Introduction
A migraine is a specific type of headache. Classic migraines usually begin in childhood and get better or worse with age. They are classified according to the symptoms they produce. Two common types of migraines include migraine with aura and migraine without aura. Abdominal migraine, basilar artery migraine, carotidynia, headache-free migraine, opthalmoplegic migraine and status migrainosus are less common. Some migraines can be triggered by hormonal changes of the menstrual cycle and pregnancy. Migraines may occur only a few times in a lifetime or several times per month. Approximately 70 percent of migraine sufferers are women.
Migraine with Aura Defined
A migraine with aura is defined by sensory symptoms that occur 10 to 30 minutes before a migraine attack. Such symptoms usually build up over a span of several minutes. Aura symptoms may include:
- Bright flashing lights or dots
- Wavy or zigzag lines
- Blind spots or distorted vision
- Temporary vision loss
- Disturbed smell, taste and touch
- Ringing in ears
- Speech disturbances
Only 20 percent of migraine sufferers will experience the sensory symptoms of an aura and men experience this type of migraine more often than women.
Migraine without Aura Defined
Previously, a migraine without an aura was called a common migraine. During a migraine without aura you may experience pain on one side of your head, sensitivity to sound or light, nausea, diarrhea, blurred vision and sometimes fainting. To rule out other types of headaches, such as tension headaches and sinus headaches, you can check for symptoms specific to migraines, such as the following:
- Moderate to severe headache
- Nausea
- Light sensitivity
Usually, other types of headaches are less severe and rarely disabling. Migraine attacks can cause significant pain lasting for hours or days.
What Causes Migraines?
The cause of migraines is unknown. Currently, doctors believe the cause is related to genetic control of certain brain cells. It is thought that hyperactive brain cells in the mid-brain area sends impulses to dilate blood vessels, release hormones and liberate inflammatory substances, which combine to cause a painful migraine. Seventy-five percent of affected individuals have a family history of migraines.
Diagnosis of Migraines
Many times, individuals can be diagnosed with migraines based on a physical exam and family history. If the migraines are unusual or severe, a variety of medical tests may be needed to rule out other causes of the pain. Computerized tomography, or CT, can be used to view cross-sections of the brain to diagnose tumors, infections, or other medical problems. Magnetic resonance imaging gives very detailed views of the brain to diagnose tumors, strokes, aneurysms and other brain abnormalities. Lumbar puncture technique allows analysis of spinal fluid for underlying conditions, such as meningitis.
Migraine Triggers
Most migraines seem to be triggered by external factors. Migraine triggers can vary from person to person. Certain foods, medications, hormonal changes or stress factors can trigger migraines. Often a combination of triggers can instigate a migraine. To determine migraine triggers, a headache diary can be useful. Include the time of day, where you were and what you were doing when the headache began. Also, record what you ate and drank 24 hours before the attack, and your complete menstrual cycle. Finding out what triggers your migraines can help your doctor determine a treatment plan.
Common food triggers include alcohol, aged cheeses, monosodium glutamate, sausages, aspartame, caffeine and processed meats. Stress can trigger migraines, as well as intense physical activity. Medications that cause blood vessel dilation can trigger migraines. Also, changes in the weather and disruption of your wake-sleep pattern may cause migraines.
Fluctuations in estrogen levels can trigger migraine headaches in many women. Migraines may occur during a specific point in the menstrual cycle, when a significant drop in estrogen happens. Some women have increased migraines during pregnancy or menopause and oral contraceptives or hormone replacement therapy may worsen or eliminate hormonal migraines.
Migraine Treatment and Prevention
Migraines do not have a cure. Treatment and management of migraines depend on the type of migraine, the frequency and severity of it and the degree of disability it causes. A treatment plan may include one or all of the following options:
- Pain-relieving medication
- Preventive medications
- Stress management
- Relaxation techniques
- Sleep regulation
- Alternative treatments
Pain Medications
Pain relieving medications work best when taken at early onset of migraine symptoms. Also, rest or sleep may enable the medications to work more effectively against migraine pain. Ibuprofen or acetaminophen can help relieve mild migraines. Combination drugs, such as aspirin, acetaminophen and caffeine work for moderate migraines, but severe migraines may need other medications. Many use triptans for effective relief of migraine pain, nausea and light sensitivity. Sometimes, combination tablets can relieve migraine symptoms better than single medications alone. Strong narcotics may be used for treating migraines in people who cannot take triptans, but such medications are used as a last resort.
Preventive Medications
If a person has more than two debilitating migraines per month, preventive medications may be able to reduce frequency, severity and length of the migraines. It is not likely that preventive medications will eliminate migraines completely and some may have serious side-effects.
Cardiovascular blockers, such as beta blockers and calcium channel blockers, have been used to prevent migraine attacks, although researchers do not understand why.
Certain antidepressants have been used to prevent migraines. The tricyclic antidepressants are thought to prevent migraines by manipulation of the serotonin levels in the brain. One serotonin-norepinephrine reuptake inhibitor, venlafaxin, has proven helpful in preventing some migraines.
Anti-seizure drugs may be able to reduce migraines. One such medication, lamotrigine, has been beneficial in preventing migraines with aura. If high dosages of these drugs need to be used to prevent migraines, side-effects of diarrhea, hair loss, vomiting and dizziness may occur. Additionally, an antihistamine called cyproheptadine has proven useful as a preventive medication in children. One last approved preventative medication for migraines is botulinum toxin, or Botox. It is given as injections into the muscles of the forehead and neck, and the injections may need to be repeated every 12 weeks to remain effective.
Stress Management, Relaxation and Sleep
Stress can trigger many different types of headaches, including migraines. Researchers believe that every-day stress causes most of the stress-related migraines, not life-changing events. Finding healthy ways to deal with stress may be able to reduce the incidence of migraines. Relaxations exercises, such as yoga or meditation, can help to reduce muscle tension and lessen stress. Eating healthy food and exercising 30 minutes per day can provide your body with energy to balance and cope with stress. Also, getting enough sleep at the same time each day, but not too much, can reduce episodes of migraine attacks. An average adult needs six to eight hours of sleep each night. Simple relaxation techniques such as gardening, painting, reading or a hot bath can help prevent stress-related migraines.
Alternative Treatments
Chronic migraine pain may benefit from nontraditional therapy. Acupuncture, which has been around for thousands of years in Chinese medicine, uses very thin needles inserted at specific points on the body to reduce migraine pain. This technique has proven helpful to some migraine sufferers.
Biofeedback techniques may be used to reduce migraine pain. Special equipment is used to monitor your control of physical responses related to stress and muscle tension. These techniques must be learned and practiced to be effective.
Message and manipulation may be able to reduce migraine frequency by reducing stress and improving sleep quality. Also, certain herbs, vitamins and minerals have shown promise in treatment and prevention of migraine headaches. All alternative treatments should be discussed with your physician prior to implementation.
Summary
Since there are several types of migraines with many possible triggers and a variety of treatment options, each migraine sufferer should work closely with their doctor to individualize their own treatment protocol. Many options exist for treatment and prevention of migraine pain.
