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Definition

Migraine is a type of recurring headache. It involves nerves and brain chemicals. Other sensations, such as auras, may come before a migraine headache.

There are 2 types of migraines:

  • Occurring with an aura—formerly called a classic migraine
  • Occurring without an aura—formerly called a common migraine

Migraine may happen several times a week or once every couple of years. They can be so severe that they interfere with the ability to work and carry on normal activities.

Causes

While the precise cause is not known, many potential triggers have been identified. Common triggers include:

  • Environmental triggers, such as odors and bright lights
  • Dietary triggers, such as alcohol
  • Certain medications
  • Changes in sleep patterns
  • Stress
  • Physiologic changes, such as menstruation and puberty
  • Weather changes

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, which help regulate pain.

Risk Factors

Migraines are more common in women, especially before the age of 40. Other factors that increase your risk for migraines may include:

  • Family history of migraines
  • Menstruation
  • Obesity
  • Presence of patent foramen ovale—a congenital heart defect
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:

  • Changes in mood, behavior, and/or activity level
  • 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
  • Lightheadedness
  • Speech disturbances

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 .

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 in intensity
    • Throbbing or pulsating
    • More severe with bright light, loud sound, or movement
  • Nausea or vomiting
  • Diarrhea
  • Lightheadedness
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

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

Your body fluids may be tested. This can be done with blood tests.

Images may be taken of your body structures. This can be done with:

CT Scan of the Head

Breast self-exam, step 5

Copyright © Nucleus Medical Media, Inc.

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. They are more likely to be helpful if taken as soon as possible at the start of a migraine. Your doctor can help you choose the medication best for you.

Medications that can help stop a migraine once it has begun include:

  • Triptans
  • Steroids
  • Acetaminophen
  • Non-steroidal anti-inflammatory drugs (NSAIDS)
  • Medications for nausea
  • Ergots
  • Combination medication that contains caffeine

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

  • Beta-blockers
  • Calcium channel blockers
  • Tricyclic antidepressants
  • Anticonvulsants
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blockers (ARBs)
Therapy

Therapy may also be used to reduce the length and frequency of migraine headaches. It may be used with or without medication and may include cognitive behavioral therapy, biofeedback, or relaxation methods.

Procedures
Botulinum Toxin Injections

Botulinum toxin injections may be used as a way to prevent migraines and to reduce the duration and intensity of the headaches in people who have headaches often.

Surgery

In some people, migraines are triggered when a nerve in the head is stimulated. With this type of surgery, the nerve trigger point is located in the head and is deactivated. 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.

Transcranial magnetic stimulation surgery may also be used in patients with migraine with aura who have not responded to other treatments.

Self-Care During the Migraine
  • Apply cold compresses to painful areas of your head.
  • Lie in a dark, quiet room.
  • Try to fall asleep.
Lifestyle Changes
  • Keep a diary. It will help identify what triggers your migraines and what helps relieve them.
  • Learn stress management and relaxation techniques.
  • Consider talking with a counselo to learn new coping skills and relaxation techniques.
  • Exercise regularly .
  • If you are a smoker, talk to your doctor about ways to quit . Smoking may worsen a migraine.
  • Avoid foods that trigger migraines.
  • Eat regular meals.
  • Maintain your regular sleep pattern even during the weekend or on vacation.
Prevention

Methods for preventing migraine include:

  • Avoiding those things that trigger the headache
  • Following your doctor's recommendations—The doctor may consider using medications to prevent headaches such as:
    • Antidepressant
    • Antiseizure
    • Medications that lower blood pressure
    • Butterbur extract

Healthy lifestyle habits that may help prevent migraines include:

  • Maintain regular sleep patterns.
  • Learn stress management techniques.
  • Do not skip meals.
  • Avoid alcohol.
  • Exercise regularly. Consider yoga as one type of activity.
  • 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.

Therapy that may decrease migraine or migraine pain include:

  • Mind-body therapies such as:
    • Biofeedback
    • Cognitive behavioral therapy
    • Guided imagery—may improve pain coping
  • Massage therapy

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
  • 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

RESOURCES:

American Headache Society
http://www.americanheadachesociety.org

The National Migraine Association
http://www.migraines.org

CANADIAN RESOURCES:

The College of Family Physicians of Canada
http://www.cfpc.ca

Health Canada
http://www.hc-sc.gc.ca

References:

Gilmore B, Michael M. Treatment of acute migraine headache. Am Fam Physician. 2011:83(3):271-280.

Migraine in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 25, 2014. Accessed January 15, 2015.

Migraine prophylaxis in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 9, 2015. Accessed January 15, 2015.

NINDS migraine information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/migraine/migraine.htm. Updated September 26, 2014. Accessed January 15, 2015.

Recognizing stroke. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=symp. Accessed January 15, 2015.

12/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Jena S, Witt CM, Brinkhaus B, Wegscheider K, Willich SN. Acupuncture in patients with headache. Cephalalgia. 2008;28:969-979.

2/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White A. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009;CD001218.

11/10/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S. A placebo-controlled surgical trial of the treatment of migraine headaches. Plast Reconstr Surg. 2009;124(2):461-468.

10/25/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Food and Drug Administration. FDA approves Botox to treat chronic migraine. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229782.htm. Published October 15, 2010. Accessed January 15, 2015.

3/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Chankrachang S, Arayawichanont A, Poungvarin N, et al. Prophylactic botulinum type A toxin complex (Dysport) for migraine without aura. Headache. 2011;51(1):52-63.

9/25/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Herman A. Episodic migraine linked to obesity. NEJM Journal Watch. 2013 Sept 12.

1/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Huquet A, McGrath PJ, et al. Efficacy of psychological treatment for headaches: an overview of systematic reviews and analysis of potential modifiers of treatment efficacy. Clin J Pain. 2014;30(4):353-369.

1/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Diener HC. Single-pulse transcranial magnetic stimulation: a new way to treat migraine attacks with aura. Lancet Neurol. 2010;9(4):335-7.

4/1/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed. Lip PZ, Lip GY. Patent foramen ovale and migraine attacks: A systematic review. Am J Med. [Epub 2013 Dec].



Last reviewed January 2015 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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