Migraine is a type of headache that is often felt in a certain area of the head. If a person experiences migraine, he or she might feel oversensitivity to light and sound. Other common symptoms of migraine include nausea and vomiting.
Migraines are usually gradual in onset, progressively more painful and then would disappear gradually. When migraines are mild to moderate (in terms of pain), they are usually described as being dull, deep and steady. When severe, migraines are throbbing or pulsating. Some migraines are worsened by head motion, sneezing, straining or physical exertion.
Migraine is a chronic condition. It is more common in women than in men. And it may occur infrequently or as often as several times a week. Migraine can occur at anytime but the most common time is in the early morning. While migraines can begin during sleep, this is uncommon and must be evaluated to rule out other conditions.
The onset of migraine usually occurs between the ages of 5 and 35. It is treatable but not curable, and it is not considered a life-threatening condition, though rarely a severe migraine may cause a stroke. However, if the headaches are severe and frequent, migraine can have a debilitating impact on a person’s life.
There are only two types of migraines.
Migraine with aura (‘aura’ here as used medically means that there are other distinct conditions associated with the pain) begins with certain neurologic symptoms. The most common of the neurologic symptoms associated with migraine are visual disturbances. The typical visual aura is characterised by a flickering jagged (or zigzag) line, usually at the side of the visual field. Other symptoms include numbness and tingling of the lips, lower face, and fingers of one hand. Some patients experience temporary paralysis on one side of the body. Auras rarely last longer than an hour and are followed by a headache 93 percent of the time.
Migraine without aura has been called common migraine because it has a greater incidence in the population (accounting for 80 percent of cases) and is not preceded by an aura. It may be preceded by mood changes, fatigue, mental fuzziness and fluid retention. In common migraine, the patient also may have diarrhea, increased urination, nausea and vomiting. The common migraine can persist three or four days, depending on treatment.
Either type of migraine may also be accompanied by nasal congestion, runny nose, tearing, and/or sinus pain or pressure. This has sometimes led to the mistaken diagnosis of “sinus headache.” True sinus headache is typically associated with an acute sinus infection, and symptoms often also include fever and thick mucous discharge.
Migraines occur in many forms.
- Hemiplegic migraine: Marked by temporary paralysis on one side of the body (hemiplegia), impaired vision and vertigo
- Ophthalmologic migraine (from ‘optha’ which means ‘eyes’, so we assume it’s in the eye-area): The pain of this rare type of headache is felt around the eye; the headache may be accompanied by a droopy eyelid and vision problems. It is now thought that this may not actually be migraine, but another neurologic condition entirely
- Basilar artery migraine: Occurs mostly in adolescent and young women. It results from a spasm to the basilar artery, a major blood vessel at the base of the brain. Symptoms can include vertigo, impaired vision, poor motor coordination, difficulty speaking or hearing, and altered consciousness.
- Benign exertional headache: A type of vascular headache triggered by physical exertion, such as running, bending and lifting, or even coughing or sneezing. This headache rarely lasts more than several minutes.
- Status migrainosus: A rare, sustained and extremely severe type of migraine with pain and nausea so intense that the person may have to be hospitalized.
- Headache-free migraine: A condition characterized by migraine symptoms, such as visual impairment, nausea, vomiting, constipation or diarrhea, but no headache.
Other types of headaches have common symptoms with migraines.
Other types of headaches have symptoms in common with migraines, but they also come with distinctive symptoms of their own. Other common headache types include:
Tension headache: Chronic headache that is associated with stress or fatigue; physical ailments such as arthritis; or psychological distress or depression. Tension headaches may be precipitated by poor posture, eyestrain, abnormalities of muscles or bones in the neck, misaligned teeth or jawbones, or unusual noise or light conditions.
A pattern of chronic tension headaches may set in between the ages of 20 and 40; women have a greater incidence of tension headache than men. Symptoms include muscle tightness in the head and neck, especially in the temple and forehead areas; pressure sometimes described as feeling like a band or vise around the head; and continuous but not throbbing pain.
Cluster headache: A type of vascular headache that sometimes occurs in a cluster of up to four separate attacks a day and has been associated with an increased level of histamine in the blood. Cluster headaches, which usually come on quite suddenly on one side of the head, are thought be the most severe and intense headaches. Patients describe excruciating, stabbing pain, often around one eye, as well as tearing from that eye and a runny nose on the affected side. These headaches can last less than an hour or for several hours or more, and they often stop as quickly as they started. The onset of cluster headaches is usually between the ages of 20 and 45 and may be linked to smoking and alcohol use; more men than women suffer from cluster headache.
