What Is a Migraine?
Migraine is a type of
headache
that is often localized in a certain area of the head and is sometimes
accompanied by a pronounced sensitivity to light and sound. Other common
migraine symptoms include nausea and vomiting. Migraines are usually
gradual in onset, progressively more painful and then undergo a gradual
resolution. When migraines are mild to moderate, they are usually
described as being dull, deep and steady. When severe, migraines are
throbbing or pulsating.
Some migraines are worsened by head motion, sneezing, straining or
physical exertion. Since many patients also become sensitive to light
and sound, some migraine sufferers will lie down in a darkened and quiet
room to relieve symptoms.
More common in women than in men, migraine is a chronic condition,
and migraine headaches may occur infrequently or as often as several
times a week. Although migraines can begin at any time, the most common
time is in the early morning. While migraines can begin during
sleep, this is uncommon and must be evaluated to rule out other conditions.
The onset of migraine usually occurs between the ages of 5 and 35. It
is treatable but not curable, and it is not considered a
life-threatening condition, though rarely a severe migraine may cause a
stroke. However, if the headaches are severe and frequent, migraine can have a debilitating impact on a person’s life.
What Are the Symptoms and Types of Migraine?
Depending on the symptoms, most migraine headaches are categorized as
“migraine with aura” (previously called classic migraine) or “migraine
without aura” (previously called common migraine).
Migraine with aura
begins with certain neurologic symptoms, the most common of which are
visual disturbances. The typical visual aura presents as a flickering
jagged (or zigzag) line, usually at the side of the visual field. The
next symptom in frequency is numbness and tingling of the lips, lower
face and fingers of one hand. Some patients experience temporary
paralysis on one side of the body. Auras rarely last longer than an hour
and are followed by a headache 93 percent of the time.
Migraine without aura has been called common migraine because it has a
greater incidence in the population (accounting for 80 percent of
cases) and is not preceded by an aura. It may be preceded by mood
changes, fatigue, mental fuzziness and fluid retention. In common
migraine, the patient also may have diarrhea, increased urination,
nausea and vomiting. The common migraine can persist three or four days,
depending on treatment.
Either type of migraine may also be accompanied by nasal congestion,
runny nose, tearing, and/or sinus pain or pressure. This has sometimes
led to the mistaken diagnosis of “sinus headache.” True sinus headache
is typically associated with an acute sinus infection, and symptoms
often also include fever and thick mucous discharge.
Are There Different Forms of Migraine?
Besides the categories of migraine with or without aura, migraines also occur in other forms, such as:
- Hemiplegic migraine: Marked by temporary paralysis on one side of the body (hemiplegia), impaired vision and vertigo
- Ophthalmologic migraine: The pain of this rare type
of headache is localized around the eye; the headache may be
accompanied by a droopy eyelid and vision problems. It is now thought
that this may not actually be migraine, but another neurologic condition
entirely
- Basilar artery migraine: Occurs mostly in
adolescent and young women. It results from a spasm to the basilar
artery, a major blood vessel at the base of the brain. Symptoms can
include vertigo, impaired vision, poor motor coordination, difficulty
speaking or hearing, and altered consciousness.
- Benign exertional headache: A type of vascular
headache triggered by physical exertion, such as running, bending and
lifting, or even coughing or sneezing. This headache rarely lasts more
than several minutes.
- Status migrainosus: A rare, sustained and extremely
severe type of migraine with pain and nausea so intense that the person
may have to be hospitalized.
- Headache-free migraine: A condition characterized
by migraine symptoms, such as visual impairment, nausea, vomiting,
constipation or diarrhea, but no headache.
How Do Other Types of Headaches Differ from Migraine?
Although other types of headaches share some symptoms with migraines,
they also come with distinctive symptoms of their own. Other common
headache types include:
Tension headache: Chronic headache that is
associated with stress or fatigue; physical ailments such as arthritis;
or psychological distress or depression. Tension headaches may be
precipitated by poor posture, eyestrain, abnormalities of muscles or
bones in the neck, misaligned teeth or jawbones, or unusual noise or
light conditions.
A pattern of chronic tension headaches may set in between the ages of
20 and 40; women have a greater incidence of tension headache than men.
Symptoms include muscle tightness in the head and neck, especially in
the temple and forehead areas; pressure sometimes described as feeling
like a band or vise around the head; and continuous but not throbbing
pain.
Cluster headache: A type of vascular headache that
sometimes occurs in a cluster of up to four separate attacks a day and
has been associated with an increased level of histamine in the blood.
Cluster headaches,
which usually come on quite suddenly on one side of the head, are
thought be the most severe and intense headaches. Patients describe
excruciating, stabbing pain, often around one eye, as well as tearing
from that eye and a runny nose on the affected side. These headaches can
last less than an hour or for several hours or more, and they often
stop as quickly as they started. The onset of cluster headaches is
usually between the ages of 20 and 45 and may be linked to smoking and
alcohol use; more men than women suffer from cluster headache.
