Migraine Headache

What is a migraine headache?

A migraine headache is a specific kind of headache that can last for hours to days. It can cause intense pain as well as other symptoms. For example, you may feel sick to your stomach or have changes in your vision just before or during the headache.

How does it occur?

The exact cause of migraines is not clear. Most experts think migraine attacks start with abnormal activity in the brain. They may be related to a problem with the blood flow in your brain, or they may happen with changes in brain chemicals. Migraine headaches often are triggered by specific things. Common migraine triggers include:

• stress
• tiredness
• changes in the weather
• certain foods, such as wine, cheese, or chocolate
• MSG or food preservatives, such as nitrates
• red wine
• some medicines
• bright lights.

Migraines tend to run in families. They affect women 3 times more often than men. They often happen right before or during a woman's menstrual period. Or they may happen when a woman is taking birth control pills or hormone replacement pills.

What are the symptoms?

Before a migraine starts, there is often a warning period when you don't feel well. Some people have vision changes before their head starts hurting. They lose part of their vision or see bright spots or zigzag patterns. These warning symptoms are called migraine aura. The vision changes of the aura usually go away as the headache begins.

Migraine symptoms may include:

• throbbing or pounding headache
• pain that gets worse with physical activity
• extreme sensitivity to light, smells, and sounds
• nausea
• vomiting

The pain is usually more severe on one side of the head, but it can affect the whole head.

Sometimes a migraine can cause symptoms such as numbness or even weakness. However, these can also be symptoms of a stroke. If you have these other symptoms along with problems with your vision, do not assume a migraine is the cause. Call your healthcare provider right away.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. There are no lab tests or X-rays for diagnosing migraine headaches.

A careful history of your headaches is very helpful. Your healthcare provider may ask you to keep a headache diary in which you record the following:

• date and time of each attack
• how long the headache lasted
• type of pain (for example, dull, sharp, throbbing, or a feeling of pressure)
• location of pain
• any symptoms before the headache began
• foods and drinks you had before the headache began (This should include checking the ingredients in the product ingredient list of packaged foods you have eaten. Saving the labels of the foods or drinks might be a good way to record this information.)
• use of cigarettes, caffeine, alcohol, or carbonated drinks before the headache began
• time you went to bed and time you got up before the headache began
• if you are a woman, the dates of your menstrual periods and use of birth control pills or other female hormones.

Depending on your headache symptoms and physical exam, your provider may recommend tests to check for other, more serious causes of your symptoms. For example, you may have a brain scan or magnetic resonance imaging (MRI).

How is it treated?

You may be able to stop mild migraine headaches by taking nonprescription pain-relief medicine when you start to have symptoms. Aspirin, acetaminophen, caffeine, ibuprofen, and naproxen have all been shown to be effective. You may find that any one of these medicines alone will treat your headache. Even just a caffeinated drink may help. However, some studies have shown combinations to be more effective and to work faster. Excedrin Migraine is an example of such a combination. It includes acetaminophen, aspirin, and caffeine. Other combination drugs, such as Midrin, are available for mild to moderate headaches with a prescription from your healthcare provider.

Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye's syndrome. Aspirin, ibuprofen, and naproxen are nonsteroidal anti-inflammatory medicines (NSAIDs). NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take NSAIDs for more than 10 days for any reason.

Other medicines your healthcare provider may prescribe to help keep headaches from getting severe once they start are:

• A group of drugs called triptans, which are available as tablets (including some that may be taken without water), a shot, and a nasal spray. Examples of triptans are naratriptan, rizatriptan, sumatriptan, and zolmitriptan.
• Ergot medicines such as dihydroergotamine (DHE) or ergotamine. These medicines are available in various forms, including pills you swallow or put under your tongue, nasal spray, rectal suppositories and shots.

It's best to take these medicines as soon as possible after a headache begins. This means you need to recognize the warning symptoms.

If you have frequent migraines (3 or more a month), you may need to take other medicine every day to prevent severe and frequent headaches. Examples of drugs your provider may prescribe for this purpose are:

• antiseizure medicines (divalproex sodium/valproate, gabapentin, or topiramate)
• antidepressants (tricyclics, such as amitriptyline, nortriptyline, or doxepin)
• some beta blockers (such as atenolol, metoprolol, nadolol, nebivolol, propranolol, or timolol)
• some calcium channel blockers (such as verapamil).

