to work down under skin to the scalp may be effective. A group of scientists found earlier this year that surgery that went through the upper eyelid also seems to be effective. These procedures have yet to be FDA approved and remain controversial.


You can also try over-the-counter medicines such as acetaminophen, aspirin, and naproxen sodium (Aleve). But always ask your doctor if it is permissible for you to take these, since some of them may interact badly with other medicines you’re taking.

Complementary and Alternative Treatment

Complementary or alternative treatments may help migraine sufferers, but they should never be undertaken without consulting a doctor. The Mayo Clinic lists the following as possible alternative treatments:

  • Acupuncture. The insertion of thin, disposable needles into defined points on the body. Research shows that acupuncture can help headache pain.
  • Biofeedback. This relaxation technique, in which the patient is taught how to monitor and control stress-related physical responses, can be effective.
  • Massage therapy. Massages help reduce migraine frequency.
  • Herbs, vitamins and minerals. There is some evidence that an herb known as butterbur could help prevent migraines or reduce severity. Feverfew, another herb said to be a preventive, hasn’t been definitively proven to work. Other possibilities include riboflavin (vitamin B-2), coenzyme Q10 supplements (which may decrease the frequency of headaches but has no effect on severity), and magnesium. Again, none of these are definitively effective, and it’s essential to consult with your doctor before using any herbs.
  • Cognitive behavioral therapy. By teaching patients to think about and respond to problems in a new way, cognitive behavioral therapy may benefit some people with migraines.

Care Guide

  • Keep to a regular sleep schedule. Disruptions to a sleep pattern – i.e. staying up all night or sleeping in – can trigger migraines.
  • Exercise. However, be careful not to over exert. Regular exercise can help control migraine frequency and severity, but overexertion can trigger attacks.
  • Eat well. A well balanced diet can boost the immune system and help control blood pressure, energy levels, and mood.
  • Know your triggers. Each person has different triggers. Keep a journal to track your migraines and the circumstances around them.
  • Practice stress management as some migraines may be triggered by stress. Experts recommend journaling, meditation, deep breathing and yoga as some possible ways to manage or avoid stress.

When To Contact A Doctor

Even if you’ve been under a physician’s care for migraines, there may be times when you need immediate medical attention. Don’t hesitate to seek help if your headache is more sudden or more severe than usual, or if you have symptoms other than the ones you usually have.

Some symptoms are of special concern:

  • Loss of vision or consciousness
  • Uncontrollable vomiting
  • Weakness
  • Paralysis
  • Slurred speech
  • Stiff neck

In any case, better safe than sorry: ask for help right away if you think you need it.

Questions For Your Doctor

Your primary care physician will likely be able to diagnose your condition based on your symptoms and family history. If he or she feels your case needs a more specialized kind of treatment, you may be referred to a headache specialist. Your doctor will likely know a specialist in your area or insurance network. Another possibility is a headache clinic, which comprises experts from several fields, including psychologists, physical therapists and neurologists. To find certified practitioners in these fields, visit the Migraine Research Foundation’s website.

Questions For A Doctor

Since many people suffer from migraine symptoms before they even consult a doctor, a diagnosis of migraine usually isn’t unexpected. Unless there is some underlying condition, a migraine diagnosis is not life-threatening. It is, however, a chronic condition without a cure.

To gain a better understanding of your condition and what living with your condition will mean, ask your doctor these questions:

  • Do I need a prescription treatment for migraine?
  • If so, why, and which one do you recommend?
  • How high a dosage am I getting?
  • How long will it take to start working?
  • How long can I expect to be taking this?
  • What are the side effects?
  • Are there any other remedies you recommend in addition to this one?
  • What kind of lifestyle changes can I make so I can better manage my migraines?
  • What is the next step if this treatment doesn’t work?

Resources

These organizations are a good source for information about migraines:

American Migraine Foundation – is a nonprofit organization dedicated to research and awareness of migraines. It has a comprehensive list of links to other helpful organizations.

American Headache Society– is a good resource for patient tools such as questionnaires and forms to keep track of both lifestyle and food triggers.

The National Headache Foundation – is a patient-friendly site offers headache management tools such as questionnaires to determine the severity of a migraine, as well as live and taped webinars by experts.