Migraines
Not just a headache
If you've ever had one, you know why migraines are sometimes referred to as "suicide headaches" or "sick headaches." Often accompanied by nausea and vomiting, migraine headaches are more common than most people realize. It is estimated that approximately 23 million people a year are affected. The symptoms aren't always easy to identify, and some don't report them for fear being labeled with a psychiatric disorder. One of the most often-heard complaints of migraine sufferers is that their loved ones really don't understand the severity of the pain that accompanies a migraine. Yet, as painful as the condition can be, there are simple, effective treatments that really do help.
Synonyms
- Sick headache
Detailed Description
The cause of migraines is not fully understood, although it is known that a migraine is a vascular headache, as opposed to a tension headache. The process usually begins with the constriction of blood vessels in the head and neck. Next, those same blood vessels dilate. The throbbing, intense pain of migraine is usually felt during the dilatation phase. Why the blood vessels constrict and then dilate, however, is the question.
There is evidence that a family history of the condition makes you more likely to experience migraines. Somewhere between 50% to 80% of sufferers have a close relative who also had migraines. Certain activities, foods, or emotional situations seem to act as triggers for people susceptible to migraines. In fact, foods are high on the list as familiar migraine triggers for many people.
While headaches might seem an adult problem, children and adolescents are not strangers to migraine headaches. In fact, most people who suffer from migraines have their first experience before age 20, and sometimes before age 10. The headaches typically continue into the 30s and 40s. Growing older has its advantages for those who suffer from migraines, as the attacks seem to lessen considerably in severity and frequency, or stop entirely after age 50. Until then, however, treatments are available that can usually help people avoid or stop most migraine episodes. For women, pregnancy often temporarily halts migraines, which may later stop completely with menopause.
There are also several types of migraine headaches, with the two main categories being "classic" and "common".
- Classic migraine. This type begins with a "warning period," often called a "prodrome" or "aura." This aura is a brief (10-to 20-minute) period where any of the following symptoms may occur: changes in mood, lightheadedness, fatigue, loss of appetite often accompanied by nausea and vomiting, extra-sensitivity to light and sound, disruption of thought processes, blurring of vision or "seeing stars," flashes or zigzag patterns of light, or a prickling of the fingers spreading up the arm to the face.
Most classic migraines occur on only one side of the head -- sometimes over one temple or eye -- with a deep, throbbing pain. However, in some cases, the pain migrates from side to side, and then sometimes affects both sides simultaneously. Some attacks are mild, some severe. - Common migraine. Approximately 75% to 80% of migraine attacks are of this type. A common migraine typically has no prodrome or warning signals. Not much difference exists in the pain intensity, but the pain sequence can be different than that of the classic migraine, and can occur frontally as well as in one, or both, sides of the head.
How Common Are Migraines?
This condition is quite prevalent in the United States. Though statistics on the condition vary, between 15% to 30% of adult women and 5% to 20% of adult men are affected by migraines. The sex ratio of this disease varies with the age group considered. On the whole, more women than men are affected. Migraines are seen in all age groups, but are most prevalent between ages 45 and 64.
Theoretical Causes
The cause of migraines has not yet been determined. Marked pulsing of vessels in the head has been noted for decades. The role of chemicals -- including serotonin -- which signal blood vessels and nerves continues to be investigated.
Risk Factors
A number of factors may put you at greater risk for developing this condition:
- Family history of migraines
- Being a woman
- Age (between 45 and 64)
- Cyclic vomiting, abdominal pain, and/or motion sickness during childhood
- Smoking
- Excessive drinking of alcohol
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Several alternative-care choices have proven successful for some people. These include supplements, herbal preparations, relaxation techniques, and acupressure/acupuncture.
Symptoms
If you display the following symptoms, you may be suffering from migraines.
