Migraine—Adult

Migraine is a type of recurring headache. It involves blood vessels, nerves, and brain chemicals. Sensations may come before a migraine. This can include ...

condition

Definition

Migraine is a type of recurring headache. It involves blood vessels, nerves, and brain chemicals. Sensations may come before a migraine. These can include visual changes, called auras.

There are two types of migraines:

Migraine occurring with an aura (formerly called "classic")
Migraine occurring without an aura (formerly called "common")

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.

Migraine

Causes

The precise cause is unknown. Among the suspected causes are:

Environmental triggers
Genetic predisposition
Dietary triggers
Physiologic (menstruation, puberty)

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. These make blood vessels swell. It may be this inflammation that causes pain and other symptoms.

Risk

Factors that increase your chance for migraines may include:

Sex: adult females
Family members with migraines
Youth (90% occur by age 40)
Medicines including:
- Hormone replacement therapy
- Drugs to dilate blood vessels
Menstruation
Fatigue
Lack of sleep or changing sleep patterns
Stress or relief from stress
Skipping meals
Alcohol, especially red wine
Altitude or weather changes
Time zone changes
Exertion that is sustained
Glaring or flashing light
Perfumes or other odors
Eating foods known to trigger migraines
Epilepsy
Overuse of pain medicines

Symptoms

Migraines occur in phases that may include:

A warning may come before a migraine. In the hours or days before the headache, symptoms may include:

A change in mood
A change in behavior
A change in the level of activity
Fatigue
Yawning
Food craving or decreased appetite
Nausea, diarrhea
Sensitivity to light

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
Dizziness, lightheadedness
Speech disturbances
Cognitive dysfunction

More rarely, an aura can occur by itself. In these cases, 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.

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 intensity
- Throbbing or pulsating
- More severe with movement
Nausea or vomiting
Diarrhea
Sensitivity to light or sound
Lightheadedness or dizziness

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

Diagnosis

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

To rule out other conditions your doctor may order a:

CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head
MRI scan —a test that uses magnetic waves to make pictures of structures inside the body

The doctor may order blood tests or other tests before starting treatment.

treatment

Treatment

Migraine therapy aims to:

Prevent headaches
Reduce headache severity and frequency
Restore your ability to function
Improve quality of life

Treatment options include:

Pain medicines 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 medicines may cause a rebound headache.

Some prescription medicines 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 medicine best for you.

Medicines that can stop a migraine once it has begun include:

Triptans ^BE
Steroids ^BE
Acetaminophen (Tylenol) ^BE
Non-steroidal anti-inflammatory drugs (NSAIDS) (eg, naproxen) ^BE
Medicines for nausea ^BE
Ergots
Combination medicine that contains caffeine

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

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

Botulinum toxin injections may be used as a way to prevent migraines and to reduce the duration and intensity of the headaches if they do occur.

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

Apply cold compresses to painful areas of your head.
Lie in a dark, quiet room.
Apply constant pressure to your temples.
Try to fall asleep.

Keep a diary. It will help identify what triggers migraines and what helps relieve them.
Learn stress management and relaxation techniques.
Consider talking with a counselor. They can help you learn new coping skills and relaxation techniques.
Exercise regularly.
If you are a smoker, quit. Smoking may worsen a migraine. It probably also increases the rare chance of stroke during a migraine attack. (especially true if you are a woman taking birth control pills or other hormone replacement therapy)
Avoid foods that trigger migraines.
Eat regular meals.
Maintain your regular sleep pattern even during the weekend or on vacation.

If you are diagnosed with a migraine, follow your doctor's instructions .

prevention

Prevention

Methods for preventing migraine include:

Avoiding those things that trigger the headache
Following your doctor's recommendations—The doctor may consider using medicines (including antiseizure medicines and antidepressants) in an attempt to prevent headaches.
Establishing other healthy habits

Suggestions include:

Maintain regular sleep patterns.
Learn stress management techniques.
Do not skip meals.
Avoid red wine and other alcohol.
Exercise regularly.
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 (eg, lima, navy, pinto, and others)
- 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
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.

BE = These therapies have the best evidence available showing that they are effective.

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