Migraine headaches

A migraine headache can cause intense throbbing or pulsing in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. In 60% of cases the pain is felt on one side of the forehead above the eye.  In 40% of cases it's felt above both eyes.  Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place

Up to 90% of people with migraines have a family history of migraine. If one or both of your parents have migraines, you may be prone to have them also. Most people have their first migraine attack during adolescence. If you have not had a migraine by age forty you probably never will. Migraines are three times more common in women than men.

Migraines may progress through two stages although many people only experience the first one.

Prodromal warning

Before the migraine begins there may be subtle clues that it’s starting up again. These may include neck stiffness, irritability or depression. The classic prodromal signs are visual disturbances referred to as auras. Many people see zigzag like colored lines and note an inability to focus and see clearly. Typically the visual disturbances last less than 30 minutes. The visual disturbance occurs in one side of your field of vision, but in both eyes. Many people see the auras but do not progress to the next stage.

Attack

The migraine attack typically lasts from 4 to 72 hours, but varies from person to person. During the attack stage most people note a throbbing pain on one side of their head. Most note sensitivity to light, sounds and rarely odors. This is often, but not always, followed by nausea and vomiting. After the attack subsides many people feel exhausted.

Triggers

No one is quite sure what causes the migraine but there are several triggers in migraine attacks.

Fluctuation in estrogen levels seem to be a common trigger in women. Migraines are more common immediately before or during their periods, when they have a major drop in estrogen level

Some foods are also migraine triggers. Beer, red wine, aged cheese, MSG and chocolate all can trigger a migraine attack in susceptible individuals.

Bright or flickering lights, loud sounds and many odors may be triggers.

Stress is a common migraine trigger.

Rapid changes in barometric pressure can prompt a migraine.

Certain medications can trigger migraines, especially oral contraceptives and vasodilators, such as nitroglycerin.

 

Treatments

There are two categories of medications used for migraines.

Pain-relieving medications

Medications, such as ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may help relieve mild migraines if taken early on in the attack. Some people are more comfortable if they rest or sleep in a darkened room. Drugs marketed for migraines, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines. The prescription pain reliever indomethacin may help ease a migraine headache.

Ergotamine and caffeine combination drugs (Migergot, Cafergot) and Dihydroergotamine (D.H.E. 45, Migranal are helpful for moderate migraines.

Medications including sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), frovatriptan (Frova) eletriptan (Relpax), and zolmitriptan (Zomig) are called Triptans. They are very helpful in severe migraine attacks. Side effects of include nausea, dizziness and muscle weakness. They are not recommended for people at risk for heart attack or stroke. A potentially life-threatening drug interaction called Seritonin syndrome can occur if you take a Triptan with antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Some common SSRIs include Zoloft, Prozac and Paxil. SNRIs include Cymbalta and Effexor.

Because migraines are often accompanied by nausea and vomiting, medications for nausea are helpful. Frequently prescribed medications are metoclopramide (Reglan) or prochlorperazine (Compro).

Medications containing narcotics, particularly codeine, are used to treat very severe migraine headaches, when people can't take triptans or ergotamine.

Sometimes the corticosteroid Dexamethasone may be used in conjunction with other medication to improve pain relief,

Preventative treatment

In patients with frequent migrains preventive medications are used to prevent the migraine from happening.. Beta blockers often used to treat high blood pressure and heart disease can reduce the frequency and severity of migraines. The beta blocker propranolol (Inderal La, Innopran XL, others) has proved effective for preventing migraines.

Calcium channel blockers, also a cardiovascular drugs, especially verapamil (Calan, Verelan, others), also may be helpful in preventing migraines and relieving symptoms. The antihypertensive medication lisinopril (Zestril) is useful in reducing the length and severity of migraines

Certain antidepressants are helpful in preventing migraines. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil) are often prescribed for migraine prevention. These drugs may reduce migraine headaches by affecting the level of serotonin and other brain chemicals.

Some anti-seizure drugs, such as valproate (Depacon), topiramate (Topamax) and gabapentin (Neurontin), reduce the frequency of migraines. Lamotrigine (Lamictal) may be helpful for migraines. These drugs may cause side effects, such as nausea, vomiting, diarrhea, cramps, hair loss, and dizziness.

Massage, acupuncture, yoga and chiropractic treatments may help reduce the frequency of migraines.

Some people think that the herbs Feverfew and Butterbur (do not use if pregnant) may help prevent migraines. A high dose of riboflavin (vitamin B-2) also may prevent migraines. Coenzyme Q10 supplements may decrease the frequency of migraines.

Other things to consider.

An ophthalmic or retinal migraine is much more serious than a common migraine. Spasms in a retinal blood vessel can a cause a partial loss of vision in one eye, unlike a common migraine in which the visual disturbance is in both eyes. This can lead to permanent loss of vision.

Several other conditions can lead to a temporary (and sometimes permanent) loss of vision. Amaurosis fugax is temporary blindness due to lack of blood flow to the eye. The symptoms can be due to a blockage in an artery leading to the eye. It may be a sign of an impending stroke. Giant cell arteritis (Temporal arteritis) is inflammation and damage to the blood vessels that supply the head area, particularly the large or medium arteries that branch from the neck and supply the temporal area.

Other blood vessel problems related to autoimmune diseases including multiple sclerosis, rheumatoid arthritis, scleraderma and SLE can lead to vision loss. Conditions that encourage abnormal blood clotting including sickle cell disease and polycythemia also lead to vision loss.

Tension headaches

Tension headaches usually the starts up the back of the neck and then becomes a dull pressure or tightness usually across the forehead and both sides of the head that can last 30 minutes to a week.  People often describe it as a metal band circling and pressing on the head.

Cluster headaches

Cluster headaches are sharp, boring, severe pain developing in minutes.  Usually they are felt on only one side around and behind an eye.  They may last 15 minutes to three hours and typically happen several times in clusters.  Other signs are nasal congestion, runny nose, a red tearing eye on one side, and often a feeling of agitation

Sinus headaches

A sinus headache often causes pain, pressure and fullness in your forehead.  The pain worsens when bending forward or lying down.  There often is a stuffy nose, sore throat, cough and a yellow-green or blood-tinged nasal discharge.

Both migraine headaches and sinus headaches may get worse when you bend forward. Also both migrine headaches and sinus headaches can have nasal congestion and a clear, watery nasal discharge.  Sinus headaches, however, aren't associated with nausea or vomiting.  Sinus headaches are not aggravated by loud noise and bright lights unlike migraine headaches.

Sinus headaches are caused by sinusitis.  this is acondition in which the membranes lining your sinuses become swollen and inflamed. Sinusitis can be caused by colds, bacterial or fungal infections, or an impaired immune system. Nasal congestion leads to an incresed pressure which triggers the headache.

You are more likely to develope sinusitis if you have a history of asthma, allergies to dust, mold or pollen, exposure to irritants, such as cigarette smoke, pollutants, or airborne chemicals.

 

If you have any of the following signs and symptoms, which may indicate other, more serious medical problems see your doctor immediately or go to the emergency room:

  • Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
  • An abrupt, severe headache like a thunderclap
  • Headache after a head injury, especially if the headache gets worse
  • A chronic headache that is worse after coughing, exertion, straining or a sudden movement
  • New headache pain if you're older than 50

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