Migraine Headaches

Migraine Headaches

A migraine is a specific type of headache that occurs in 10 percent to 20 percent of the population. The pain of migraine can range from mild to severe and the tendency to get migraine headaches may be inherited, which means a migraine sufferer is likely to have a parent with migraines. Migraines are twice as common in women as in men with the frequency of headaches varying from one or two migraines per year to several per week. Specialists think that migraine headaches are due to a problem with the biochemical serotonin in which abnormal levels create changes in the brain and blood vessels that lead to migraine headaches.

Migraine pain tends to occur on one side of the head only with nausea and vomiting often accompanying the headaches. Additional symptoms may include weakness in an arm, generalized weakness or fatigue, partial loss of vision, strange smells, diarrhea, and difficulty speaking.

The main features of migraine headaches are throbbing pain, one sided pain, lasting from 4 to 72 hours, nausea, sensitivity to light, sensitivity to sounds, and made worse by physical activity. Among these features, nausea, worsening with physical activity, and aversion to lights are the most frequent.

Types of Migraine Headaches

Migraines headaches are classified into 2 main types. The first, migraine with aura (classic migraine) in which the aura is a warning symptom that begins before the headache, and then fades when the head pain starts. With visual auras, the person sees spots, flickering lights or funny shapes, while other people may experience strange smells, weakness in an arm or leg, dizziness or numbness. The second type is migraine without aura (common migraine). In both migraine with aura and migraine without aura, the patterns of pain are similar.

Treatment of Migraine Headaches

The goals are to decrease the frequency and severity of headaches (preventative treatment) and to relieve a current headache (symptomatic treatment).

Preventative Treatment:
One important measure is to avoid triggers which can set off migraine headaches in susceptable persons. Some of the possible triggers are psychological stress, exposure to cigarette smoke, certain foods, and birth control pills. According to Precipitating Factors in Migraine: The Journal of Head and Face Pain 34 (4), 214–216, Stress (62%) was the most frequently cited precipitant. Weather changes (43%), missing a meal (40%), and bright sunlight (38%) were also prominent factors. Additionally, spring was cited by 14% of patients as a time for increased migraine attacks, followed by fall (13%), summer (11%), and winter (7%).

Among women with menstrual triggers, migraine headaches most commonly occur during the week before the onset of menses. Migraines during menses are the next most frequent. Less frequent precipitants include lack of sleep, perfume or odors, and weather change.

Specific food triggers include cheese, chocolate, and alcohol. Cheese is the most frequent precipitant. Chocolate is the most specific trigger.

Medications that decrease the frequency of headaches are called preventative or prophylactic medications. Common medications used are Beta-Blockers (Nadolol, Propranolol), calcium channel blockers (Verapamil), Antidepressants (Nortriptyline, Amitriptyline), Ergots (Methylsergide), Nonsteroidal anti-inflammatory drugs, and Anticonvulsives (Valproate, Phenytoin, Clonazepam).

Symptomatic Treatment:
Some people respond to simple symptomatic treatments, such as lying in a dark room, putting an ice bag on the part of the head that hurts, or using over-the-counter pain medications.

Medications taken to stop a headache that has already begun are called symptomatic or abortive medications. One of the major breakthroughs in the symptomatic treatment of migraine is a new class of drugs called triptans, which work by adjusting one of the biochemical abnormalities that can cause migraine. There are now several triptan drugs available as pills, nasal spray or injection.

Nonsteroidal anti-infammatory drugs, NSAIDs, can be very effective for mild or moderate headache. If NSAIDs do not work, an oral nasal spray or injectable triptan is usually tried next. Other drugs for symptomatic treatment include Midrin, ergotamines, or sedatives. Unfortunately, overuse or even daily use of symptomatic medications poses the risk of increasing the frequency of migraine headaches.