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Headache, Migraine

Migraine headaches are a common type of vascular headache experienced by about 12% of people.

Woman with migraine

Migraine headaches involve recurrent attacks of moderate to severe pain that is throbbing or pulsing and often strikes one side of the head, though both sides may ache. Other common symptoms are increased sensitivity to light, noise, and odors; and nausea and vomiting. Routine physical activity, movement, or even coughing or sneezing can worsen the headache pain.

Migraines occur most frequently in the morning, especially upon waking. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work. Many people feel exhausted or weak following a migraine but are usually symptom-free between attacks.

What happens during a migraine?

An untreated migraine attack usually lasts from 4 to 72 hours. This may unfold in four phases that can overlap.

What is a "Common" or "Classic" Migraine?

Most people with migraine headaches will experience either a "classic migraine" or "common migraine".

"Common migraine" is also called "migraine without aura". As its name implies, this is the most frequent form of migraine. Symptoms include headache pain that occurs without warning and is usually felt on one side of the head, along with nausea, confusion, blurred vision, mood changes, fatigue, and increased sensitivity to light, sound, or noise.

"Classic migraine" is also called a "migraine with aura". It includes visual disturbances (flashing lights, zigzag lines) and other neurological symptoms that appear about 10 to 60 minutes before the actual headache and usually last no more than an hour. Individuals may temporarily lose part or all of their vision. The aura may occur without headache pain, which can strike at any time.

Other classic symptoms include trouble speaking; an abnormal sensation, numbness, or muscle weakness on one side of the body; a tingling sensation in the hands or face, and confusion. Nausea, loss of appetite, and increased sensitivity to light, sound, or noise may precede the headache.

Both common and classic migraines can strike as often as several times a week, or as rarely as once every few years. Both types can occur at any time.

What are other types of migraines?

Other types of migraine headaches include:

Who Gets Migraine Headaches?

Migraine symptoms can begin in infancy, but are usually first experienced between the ages of 5 and 35. Although migraines affect both men and women, adult women are three times more likely to suffer migraine headaches than men.

Most people who suffer migraine headaches have a family history of headaches. This suggests that there is some genetic trait that may be inherited.

Migraine in women often relates to changes in hormones. Women may have "menstrual migraines" around the time of their menstrual period. These may disappear during pregnancy, while other women develop migraines for the first time when they become pregnant. Some are first affected after menopause.

Women with migraine who take birth control pills may experience changes in the frequency and severity of migraine attacks, while women who do not suffer from headaches may develop migraines as a side effect of oral contraceptives.

Migraine headaches also more frequently in people who have other medical conditions, such as eepression, anxiety, bipolar disorder, sleep disorders, and epilepsy.

What causes migraine headaches?

The precise cause of migraine headaches in unclear, but there is general agreement that blood flow changes in the brain are a key factor.

People who get migraine headaches have a nervous system that overreacts to a trigger such as stress by causing a spasm of the arteries at the base of the brain. This spasm closes down or constricts several arteries supplying blood to the brain. As these arteries constrict, the flow of blood to the brain is reduced. At the same time, platelets in the blood clump together and release a chemical called serotonin that further constricts the arteries.

This reduced blood flow decreases the brain's supply of oxygen and results in distorted vision or speech, and the general symptoms of an aura.

Then, other arteries within the brain react to the reduce oxygen supply and open wider (dilate) The dilation of these arteries triggers the release of pain-producing substances called prostaglandins from various tissues and blood cells. Chemicals which cause inflammation and swelling, and substances which increase sensitivity to pain, are also released. The circulation of these chemicals and the dilation of the scalp arteries stimulate the pain receptors in the arteries (there are no pain receptors in the brain tissue). A throbbing pain in the head results.

What triggers a migraine?

There are a variety of factors that can trigger a migraine attack in someone who is susceptible to developing migraine headaches. These triggers vary from person to person and include sudden changes in weather or environment, too much or not enough sleep, strong odors or fumes, emotion, stress, overexertion, loud or sudden noises, motion sickness, low blood sugar, skipped meals, tobacco, depression, anxiety, head trauma, hangover, some medications, hormonal changes, and bright or flashing lights.

Medication overuse or missed doses of medications may also cause headaches.

About one-half of migraine sufferers report that foods or certain ingredients can trigger their migraines. These include aspartame, caffeine (or caffeine withdrawal), wine and other types of alcohol, chocolate, aged cheeses, monosodium glutamate, some fruits and nuts, fermented or pickled goods, yeast, and cured or processed meats. Seemingly harmless foods as yogurt, nuts, and lima beans can result in a painful migraine headache. However, some scientists believe that these foods and several others contain chemical substances, such as tyramine, which constrict arteries - the first step of the migraine process.

Keeping a diet journal can help you identify foods that may trigger your migraines.

What are the treatment options for migraine?

Migraine treatment options include:

During a migraine headache, temporary relief can sometimes be obtained by applying cold packs to the head or by pressing on the bulging artery found in front of the ear on the painful side of the head.

Migraine Medications

For infrequent migraine, drugs can be taken at the first sign of a headache in order to stop it or to at least ease the pain. People who get occasional mild migraine may benefit by taking aspirin or acetaminophen at the start of an attack. Aspirin raises a person's tolerance to pain and also discourages clumping of blood platelets. Small amounts of caffeine may be useful if taken in the early stages of migraine.

For most people who suffer from moderate to severe migraines, stronger medications are usually necessary to effectively treat an acute headache.

Triptans are one of the most commonly prescribed medications for the treatment of migraine headaches. Triptans ease moderate to severe migraine pain and are available as tablets, nasal sprays, and injections. Some brands of triptans include Imitrex® (sumatriptan), Maxalt® (rizatriptan), Treximet® (sumatriptan and naproxen), and Zomig (zolmitriptan).

For optimal benefit, a triptan should be taken during the early stages of an attack. If a migraine has been in progress for about an hour after the drug is taken, a repeat dose can be given.

People are advised not to take triptans if they have angina pectoris, basilar migraine, severe hypertension, or vascular, or liver disease.

Ergotamines (Cafergot®) bind to serotonin receptors on nerve cells and decrease the transmission of pain messages along nerve fibers. They are most effective during the early stages of migraine and are available as nasal sprays and injections.

Taking headache relief drugs more than three times a week may lead to medication overuse headache (previously called rebound headache), in which the initial headache is relieved temporarily but reappears as the drug wears off. Taking more of the drug to treat the new headache leads to progressively shorter periods of pain relief and results in a pattern of recurrent chronic headache. Headache pain ranges from moderate to severe and may occur with nausea or irritability. It may take weeks for these headaches to end once the drug is stopped.

For headaches that occur three or more times a month, preventive treatment may be recommended. Medications used to prevent classic and common migraine include methysergide maleate, propranolol, amitriptyline, valproic acid, and verapamil.

Many antimigraine drugs can have adverse side effects. But like most medicines they are relatively safe when used carefully and under a physician's supervision. To avoid long-term side effects of preventive medications, reduce the dosage of these drugs and then stop taking them as soon as possible.

Take your medications exactly as directed.


Reference: National Institute of Neurological Disorders and Stroke