Migraine Headache Health Article

Diagnosis

Migraine is diagnosed by a careful medical history. Lab tests and imaging studies such as computed tomography (CT scan) or magnetic resonance imaging (MRI) scans have not been useful for identifying migraine. However, for some patients, those tests may be needed to rule out a brain tumor or other structural causes of migraine headache.

Treatment

Once a migraine begins, the person will usually seek out a dark, quiet room to lessen painful stimuli. Several drugs may be used to reduce the pain and severity of the attack.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful for early and mild headache. NSAIDs include acetaminophen, ibuprofen, naproxen, and others. A recent study concluded that a combination of acetaminophen, aspirin, and caffeine could effectively relieve symptoms for many migraine patients. One such over-the-counter preparation is available as Exedrin Migraine.

More severe or unresponsive attacks may be treated with drugs that act on serotonin receptors in the smooth muscle surrounding cranial blood vessels. Serotonin, also known as 5-hydroxytryptamine, constricts these vessels, relieving migraine pain. Drugs that mimic serotonin and bind to these receptors have the same effect. The oldest of them is ergotamine, a derivative of a common grain fungus. Ergotamine and dihydroergotamine are used for both acute and preventive treatment. Derivatives with fewer side effects have come onto the market in the past decade, including sumatriptan (Imitrex). Some of these drugs are available as nasal sprays, intramuscular injections, or rectal suppositories for patients in whom vomiting precludes oral administration. Other drugs used for acute attacks include meperidine and metoclopramide.

Studies are showing that rizatriptan is a promising drug for the treatment of migraines. One study showed that 10mg of rizatriptan provided relief to 90% of the patients in the study group and kept 50% of them pain-free 2 hours after taking the medication. Sumatriptan has been on the market since 1993, while rizatriptan became available in 1998.

Continued use of some anti-migraine drugs can lead to "rebound headache," marked by frequent or chronic headaches, especially in the early morning hours. Rebound headache is avoided by using anti-migraine drugs under a doctor's supervision, with the minimum dose necessary to treat symptoms. Patients with frequent migraines may need preventive therapy.

Alternative treatment

Alternative treatments are aimed at prevention of migraine. Migraine headaches are often linked with food allergies or intolerances. Identification and elimination of the offending food or foods can decrease the frequency of migraines and/or alleviate these headaches altogether. Herbal therapy with feverfew (Chrysanthemum parthenium) may lessen the frequency of attacks. Learning to increase the flow of blood to the extremities through biofeedback training may allow a patient to prevent some of the vascular changes once a migraine begins. During a migraine, keep the lights low; put the feet in a tub of hot water and place a cold cloth on the occipital region (the back of the head). This draws the blood to the feet and decreases the pressure in the head.

Prognosis

Most people with migraines can bring their attacks under control through recognizing and avoiding triggers, and by use of appropriate drugs when migraine occurs. Some people with severe migraines do not respond to preventive or drug therapy. Migraines usually wane in intensity by age 60 and beyond.

Prevention

The frequency of migraine may be lessened by avoiding triggers. It is useful to keep a headache journal, recording the particulars and noting possible triggers for each attack. Specific measures which may help include:

• eating at regular times, and not skipping meals
• reducing the use of caffeine and pain relievers
• restricting physical exertion, especially on hot days
• keeping regular sleep hours, but not oversleeping
• managing time to avoid stress at work and home

Some drugs can be used for migraine prevention, including specific members of these drug classes:

• beta blockers
• tricyclic antidepressants
• calcium channel blockers
• anticonvulsants
• prozac
• monoamine oxidase inhibitors (mao)
• serotonin antagonists

For most patients, preventive drug therapy is not an appropriate option, since it requires continued use of powerful drugs. However, for women whose migraines coincide with the menstrual period, limited preventive treatment may be effective. Since these drugs are appropriate for patients with other medical conditions, the decision to prescribe them for migraine may be influenced by expected benefit elsewhere.

BOOKS

Larson, David E. Mayo Clinic Family Health Book. New York:

William Morrow and Company, 1996.

Rakel, Robert. Conn's Current Therapy: Latest Approved Methods of Treatment for the Practicing Physician. Philadelphia: W.B. Saunders Company, 2001.

Tierney, Lawrence, et. al. Current Medical Diagnosis and Treatment. Los Altos: Lange Medical Publications, 2001.