Migraines occur due to various “triggers”.
The propensity to get migraine headaches may be genetic. Research is underway to identify the genes involved in migraine headaches that run in families. Essentially, if members of your immediate family (mother, father and siblings) suffer from migraine, you are at risk too.
Migraine headaches may be precipitated by a variety of factors called “triggers”:
- Skipping meals
- Drinking alcohol (especially red wine)
- Eating foods containing monosodium glutamate (MSG), or that are high in caffeine (coffee, tea, colas) or nitrates and nitrites (preserved meats), or contain tyramine (aged cheeses)
- Menstruation or oral contraception use
- Getting too little or too much sleep
- Stress in your work and personal life
- Factors in the environment, such as glaring lights, strong smells, weather changes or high altitude
Certain medical events may put a person at risk for migraine
Though many people who have migraines also have co-existing health issues, it has not been established that having other conditions causes migraines. Nor has it been established that having migraines leads to other medical problems.
Two conditions found to exist in a high proportion of people who have migraines are depression and anxiety, though the reason for this is unclear. Doctors have also observed that in people who have cardiovascular disease, there is a slightly increased incidence of migraine. Also, many people who have conditions with nasal and sinus inflammation appear to have migraines as well.
Certain medical events may also put a person at risk for migraine, among them are trauma to the brain from head or neck injury, and infections or hemorrhages in the brain. In addition, certain medications can begin a headache pattern that can become migraine-like in nature.
How Is Migraine Diagnosed?
Migraine can generally be diagnosed from its clear-cut symptoms, which usually fall into a recognizable pattern. A patient with suspected migraine will be asked how often the headaches occur, where the pain is localized, how long the headaches last and related questions. The physician also will take a full medical history, including information about any past head injury, eye strain, sinus condition, and dental or jaw problems.
The physician may order exams and blood work to exclude other possible causes for the headache pain. It is usually not necessary to do X-ray or other scans of the brain. This would be recommended in certain situations such as unexplained onset at a later age, an unexplained finding on neurologic exam or features that are atypical for migraine. Patients with sudden onset of extremely severe headache must be immediately scanned to rule out the possibility of an aneurysm. Other signals for scanning are rapidly increasing frequency of headache or persistent headache unresponsive to treatment.
What Medications Are Used to Treat Migraine?
Migraine drugs fall generally into two categories. Those for acute migraine headaches are considered abortive treatments because they interrupt an attack or episode of migraine headache and are given once the symptoms of a migraine have appeared. The second category is preventive medications, which are taken regularly to keep headaches from occurring.
- OTC medications: These include aspirin, ibuprofen, naproxen or acetaminophen. Some of these products are combined with aspirin and caffeine.
- Nonsteroidal anti-inflammatory drugs (NSAIDS) and other analgesics including narcotics and non-narcotics.
- Serotonin agonists: (sumatriptan [Imitrex], zolmitriptan [Zomig], naratriptan [Amerge], rizatriptan [Maxalt]), almotriptan [Axert], eletriptan [Relpex] and frovatriptan [Frova]). Treximet is a combination pill containing both sumatriptan and naproxen. The ‘”triptan” medications cause vasoconstriction and are therefore contraindicated in people who have uncontrolled high blood pressure, angina pectoris (chest pain due to clogged arteries), heart attack, stroke or basilar migraine.
- Vasoconstrictors: (ergotamine [Migranal], Cafergot [ergotamine/caffeine]): Useful in the painful dilation stage of a migraine.
The daily preventive medications prescribed for migraine headache include:
- Tricyclic anti-depressants (such as amitriptyline)
- Beta-blockers (propranolol or timolol)
- Calcium channel blockers (verapamil)
- Anti-convulsants (Depakote, also known as divalproex sodium; Topamax, or topiramate; Neurontin, or gabapentin)
- Alternative treatments (vitamin B2, magnesium)
- Vasodilators (methysergide maleate, or Sansert)
- Hormone therapy (for women with menstrual migraine)
Are There Non-Drug Treatments for Migraine?
Doctors recommend behavioral measures both to prevent and treat migraines: one is to stay away from avoidable triggers, such as alcohol or certain foods.
Behavioral treatments can also help prevent stress-related migraine. These treatments include:
- Relaxation training: including thermal and electromyographic (EMG) biofeedback techniques that help patients develop a degree of voluntary control over their blood pressure, heart rate, temperature, muscle tension, brain waves and body temperature
- Cognitive-behavioral therapy (stress management)
- Regular exercise: such as swimming or walking, which can reduce stress and the frequency and severity of migraines.