Migraine headaches are preceded by the following:
- Aura (changes in vision which include seeing geometric patterns, blind spots, and/or shimmering lights that may last several minutes or hours)
- Changes in the way you perceive your environment
- Sensations on the face or arms
- Mood changes
- Fatigue
- Muscle tension
- Yawning
Migraine headaches:
- Usually appear one hour after the aura ends
- Include pain (and possibly throbbing) in one or both temples
- Are accompanied by nausea, vomiting, diarrhea, extreme sensitivity to light, fear of sound, sore muscles, lightheadedness, and/or dizziness
After a migraine headache these symptoms may linger:
- Inability to concentrate
- Fatigue
- Sore muscles
Conditions That May Be Mistaken for Migraines
A number of other conditions exhibit similar symptoms and may be confused with migraines. They include the following:
- Tension-type or cluster headaches
- Headaches caused by an underlying condition (including infection such as meningitis, stroke, temporal arteritis, brain aneurysm, and drug use
- Psychiatric diseases
How Migraines Are Diagnosed
To determine if your symptoms are caused by a migraine, your physician will perform a complete physical examination and take a personal and medical history, asking about the location, severity, duration, and frequency of your headaches, as well as other symptoms you may have and medications you may be taking. If you have a family history of migraines, you may want to tell your physician.
Laboratory Tests
Laboratory tests used to see if the headache is actually a symptom of an underlying condition may include a complete blood count (CBC), serum chemistry profile, cerebral spinal fluid sample, and an ocular exam.
Imaging
In some cases a sinus X-ray maybe be taken. When associated neurological impairment is severe or long-lasting, or migraine attacks are not typical, magnetic resonance imaging (MRI) and computed tomography (CT) scans are used to rule out structural damage.
Goals of Treatment
There is no cure for migraine headaches, but for most people an effective treatment can be found, whether it be medication, behavioral and alternative-care treatment, or self-help. The goal is to prevent an attack or halt an oncoming attack. If a full-blown migraine headache is not stopped or prevented, then the goal is to relieve the pain.
Treatment Overview
Because each person's migraine headache can have a unique combination of triggers, possible treatments include a wide variety of therapies. Medications, diet, and relaxation techniques may be integrated, customizing the treatment plan to each individual case. A combination of health providers, including neurologists, neuropsychiatrists, and clinical psychologists may be consulted. There are many self-care measures that may be employed, enabling each person to take an active part in minimizing or eliminating the migraine attacks.
Drug Therapy
Drugs most commonly prescribed
- Acetaminophen, Caffeine, and Butalbital (fioricet) with or without codeine
- Advil, Motrin (ibuprofen)
- Amerge (naratriptan)
- Ergostat, Cafergot, and others (ergotamine)
- Fiorinal (aspirin, caffeine, and butalbital with or without codeine
- Imitrex (sumatriptan)
- Maxalt (rizatriptan)
- Midrin (acetaminophen, isometheptene, and dichloralphenazone)
- Naprosyn (naproxen)
- Reglan (metoclopramide) for nausea
- Zomig (zolmitriptan)
Second choices
- Tylenol # 3 (acetaminophen with codeine)
- Roxanol (morphine)
Drugs used for prophylaxis
- Beta-blockers such as Inderal (propranolol)
- Tricyclic antidepressants such as Elavil (amitriptyline)
- Calcium-channel blockers such as Calan (verapamil)
- Anticonvulsants such as Depakote (divalproex sodium)
- Serotonin antagonists such as Sansert (methysergide)
Activity & Diet Recommendations
During an attack, a quiet, dark room with a place to lie down is the best place for a person with a migraine. Usually, normal activity can be resumed after the attack, but there may be a strong urge to sleep.
Food can play a key role in migraines. Almost all people who experience migraines are sensitive to alcohol, and many are also sensitive to chocolate and MSG. Reducing other foods may be considered on an individual basis by trial elimination. Suspect foods and ingredients include the following:
- Alcohol in any form (red wine especially)
- MSG (monosodium glutamate)
- Chocolate
- Nitrates (in cured and processed meats)
- Pickles and fermented foods
- Aged cheeses
- Aspartame (Nutrasweet)
- Peanut butter and nuts
While caffeine is sometimes used as a migraine pain-relief component, it can also act as a trigger, so avoid caffeine or watch your intake carefully.
Possible Complications
There are a few (rare) possible complications produced by migraines, including the following:
- Status migrainosis (a continual migraine headache)
- Cerebral ischemic events (stroke)
- Iatrogenic effects of treatment (treatment-induced complications)
Quality of Life
If you feel that your quality of life suffers greatly from the experience of migraine attacks, it may make sense to assess the nature of your migraine headaches more thoroughly. For instance, if you have not yet determined your specific triggers, try to do so. Everyone is different when it comes to migraine headaches, and what may work for someone else may not work for you. If there is a trigger activity or emotional situation that you can pinpoint, try to avoid it in the future.