Women who have migraines triggered by their menstrual cycle may take preventive medicines for a few days around their period. Medicines that may be recommended are NSAIDs, triptans, and ergots. If these medicines do not work, hormone (estrogen) therapy may be helpful. Hormone therapy may also be helpful for women who have migraines during or after menopause. However, there is an increased risk of stroke for women with migraines who use birth control products (contraceptives) that contain estrogen.

You may need to take preventive medicine for several weeks before you know if it is helpful for you.

If you are planning to get pregnant, be sure to talk to your healthcare provider about whether the medicines you have been prescribed are safe during pregnancy. If they are not known to be safe, you will need a different treatment plan while you are trying to get pregnant and during pregnancy and breast-feeding.

How long will the effects last?

The headache may last from a few hours to a few days. You may tend to get migraines for the rest of your life. However, many people find that they have migraines less often as they get older.

How can I take care of myself?

When you have a migraine:

• As soon as possible after the symptoms start, take the medicine recommended or prescribed by your healthcare provider.
• If you can, rest in a quiet room until the symptoms are gone. The pain may go away with sleep.
• Put a cool, moist washcloth on the painful side of your head. You might also try a heating pad set on the lowest setting.
• Don't drive a car while you have the headache.

You can make your migraines easier to take care of. Learn to become aware of your early warning signs of headache. You will need to pay close attention to your body to be aware of these signs. When the warning signs appear, try going to a quieter place and doing relaxation exercises. This early care can make a big difference in how easily you can get over the migraine.

If your symptoms don't get better when you take medicine, make another appointment with your healthcare provider. It may take several visits to find the best way to control your headaches. Also, if you are having headaches more often, make a follow-up appointment with your provider to see if something has changed or you need more testing or preventive medicine.

Call your healthcare provider right away if:

• Changes in your vision do not go away.
• You have symptoms that are not usually part of your migraines, such as:
  • trouble talking or slurred speech
  • arm or leg weakness
• You have other symptoms such as:
  • fever
  • stiff neck
  • repeated vomiting for several hours
  • numbness or tingling in your face, arms, or legs
• You are pregnant and your headache is particularly bad or it seems different from your usual migraines, particularly in the last half of pregnancy. This is especially important if you have problems with your vision such as flashing lights, difficulty focusing or blurriness, any nausea or vomiting, or weakness in any part of your body. These may be signs of a pregnancy problem that needs immediate attention.

How can I help prevent migraine headaches?

Prevention is an important part of treatment. To help prevent migraine headaches:

• You may need to take medicine prescribed by your healthcare provider.
• You may need to avoid certain foods or activities suggested by your headache diary as possible triggers of headaches. Common food triggers are:
  • citrus fruit
  • chocolate
  • cheese and other preserved or aged foods containing tyramine, including leftovers held for more than 1 or 2 days at refrigerator temperature
  • sodium nitrate (found, for example, in food coloring, preservatives, processed meats and fish, hot dogs, and luncheon meats)
  • monosodium glutamate "MSG" (found, for example, in Chinese food, pepperoni, and many processed foods)
  • red wine and beer
  • the artificial sweetener aspartame
• Ask your provider about avoiding medicines that may trigger headaches.
• If you are taking birth control pills or other female hormones, ask your provider if you should stop taking them.
• If you smoke, stop. If someone else in your household smokes, ask them to smoke outside. Cigarette smoke can make your symptoms worse.
• Eat healthy meals at about the same time each day. Don’t skip meals, especially breakfast.
• Get regular rest and exercise.
• Try to reduce stress. Relaxation exercises and biofeedback may help you manage stress.
• Limit alcohol to no more than 1 drink a day for women and two drinks a day for men.

For more information, call or write:

American Council for Headache Education (ACHE)
Phone: 800-255-ACHE (255-2243)
Web site: http://www.achenet.org

National Headache Foundation
Phone: 800-843-2256
Web site: http://www.headaches.org
(includes more information about diet)