Migraine

What is Migraine?

Migraine is a severe and disabling headache that results from dilation of arteries in the head. The headaches usually begin in adolescence or early adulthood and are more common in women. Many migraine sufferers are perfectionists and worriers. The headaches interfere greatly with the individual's life. Migraines may be triggered by a variety of factors including emotional or physical stress, alcohol, certain foods (chocolate, cheese, or MSG), missed meals, too much or too little sleep, or menstruation. Estrogen pills for birth control or menopause can precipitate the headaches. The underlying cause of migraine is unknown. It may have a hereditary predisposition, as individuals often have a family history of migraine.

How is it diagnosed?

History is of gradual onset of the headache over an hour. The headache is usually one sided, but can be generalized. Migraine is most often present on awakening. It is usually throbbing in quality, and may vary in intensity and duration, lasting from several hours to three days. It is often accompanied by nausea, vomiting, and sensitivity to light and sound. In some individuals, the headache is preceded by a warning (aura) such as visual disturbances (light flashes or decreased vision), difficulty speaking, or numbness or weakness of one side of the body. These symptoms often disappear as the headache begins.

Physical exam is not helpful in this diagnosis. Tests are similarly not helpful, but may be done to explore anatomic causes of headache like brain tumor or bleeding.

How is Migraine treated?

During an acute episode, the individual may be helped by resting in a quiet, darkened room. A non-narcotic analgesic sometimes is effective, when it is taken as soon as the symptoms begin. Once the headache is underway, treatment usually requires a vasoconstrictor (e. g. , an ergot alkaloid) to stop the attack. A new type of vasoconstrictor has become available, and pain relief may begin within a few minutes of the injection or ingestion.

If nausea and vomiting are present, medication may have to be administered under the tongue, by injection, or rectally. Prevention of migraine is an important part of treatment. The frequency of acute episodes may be decreased by avoiding precipitating factors. If episodes occur more than two or three times a month, a variety of drugs can be taken for prevention. These include beta-blockers, tricyclic antidepressants, ergot alkaloids, and calcium channel blockers. The person may have to try several of these before the headaches are brought under control. Once an effective drug is found, it should be continued for several months. If the individual remains free of headaches, the drug may be tapered gradually off.

Medications

• No single drug is preferable or effective. A wide variety of headache drugs can be prescribed for migraine symptoms and prevention. Follow all prescription instructions carefully.
• Ergotamines (contain caffeine) in oral form, suppository or inhaler.
• Aspirin, acetaminophen or ibuprofen.
• Drugs that combine acetaminophen and a narcotic (codeine).
• Antihistamines to expand blood vessels.
• Antiemetics to decrease nausea and vomiting.
• Vasoconstrictors to narrow blood vessels.
• Sumatriptan (Imitrex) in self-administered subcutaneous (under the skin) injection, or oral tablet.
• Beta-adrenergic or calcium channel blockers or tricyclic antidepressants to prevent attacks, if headaches are so frequent or severe that you can't function normally. These medications may have undesirable side effects and may not help everyone.

Information	Brand	Generic	Label	Rating
	Elavil	Amitriptyline
	Effexor	Venlafaxine
	Neurontin	Gabapentin
	Lioresal	Baclofen
Luvox (Fluvoxamine), Depakote (Divalproex), Desyrel (Trazodone), Pamelor (Nortriptyline), Prozac (Fluoxetine), Sinequan (Doxepin), Tofranil (Imipramine), Reglan (Metoclopramide), Motrin (Ibuprofen), Remeron (Mirtazapine), Tenormin (Atenolol), Tegretol (Carbamazepine)
Migraine prophylaxis
Periactin (Cyproheptadine) Topamax (Topiramate)

Activity

• Rest during attacks. Between attacks, exercise to achieve maximum fitness.
• Do not drive or use dangerous machinery during an attack.

Diet

Because some attacks are caused by foods, such as cheese or chocolate, keep a record of what you ate before each attack. Avoid foods that seem to trigger migraine attacks. Otherwise, no special diet is necessary.

What might complicate it?

There are complications of frequent use of ergot drugs or the newer vasoconstrictor. Vertigo can be a complicating symptom. Motion sickness frequently is another complaint in migraine sufferers.

Predicted outcome

Some individuals see the headaches disappear in their 30s or 40s. The headaches may persist if precipitating causes are not identified and avoided including issues of lifestyle.

Alternatives

Other possibilities are high blood pressure, infections or tumors of the sinuses, dental pain (which can radiate to the head), cold substances in contact with the palate, coital headaches at climax, headache following closed head injury, and post-lumbar puncture headache.

Appropriate specialists

Neurologist.

Last updated 21 December 2015