If you do not experience them yourself, but are involved with someone who does have migraine headaches, take heed. A major complaint of those afflicted is that the pain is more severe than their families or friends realize, and they may feel isolated in their pain.
Considerations for Women
Though more women suffer from migraines than men, women get a reprieve with the onset of menopause, and usually with pregnancy as well. Headaches may also fluctuate in frequency and intensity during a menstrual cycle.
If you are planning a pregnancy, are pregnant, or are breastfeeding, you should inform your doctor. Many medications are not recommended during these circumstances.
Considerations for Children and Adolescents
Sometimes children are less able to articulate how a particular pain feels. It may also be difficult for them to point to the spot where they feel pain. Be prepared to ask your child particular questions to determine whether it is a migraine or another kind of headache. Apply cold packs during an attack. Have your child lie down in a dark, quiet room. After a bout with a migraine your child may need to rest a while longer. After resting, he or she should be able to enjoy normal activity.
Supplements
Magnesium: Several studies show that it may help to minimize migraines. For example, in one two-month study, Italian researchers gave 20 female migraine sufferers either a placebo or magnesium (360 mg a day). The women taking magnesium reported briefer, milder migraines. [1]
Herbs
Feverfew: Since 1985, several studies have shown that this herb (50 mg/day) can help prevent migraine attacks. For example, Israeli researchers gave 57 migraine sufferers a placebo or feverfew. Eight weeks later, the feverfew group switched to the placebo, and vice versa, for another eight weeks. While taking feverfew, the participants reported significantly fewer headaches. [2]
Relaxation
Deep relaxation is a major boon to people with migraines. At Ohio University, researchers reviewed 25 studies in which relaxation therapies were used to prevent migraines and compared them with studies that used drugs to prevent the headaches. Tested against a control group that took placebos, both treatments produced the same benefit -- a significant reduction in migraine attacks. [3] Biofeedback was the most effective relaxation treatment, but meditation, deep breathing, and visualization produced similar benefits.
Biofeedback sessions teach you to redirect blood flow away from the dilated vessels in the head. You will most likely need a few sessions of practice to learn this method. You take the learning sessions when you are not experiencing the headache, so that you can make use of the technique the next time you feel an attack.
With hypnosis or self-hypnosis, a certified hypnotist can make suggestions and even teach you how to perform self-hypnosis in order to avoid or halt headaches.
Acupuncture
An ancient Chinese practice, acupuncture consists of inserting very fine needles into the skin along a series of energy channels or paths known as meridians. It stimulates particular areas or systems of the body to promote healing and wellness.
Acupuncture is an effective treatment for migraines. In one study, researchers asked 26 migraine sufferers to chart their attacks for five weeks, and then gave them weekly acupuncture treatments for 12 weeks. Shortly after acupuncture treatment, half said their pain was significantly reduced. In addition, for three years following acupuncture, they used less migraine medication than they had before the study. [4]
1 Facchinetti, F., et al. "Magnesium Prophylaxis of Menstrual Migraine," Headache 31:298, 1991.
2 Palevitch, D.G., et al. "Feverfew as a Prophylactic Treatment for Migraine: A Double-Blind, Placebo-Controlled Study," Phytotherapy Research 11:506, 1997.
3 Holyroyd, K., and D. Penzien, "Pharmacological vs. Non-Pharmacological Prophylaxis of Recurrent Migraine Headache: A Meta-Analytic Review of Clinical Trials," Pain 42:1, 1990.
4 Baischer, M.D., "Acupuncture in Migraine: Long-Term Outcome and Predicting Factors," Headache 35:472, 1995.
Self-Care Measures
- Chart your migraines. Because so many things can trigger them, every time you have a migraine, jot down the date, time, the foods and beverages you'd consumed that day, and any other factors you think might have contributed to your attack. If a pattern emerges, you can take steps to change it.
- Try eating a low-fat diet. At Loma Linda University in Southern California, researchers asked 54 migraine sufferers to chart their attacks for a month. Then the participants were placed on a low-fat diet for two months. The group had significantly fewer migraines, and the ones that occurred were brief.
Preventing Migraines
Medicinal and non-medicinal prevention measures exist. Non-medicinal steps include the following:
- Avoid your migraine triggers. The following list includes some of the more common ones:
- Foods: cow's milk, meats (especially deli meats), wheat products, chocolate, eggs, citrus fruits, alcohol, pickled items, MSG, high-fat diets, and strong cheeses.