What Are the Risk Factors for Migraine?
The propensity to get migraine headaches may be genetic. Research is
underway to identify the genes involved in migraine headaches that run
in families. Essentially, if members of your immediate family (mother,
father and siblings) suffer from migraine, you are at risk too.
Migraine headaches may be precipitated by a variety of factors called “triggers”:
- Hunger (missed meals)
- Drinking alcohol (especially red wine)
- Eating foods containing monosodium glutamate (MSG), or that are high
in caffeine (coffee, tea, colas) or nitrates and nitrites (preserved
meats), or contain tyramine (aged cheeses)
- Menstruation or oral contraception use
- Getting too little or too much sleep
- Stress in your work and personal life
- Factors in the environment, such as glaring lights, strong smells, weather changes or high altitude
Do Other Medical Conditions Increase Your Migraine Risk?
Though many people who have migraines also have co-existing health
issues, it has not been established that having other conditions causes
migraines. Nor has it been established that having migraines leads to
other medical problems.
Two conditions found to exist in a high proportion of people who have migraines are
depression and
anxiety, though the reason for this is unclear. Doctors have also observed that in people who have
cardiovascular disease,
there is a slightly increased incidence of migraine. Also, many people
who have conditions with nasal and sinus inflammation appear to have
migraines as well.
Certain medical events may also put a person at risk for migraine,
among them are trauma to the brain from head or neck injury, and
infections or hemorrhages in the brain. In addition, certain
medications can begin a headache pattern that can become migraine-like in nature.
How Is Migraine Diagnosed?
Migraine can generally be
diagnosed
from its clear-cut symptoms, which usually fall into a recognizable
pattern. A patient with suspected migraine will be asked how often the
headaches occur, where the pain is localized, how long the headaches
last and related questions. The physician also will take a full medical
history, including information about any past head injury, eye strain,
sinus condition, and dental or jaw problems.
The physician may order exams and blood work to exclude other
possible causes for the headache pain. It is usually not necessary to do
X-ray or other scans of the brain. This would be recommended in certain
situations such as unexplained onset at a later age, an unexplained
finding on neurologic exam or features that are atypical for migraine.
Patients with sudden onset of extremely severe headache must be
immediately scanned to rule out the possibility of an aneurysm. Other
signals for scanning are rapidly increasing frequency of headache or
persistent headache unresponsive to treatment.
What Medications Are Used to Treat Migraine?
Migraine drugs fall generally into two categories. Those for acute
migraine headaches are considered abortive treatments because they
interrupt an attack or episode of migraine headache and are given once
the symptoms of a migraine have appeared. The second category is
preventive medications, which are taken regularly to keep headaches from
occurring.
Abortive medications:
- OTC medications: These include aspirin, ibuprofen, naproxen or acetaminophen. Some of these products are combined with aspirin and caffeine.
- Non-steroidal anti-inflammatory drugs (NSAIDS) and other analgesics including narcotics and non-narcotics.
- Serotonin agonists: (sumatriptan [Imitrex],
zolmitriptan [Zomig], naratriptan [Amerge], rizatriptan [Maxalt]),
almotriptan [Axert], eletriptan [Relpex] and frovatriptan [Frova]).
Treximet is a combination pill containing both sumatriptan and naproxen.
The '”triptan” medications cause vasoconstriction and are therefore
contraindicated in people who have uncontrolled high blood pressure,
angina pectoris (chest pain due to clogged arteries), heart attack,
stroke or basilar migraine.
- Vasoconstrictors: (ergotamine [Migranal], Cafergot [ergotamine/caffeine]): Useful in the painful dilation stage of a migraine.
Preventive medications:
The daily preventive medications prescribed for migraine headache include:
- Tricyclic antidepressants (such as amitriptyline)
- Beta blockers (propranolol or timolol)
- Calcium channel blockers (verapamil)
- Anti-convulsants (Depakote, also known as divalproex sodium; Topamax, or topiramate; Neurontin, or gabapentin)
- Alternative treatments (vitamin B2, magnesium)
- Vasodilators (methysergide maleate, or Sansert)
- Hormone therapy (for women with menstrual migraine)
Are There Non-Drug Treatments for Migraine?
Doctors recommend behavioral measures both to prevent and treat
migraines: one is to stay away from avoidable triggers, such as alcohol
or certain foods.
Behavioral treatments can also help prevent stress-related migraine. These treatments include:
- Relaxation training: including thermal and
electromyographic (EMG) biofeedback techniques that help patients
develop a degree of voluntary control over their blood pressure, heart
rate, temperature, muscle tension, brain waves and body temperature
- Cognitive-behavioral therapy (stress management)
- Regular exercise: such as swimming or walking, which can reduce stress and the frequency and severity of migraines.