Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Migraine Headache

Migraine headache is generally more severe than an "ordinary" or tension headache. Migraine is defined as episodic attacks of headache lasting 4 to 72 hours and characterized by at least two of the following: moderate to severe intensity, one-sided pain, throbbing, and worsening with movement. In addition, there is nausea or vomiting (which may be treated with metoclopramide [Reglan] 10 mg by mouth or with ondansetron [Zofran] 4 mg oral dissolving tablet), and aversion to light or sound. Migraine headache is caused by painful dilation of small arteries in the head. Migraine headaches have many variations, which may include stuffy or runny nose and weakness of an arm or leg. Some people experience an “aura” prior to the “classic” migraine headache, in which they may smell strange odors or see flashing lights. Others develop "tunnel vision", which is diminished peripheral vision. The headaches are characterized as excruciating, pounding, or explosive. Occasionally they will respond to nonsteroidal anti-inflammatory medications ("NSAIDs"), such as ibuprofen, but migraine sufferers often require stronger pain medications and sometimes may need to be treated with narcotics.

Specific anti-migraine medications include the “triptans,” such as sumatriptan (Imitrex) and zolmitriptan (Zomig). These medications should be given as early as possible in the course of the headache to achieve maximal effectiveness. Other medicines that are effective include propranolol or metoprolol (both "beta-blockers"), amitriptyline, methysergide, flunarizine, and prochlorperazine (Compazine) given with diphenhydramine (Benadryl). Ergotamine drugs (such as dihydroergotamine mesylate [Migranal] nasal spray) directly constrict arteries; these should only be used under the direct supervision of a physician, since they may worsen the effects of certain types of migraines. If an oxygen tank is available, the victim may achieve some relief by breathing 10 liters per minute by face mask. An elderly person with a severe migraine should seek immediate medical attention, because sometimes what appears to be a migraine headache may actually be a stroke.

A migraine headache may be precipitated by lack of sleep, high altitude, emotional stress, cyclical hormone changes, noxious odors, and certain ingested substances (such as caffeine and monosodium glutamate). Therefore, the migraine sufferer should seek to obtain regular sleep (go to bed and wake up at the same times every day), rest, and meals (do not skip or delay); limit caffeine consumption to the equivalent of two cups or coffee or two 12-ounce sodas per day; avoid tobacco products; avoid known personal triggers (e.g., red wine); practice relaxation techniques; and strive to maintain fitness through regular exercise and dietary discretion.

molecular diagram of sumatriptan courtesy of

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.