- Drugs: Tagamet (for indigestion), birth control pills, and pain and asthma medications, among others.
- Environment: hunger, fatigue, noise, and strong odors -- among many other things -- have been identified as potential triggers.
- Try relaxation techniques. Enhancing resistance to headache through behavioral and relaxation techniques, psychotherapy and biofeedback.
Many medications -- including anti-inflammatory drugs, beta-blockers, and tricyclic antidepressants -- are also used to reduce migraine frequency. (Learn more in the Drug Therapy section of Migraines: Conventional Treatment.)
Websites & Organizations
American Academy of Head, Neck and Facial Pain
520 W. Pipeline Road
Hurst, TX 76053-4924
Phone: 817-282-1501
Email: central@aahnfp.org
American Council for Headache Education
19 Mantua Road
Mt. Royal, NJ 08061
Phone: 609-423-0258
Fax: 609-423-0082
Email: achehq@ache.smarthub.com
The American Medical Association
Dr.Greene's House Calls
The Equinox
Headache Hotline
800-843-2256
Headache Prevention Institute
800 W. Long Lake Road, Suite 135
Bloomfield Hills, MI 48302
Migraine Information Center
National Headache Foundation
428 West St. James Place -- 2nd Floor
Chicago, IL 60614-2750
Phone: 888-NHF-5552 (888-643-5552)
Sources for This Article
Books
Balch, James F. and Balch, Phyllis A. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing, 1997.
Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.
Fauci, Anthony J. et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.
Hardman, Joel G. and Limbird, Lee E. Goodman and Gilman's The Pharmacological Basis of Therapeutics eds. New York: McGraw-Hill, 1996.
Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.
Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.
Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.
Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.
Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.
Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.
Tierney, LM, McPhee, SJ, and Papadakis, MA. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.
Articles
Baischer, MD. "Acupuncture in Migraine: Long-Term Outcome and Predicting Factors," Headache, 35:472, 1995.
Blau, JN. "Migraine Triggers: Practice and Theory." Pathol Biol (Paris). 40(4):367-72. Apr 1992.
Cady, RK, Shealy, CN. "Recent Advances in Migraine Management." J Fam Pract. 36(1):85-91. Jan 1993.
Dechant, KL, Clissold, SP. "Sumatriptan. A Review of its Pharmacodynamic and Pharmacokinetic Properties, and Therapeutic Efficacy in the Acute Treatment of Migraine and Cluster Headache." Drugs. 43(5):776-98. May 1992.
Holyroyd, K. and D. Penzien, "Pharmacological vs. Non-Pharmacological Prophylaxis of Recurrent Migraine Headache: A Meta-Analytic Review of Clinical Trials," Pain, 42:1, 1990.
Lipton, RB, Stewart, WF, Ryan Jr., RE, Saper, J, Silberstein, S, Sheftell, F. "Efficacy and Safety of Acetaminophen, Aspirin, and Caffeine in Alleviating Migraine Headache Pain: Three Double-Blind, Randomized, Placebo-Controlled Trials." Arch Neurol. 55(2):210-7. Feb 1998.
Marks, DR, Rapoport, AM. "Diagnosis of Migraine." Semin Neurol. 17(4):303-6. 1997.
Palevitch, DG et al. "Feverfew as a Prophylactic Treatment for Migraine: A Double-Blind, Placebo-Controlled Study," Phytotherapy Research, 11:506, 1997.
Pryse-Phillips, WE, Dodick, DW, Edmeads, JG, Gawel, MJ, Nelson, RF, Purdy, RA, Robinson, G, Stirling, D, Worthington, I. "Guidelines for the Diagnosis and Management of Migraine in Clinical Practice." Canadian Headache Society. CMAJ. 156(9):1273-87. May 1, 1997.
Silberstein, SD, Lipton, RB. "Epidemiology of Migraine." Neuroepidemiology. 12(3):179-94. 1993.
Smith, R. "Impact of Migraine on the Family." Headache. 38(6):423-6. Jun 1998.
Solomon, S. "Migraine Diagnosis and Clinical Symptomatology." Headache. 34(8):S8-12. Sep 1994.
Tfelt-Hansen, P. "Migraine--Diagnosis and Pathophysiology." Pharmacol Toxicol. 75(Suppl 2):72-5. 1994.
"Low-Fat Diet Reduces Migraine Frequency, Intensity," Modern Med. 8-96.