Migraine is a type of recurring headache. It involves blood vessels, nerves, and brain chemicals. Sensations may come before a migraine. This can include visual changes, called auras.

There are two types of migraines:

• Migraine occurring with an aura (formerly called "classic")
• Migraine occurring without an aura (formerly called "common")

Migraine

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The precise cause is unknown. Among the suspected causes are:

• Environmental triggers
• Genetic predisposition
• Dietary triggers
• Physiologic (menstruation, puberty)

A trigger sets the process in motion. It is possible that the nervous system reacts to the trigger by conducting electrical activity. This spreads across the brain. It leads to the release of brain chemicals. These make blood vessels swell. It may be this inflammation that causes pain and other symptoms.

Risk Factors

Factors that increase your chance for migraines may include:

• Sex: adult females
• Family members with migraines
• Youth (90% occur by age 40)
• Medications including:
  • Hormone replacement therapy
  • Drugs to dilate blood vessels
• Menstruation
• Fatigue
• Lack of sleep or changing sleep patterns
• Stress or relief from stress
• Skipping meals
• Alcohol, especially red wine
• Altitude or weather changes
• Time zone changes
• Exertion that is sustained
• Glaring or flashing light
• Perfumes or other odors
• Eating foods known to trigger migraines
• Epilepsy
• Overuse of pain medications

Symptoms

Migraines occur in phases that may include:

Warning

A warning may come before a migraine. In the hours or days before the headache, symptoms may include:

• A change in mood
• A change in behavior
• A change in the level of activity
• Fatigue
• Yawning
• Food craving or decreased appetite
• Nausea, diarrhea
• Sensitivity to light

Aura

The most common aura is visual. The aura lasts about 15-30 minutes. It may produce the following sensations:

• Flashing lights, spots, or zig zag lines
• Temporary, partial loss of vision
• Speech difficulties
• Weakness in an arm or leg
• Numbness or tingling in the face and hands
• Confusion
• Dizziness, lightheadedness
• Speech disturbances
• Cognitive dysfunction

More rarely, an aura can occur by itself. In these cases, it is important to seek medical attention to make sure the symptoms are not due to a more serious cause. This can include stroke or seizure.

The Migraine Headache

Migraine pain starts within an hour of the aura ending. Symptoms include:

• A headache (usually on one side but may involve both sides) that often feels:
  • Moderate or severe intensity
  • Throbbing or pulsating
  • More severe with movement
• Nausea or vomiting
• Diarrhea
• Sensitivity to light or sound
• Lightheadedness or dizziness

A Post-Headache Period

Migraines usually last from 4-72 hours. They often go away with sleep. After the headache, you may experience:

• Trouble concentrating
• Fatigue
• Sore muscles
• Irritability
• Mood changes

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. You may also be given a neurological exam.

To rule out other conditions your doctor may order a:

• CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head
• MRI scan —a test that uses magnetic waves to make pictures of structures inside the body

Treatment

Migraine therapy aims to:

• Prevent headaches
• Reduce headache severity and frequency
• Restore your ability to function
• Improve quality of life

Treatment options include:

Medications

Pain medications are often needed to ease or stop the pain. Over-the-counter pain pills may ease mild symptoms.

Warning: Regular use of some over-the-counter medications may cause a rebound headache.

Some prescription medications act directly to stop the cause of the migraine headache. These include drugs that:

• Quiet nerve pathways
• Reduce inflammation
• Bind receptors for serotonin, a brain chemical

These drugs can be taken by mouth. They may act more quickly in forms that dissolve in the mouth, are inhaled through the nose, or injected. Your doctor can help you choose the medication best for you.

Medications that can stop a migraine once it has begin include:

• Ergots
• Triptans
• Steroids
• Acetaminophen (Tylenol)
• Medications for nausea
• Non-steroidal anti-inflammatory drugs (NSAIDS) (eg, aspirin, ibuprofen, naproxen)

Other drugs can help prevent migraines for people with frequent migraines. Preventive drugs are taken every day. Classes of preventative medications include:

• Beta-blockers
• Calcium channel blockers
• Tricyclic antidepressants
• Anticonvulsants

Surgery

In some people, migraines are triggered when a nerve in the head is stimulated. With this type of surgery, the doctor finds the nerve trigger point in the head and deactivates it. This surgery may reduce the number of migraines or completely eliminate them in sufferers who do not respond to conventional treatments. Most migraines are not treated with surgery.

Self-Care During the Migraine

• Apply cold compresses to painful areas of your head.
• Lie in a dark, quiet room.
• Apply constant pressure to your temples.
• Try to fall asleep.

Lifestyle Changes

• Keep a diary. It will help identify what triggers migraines and what helps relieve them.
• Learn stress management and relaxation techniques.
• Consider talking with a counselor. They can help you learn new coping skills and relaxation techniques.
• Exercise regularly.
• If you are a smoker, quit. Smoking may worsen a migraine. It probably also increases the rare chance of stroke during a migraine attack. (especially true if you are a woman taking birth control pills or other hormone replacement therapy)
• Avoid foods that trigger migraines.
• Eat regular meals.
• Maintain your regular sleep pattern even during the weekend or on vacation.

If you are diagnosed with a migraine, follow your doctor's instructions .

Prevention

Methods for preventing migraine include:

• Avoiding those things that trigger the headache.
• The doctor may consider using medications (including antiseizure medications and antidepressants) in an attempt to prevent headaches.
• Establishing other healthy habits.

Suggestions include:

• Maintain regular sleep patterns.
• Learn stress management techniques.
• Do not skip meals.
• Avoid red wine and other alcohol.
• Exercise regularly.
• Foods are not proven to trigger migraine, but consider keeping a diary of migraine and diet to identify foods that may trigger migraines for you. Foods suspected to trigger migraine include:
  • Nuts and peanut butter
  • Beans (eg, lima, navy, pinto, and others)
  • Aged or cured meats
  • Aged cheese
  • Processed or canned meat
  • Caffeine (intake or withdrawal)
  • Canned soup
  • Buttermilk or sour cream
  • Meat tenderizer
  • Brewer's yeast
  • Avocados
  • Onions
  • Pickles
  • Red plums
  • Sauerkraut
  • Snow peas
  • Soy sauce
  • Anything with MSG (monosodium glutamate), tyramine, or nitrates
• Ask your doctor if acupuncture is right for you. It may help you to have more headache-free days, as well as lessen the intensity of headaches when they do occur.