Migraine Headache

A migraine headache is a special kind of headache that can last for hours to days. It can cause intense pain as well as other symptoms, such as feeling sick to your stomach or having changes in your vision.

For years migraine headaches were thought to be caused when blood vessels in the head contract and then swell, producing pain. Certain brain chemicals, called neurotransmitters, may cause the vessels to contract.

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
• bright lights.

Migraines tend to run in families. They affect women 3 times more often than men. They often occur during, or right before, a woman's menstrual period.

Before a migraine starts, there is often a warning period when you don't feel well. Some people lose part of their vision or see bright spots or zigzag patterns in front of their eyes. These symptoms, which may precede and predict a migraine headache, are called migraine aura. The vision changes of the aura usually go away as the headache begins. Many people with migraines do not have the visual symptoms.

Migraine symptoms may include:

• throbbing or pounding headache
• extreme sensitivity to light and noise
• nausea and vomiting.

The pain is usually more severe on one side of the head but can affect the whole head. Sometimes a migraine can cause symptoms such as visual field loss, numbness, or even weakness, just like a stroke. Although migraines can cause these nerve symptoms, do not assume a migraine is the cause. If you have these symptoms, call your health care provider right away.

Your health care 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 health care 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 lasts
• 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.)
• 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, your menstrual periods and use of birth control pills or other female hormones.

Depending on your headache symptoms, 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).

Your health care provider may prescribe medicine that you can take as soon as you start having symptoms of a migraine. The medicine will help keep headaches from becoming severe once they start. Medicines most often used for this purpose are:

• A group of drugs called triptans available as tablets (including some that may be taken without water), a shot, and a nasal spray. Examples of triptans are almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan.
• Ergot medicines such as ergotamine, dihydroergotamine, ergonovine, and methysergide. Some of these medicines are shots your provider can give you, or you may learn how to give them to yourself.

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

You may need to take other medicine every day to prevent severe and frequent headaches. Drugs your provider may prescribe for this purpose are propranolol, verapamil, and antidepressants. You may need to try a preventive medicine for several weeks to see if it works.

The headache may last from a few hours to a few days. You may be susceptible to migraines the rest of your life. However, attacks usually occur less often as you grow older.

When a migraine begins:

• As soon as possible after headache symptoms begin, take the medicine recommended or prescribed by your health care provider.
• Rest in a quiet, dark room until the symptoms are gone. Putting a cool, moist washcloth on your forehead might help.

Don't drive a car during a migraine.

If your symptoms get worse, or if they don't get better when you take medicine, make another appointment with your health care provider. It may take several visits to find the best way to control your headaches.

Call your provider right away if:

• 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
  • inability to move a body part (paralysis).

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

• You may need to take medicine prescribed by your health care provider.
• You may need to avoid certain foods or activities suggested by your headache diary as possible triggers of headaches. Avoid foods from the following list if eating them seems to cause your headaches:
  • wine, ale, and beer
  • aged and processed cheeses
  • aged, canned, cured, and processed meats
  • breads made with yeast and yeast extracts
  • foods containing cheese, chocolate, or nuts
• 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.
• Avoid smoking.
• Eat regular meals and get regular rest and exercise.
• Try to identify and avoid stress. Relaxation exercises and biofeedback may help you manage stress.

For more information, call or write:

American Council for Headache Education (ACHE)
Phone: 800-255-ACHE (255-2243)
Web site: http://www.achenet.org
Educational materials, referrals to support groups

National Headache Foundation
Phone: 800-843-2256
Web site: http://www.headaches.org
Educational materials, list of headache specialists, information specialists