Migraine Headaches

Introduction

Although any head pain can be miserable, a migraine headache is often disabling. In some cases, these painful headaches are preceded or accompanied by a sensory warning sign (aura). A migraine headache is also often accompanied by other signs and symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. Migraine pain can be excruciating and may incapacitate you for hours or even days.

Signs and symptoms

A typical migraine headache attack produces some or all of these signs and symptoms:

• Severe pain — many migraine headache sufferers feel pain on only one side of their head, while some experience pain on both sides
• Pain that hinders your regular daily activities
• Nausea with or without vomiting
• Sensitivity to light and sound

When left untreated, a migraine headache typically lasts from four to 72 hours, several times a month or just once or twice a year.

Not all migraine headaches are the same. Most people suffer from migraines without auras, which were previously called common migraines. Some have migraines with auras, which were previously called classic migraines. Auras may include:

• Sparkling flashes of light
• Dazzling zigzag lines in your field of vision
• Slowly spreading blind spots in your vision
• Tingling, pins-and-needles sensations in one arm or leg
• Rarely, weakness or language and speech problems

Whether or not you have auras, you may have one or more sensations of premonition (prodrome) several hours or a day or so before your headache strikes.

Migraine headache triggers
Whatever the exact mechanism of headaches, a number of things may trigger them. Common migraine headache triggers include:

• Hormonal changes. Women with a history of migraines often have reported headaches immediately before or during their periods. Others report more migraines during pregnancy or menopause. Hormonal medications, such as contraceptives and hormone replacement therapy, also may worsen migraines.
• Foods. Certain foods appear to trigger headaches in some people. Common offenders include alcohol; aged cheeses; chocolate; monosodium glutamate — a key ingredient in some Asian foods; certain seasonings; and many canned and processed foods. Skipping meals or fasting also can trigger migraines.
• Stress. Stress at work or home also can instigate migraines.
• Sensory stimulus. Bright lights and sun glare can produce head pain. So can unusual smells — including pleasant scents, such as perfume and flowers, and unpleasant odors, such as paint thinner and secondhand smoke.
• Physical factors. Intense physical exertion, including sexual activity, may provoke migraines. Changes in sleep patterns — including too much or too little sleep — also can initiate a migraine headache.
• Changes in the environment. A change of weather, season, altitude level, barometric pressure or time zone can prompt a migraine headache.

Risk factors

Many people with migraines have a family history of migraine. If both your parents have migraines, there’s a good chance you will too. Even if only one of your parents has migraines, you’re still at increased risk of developing migraines.

You also have a relatively higher risk of migraines if you’re young and female, women are three times as likely to have migraines as men are. Headaches tend to affect boys and girls equally during childhood but increase in girls after puberty.

Screening and diagnosis

If you have typical migraine headaches or a family history of migraines, your doctor will likely diagnose the condition based on your medical history and a physical exam.

You may have vision tests, a computerized tomography (CT) head scan or magnetic resonance imaging (MRI).

Treatment

Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine headache. It may help if you rest or sleep in a dark room after taking them:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen or Paracetamol.
• Triptans. Sumatriptan (Imitrex) was the first drug specifically developed to treat migraines. Sumatriptan works faster than any other migraine-specific medication and is effective in most cases.

Preventive medications
Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of pain-relieving medicines used during migraine attacks. In most cases, preventive medications don’t eliminate headaches completely.

Prevention

Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you:

• Avoid triggers. If certain foods seem to have triggered your headaches in the past, eat something else. If certain scents are a problem, try to avoid them. Try to establish a daily routine with regular sleep patterns and regular meals.
• Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. Choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches.
• Quit smoking. If you smoke, talk to your doctor about quitting. Smoking can trigger headaches or make headaches worse.

Self-care

Self-care measures can help ease the pain of a migraine headache. Try these headache helpers:

• Keep a diary. A diary can help you determine what triggers your migraines. Note when your headaches start, how long they last and what if anything, provides relief. Be sure to record your response to any headache medications you take. Also pay special attention to foods you ate in the 24 hours preceding attacks, any unusual stress, and how you feel and what you’re doing when headaches strike.
• Try relaxation exercises. Progressive muscle relaxation, meditation and yoga don’t require any equipment. You can learn them in classes or at home or spend at least a half-hour each day doing something you find relaxing — listening to music, gardening, taking a hot bath or reading.
• Get enough sleep, but don’t oversleep. The average adult needs seven to nine hours of sleep a night.
• Rest and relax. If possible, rest in a dark, quiet room when you feel a headache coming on. Apply gentle pressure to painful areas on your scalp.