Migraines

What is a migraine headache?

A migraine is a periodic, throbbing headache- usually on one side of the head.

What causes migraine?

The cause of migraine is unknown. One theory suggests that the nervous system is reacting to sudden changes in the body or the environment. Many researchers believe that people with migraines have a more sensitive nervous system response than other people do. During a migraine attack, changes in brain activity may cause blood vessels and nerves around the brain to become inflamed. Migraine drugs may give relief by quieting sensitive nerve pathways at nerve endings and in the brain itself. They may also have a direct effect in reducing the inflammation response itself.

What are the symptoms?

  • A moderate to severe headache that lasts 4 to 72 hours.
  • A throbbing pain, often on one side of the head.
  • Pain is worse when you exercise or move.
  • Your pain comes with an upset stomach and/or sensitivity to light, sound, and odors.

About one out of five people who have migraines also have an aura prior to the headache. If you have an aura, you may see flashing lights, temporarily lose your sight, or go numb on one side of your body. Usually, an aura lasts 5 to 30 minutes, but yours may be shorter or longer.

Migraine can strike anyone, at any age. It is most common in young women. If a close relative has migraines, you are more likely to have them.

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How is migraine diagnosed?

Migraine is often difficult to diagnose. No medical test can tell you if you have migraines. Instead, you must carefully tell your doctor about your headache and its symptoms. The following questions will help determine if you have migraine headaches:

  • How painful are your headaches?
  • How often do they happen?
  • How long do your headaches last?
  • Are there any other symptoms that happen with your headaches?
  • What medicines do you currently take?
  • What is your medical history?

In addition, your doctor will do a complete physical exam that will help determine if you are having migraine headaches.

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How is migraine treated?

While there is no cure, migraine is treatable with your help and proper medical care. Your treatment plan can reduce the effect that migraine has on your life by:
  • Identifying and controlling triggers that start a migraine.
  • Utilizing medications to prevent and treat migraine attacks.
  • Making healthy behavior and lifestyle changes.

To give you the best shot at success, you and your doctor must work as a team. A diary can be a very valuable tool. You will use it to help identify your migraine triggers, track how well your medications are working, and monitor the benefits of treatment and lifestyle changes. Regular follow-up visits and proper medication use can be your best route to control your headaches. Many people know and can avoid their migraine triggers.

Diet
Missed meals, alcohol (especially red wine), foods with monosodium glutamate (msg), preserved meats with nitrates and nitrites, and foods that contain tyramine, such as aged cheeses, may trigger migraine.

Sleep
Too much or too little sleep can trigger a migraine attack.

Hormones
Many women have migraine attacks linked to their menstrual cycles. Menstrual migraines can be more debilitating, more difficult to treat, and longer lasting than other migraines. Migraine is generally worse in early pregnancy, but improves in later pregnancy. Women generally have fewer migraines as they get older.

Environmental factors
Weather or temperature changes, glaring or fluorescent lights, computer screens, strong odors, and high altitude can trigger migraine.

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Migraine management

The goal of migraine management is to provide therapy that consistently relieves migraine symptoms, preserves the ability to function at normal or near-normal levels, and lessens the frequency and duration of future migraine attacks. Individuals who experience frequent attacks can take a prophylactic, or preventive, treatment so that migraines will strike less often and last for a shorter time.

Pain-relieving drugs for migraine attacks include:

  • Nonprescription (over-the-counter) medications, such as aspirin or acetaminophen, alone or in combination with antihistamines, decongestants or caffeine.
  • Prescription analgesics, including narcotics, non-narcotics, or both.
  • Nonsteroidal anti-inflammatory drugs.

Specific drugs used to stop migraine attacks include:

  • Ergot alkaloids, such as ergotamine and dihydroergotamine.
  • Triptans, such as sumatriptan, zolmitriptan, naratriptan, and rizatriptan (relatively new drugs developed specifically to stop migraine headaches).

Drugs used in hospital emergency rooms include:

  • Narcotics, anti-emetics (anti-nausea drugs), and corticosteroids.

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Migraine prevention

Sometimes migraines are so frequent or severe that preventive therapy is needed. Preventive therapy may also be used if pain medication at the time of your migraine does not work. While these drugs may not prevent all migraines, they often can reduce the frequency, pain and length of attacks.

Drugs used to prevent migraine included:

  • Antidepressants, such as amitriptyline, nortriptyline, and doxepin.
  • Beta-blockers, such as propranolol, metoprolol, timolol, or atenolol.
  • Calcium channel blockers, such as verapamil, diltiazem, or nifedipine.
  • Seratonin antagonists, such as methysergide.
  • Anticonvulsants, specifically divalproex sodium.
  • Vitamins, specifically riboflavin.

A physician should be contacted if your medication is becoming less effective or if you find you need to use more of the acute medication. Overuse of acute medication can lead to daily rebound headache.

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Progress through research

Research into the causes and treatments of migraine has led to numerous exciting discoveries that may result in more prevention and treatment options for people with migraine. The next generation of "triptan" drugs has arrived, and newer drugs are in testing. There is hope for migraine sufferers who cannot take or do not respond to the current medications.

Please contact the AAN Education & Research Foundation at (651)695-2712 to contribute to research on migraine and other neurological disorders. Only through continued research can we hope for more treatments and a cure.

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Information provided by the American Academy of Neurology, The Brain Matters campaign.

 
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