Migraine Headache Health Article

Symptoms

Migraine without aura may be preceded by elevations in mood or energy level for up to 24 hours before the attack. Other premigraine symptoms may include fatigue, depression, and excessive yawning.

Aura most often begins with shimmering, jagged arcs of white or colored light progressing through the visual field over the course of 10–20 minutes. This may be preceded or replaced by dark areas or other visual disturbances. Numbness and tingling is common, especially of the face and hands. These sensations may spread, and may be accompanied by a sensation of weakness or heaviness in the affected limb.

The pain of migraine is often present only on one side of the head, although it may involve both, or switch sides during attacks. The pain is usually throbbing, and may range from mild to incapacitating. It is often accompanied by nausea or vomiting, painful sensitivity to light (photophobia) and sound (phonophobia), and intolerance of food or odors. Blurred vision is common.

Migraine pain tends to intensify over the first 30 minutes to several hours, and may last from several hours to a day or longer. Afterward, the affected person is usually weary, and sensitive to sudden head movements.

Diagnosis

Migraine is diagnosed by a careful medical history. Lab tests and imaging studies such as computed tomography (CT) 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, and many people with migraines learn to prevent attacks altogether by recognizing and avoiding their triggers.

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 Excedrin 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 relief 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 (Demerol) and metoclopramide (Reglan).

Continued use of some antimigraine drugs can lead to "rebound headache," marked by frequent or chronic headaches, especially in the early morning hours. This can be avoided by using antimigraine drugs under a health care provider's supervision, with the minimum dose necessary to treat symptoms. Patients with frequent migraines may need preventive therapy.

Alternative treatments are aimed at prevention. Since migraines are often linked with food allergies or intolerances, identifying and eliminating 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. Relaxation using focused breathing techniques can also be useful. 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 by recognizing and avoiding their triggers, and by using the appropriate drugs when migraines occur. There are, unfortunately, some people with severe migraines that do not respond to either preventive or drug therapy. Migraines usually wane in intensity after age 60.