Migraine

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Definition

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. 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 to lie down.

Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots or tingling in your arm or leg.

Medications can help reduce the frequency and severity of migraines. If treatment hasn't worked for you in the past, talk to your doctor about trying a different migraine headache medication. The right medicines, combined with self-help remedies and lifestyle changes, may make a tremendous difference.

Symptoms

Migraine headaches often begin in childhood, adolescence or early adulthood. Migraines may progress through four stages — prodrome, aura, attack and postdrome — though you may not experience all the stages.

ProdromeOne or two days before a migraine, you may notice subtle changes that may signify an oncoming migraine, including:

• Constipation
• Depression
• Diarrhea
• Food cravings
• Hyperactivity
• Irritability
• Neck stiffness

AuraMost people experience migraine headaches without aura. Auras are usually visual but can also be sensory, motor or verbal disturbances. Each of these symptoms typically begins gradually, builds up over several minutes, then commonly lasts for 10 to 30 minutes. Examples of aura include:

• Visual phenomena, such as seeing various shapes, bright spots or flashes of light
• Vision loss
• Pins and needles sensations in an arm or leg
• Speech or language problems

Less commonly, an aura may be associated with aphasia or limb weakness (hemiplegic migraine).

AttackWhen untreated, a migraine typically lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or much less frequently. During a migraine, you may experience some of the following symptoms:

• Pain on one side of your head
• Pain that has a pulsating, throbbing quality
• Sensitivity to light, sounds and sometimes smells
• Nausea and vomiting
• Blurred vision
• Diarrhea
• Lightheadedness, sometimes followed by fainting

PostdromeThe final phase — known as postdrome — occurs after a migraine attack, when you may feel drained and washed out, though some people report feeling mildly euphoric.

When to see a doctorMigraine headaches are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches and decide on a treatment plan.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

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

• An abrupt, severe headache like a thunderclap
• Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
• 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

Causes

Although much about the cause of migraines isn't understood, genetics and environmental factors seem to both play a role.

Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway. Imbalances in brain chemicals, including serotonin — which helps regulate pain in your nervous system — also may be involved.

Serotonin levels drop during migraine attacks. This may trigger your trigeminal system to release substances called neuropeptides, which travel to your brain's outer covering (meninges). The result is headache pain.

Migraine headache triggersWhatever the exact mechanism of the headaches, a number of things may trigger them. Common migraine triggers include:

• Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications — such as oral contraceptives and hormone replacement therapy — also may worsen migraines, though some women find it's beneficial to take them.
• Foods. Some migraines appear to be triggered by certain foods. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; aspartame; overuse of caffeine; monosodium glutamate — a key ingredient in some Asian foods; salty foods; and processed foods. Skipping meals or fasting also can trigger migraine attacks.
• Stress. Stress at work or home can instigate migraines.
• Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Unusual smells — including pleasant scents, such as perfume, and unpleasant odors, such as paint thinner and secondhand smoke — can also trigger migraines.
• Changes in wake-sleep pattern. Either missing sleep or getting too much sleep may serve as a trigger for migraines in some individuals, as can jet lag.
• Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
• Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
• Medications. Certain medications can aggravate migraines, especially oral contraceptives and vasodilators, such as nitroglycerin.

Risk factors

Several factors make you more prone to having migraines.

• Family history. Up to 90 percent of people with migraines have a family history of migraine attacks. If one or both of your parents have migraines, there's a good chance you will, too.
• Age. Migraine can begin at any age, though most people experience their first migraine during adolescence. By age 40, most people with migraine have had their first attack.
• Gender. Women are three times more likely to have migraines. Headaches tend to affect boys more than girls during childhood, but by the time of puberty, more girls are affected.
• Hormonal changes. If you're a woman who has migraines, you may find that your headaches begin just before or shortly after onset of menstruation. They may also change during pregnancy or menopause. Some women report that their migraine attacks got worse during the first trimester of a pregnancy, though for many, the attacks improved during later stages in the pregnancy.

Complications

Sometimes your efforts to control your pain cause problems.

• Abdominal problems. Certain pain relievers, such as ibuprofen (Advil, Motrin, others), may cause abdominal pain, bleeding and ulcers — especially if taken in large doses or for a long period of time.
• Rebound headaches. In addition, if you take over-the-counter or prescription headache medications more than nine days per month or in high doses, you may be setting yourself up for a serious complication known as rebound headaches. Rebound headaches occur when medications not only stop relieving pain, but actually begin to cause headaches. You then use more pain medication, which traps you in a vicious cycle.
• Serotonin syndrome. This potentially life-threatening drug interaction can occur if you take migraine medicines called triptans, such as sumatriptan (Imitrex) or zolmitriptan (Zomig), along 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. Fortunately, serotonin syndrome is rare.