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HomeHealth A-Z Migraines
Migraine Headaches
There are two types of migraines - migraine occurring with an aura and migraine occurring without an aura.



Definition of Migraine

Migraine is a type of headache with moderate to severe pain that involves swelling or disturbance of the blood vessels, nerves, or brain chemicals.

Description of Migraine

Migraine headaches are a chronic illness that affects twenty to thirty million people in the US. Each year billions of dollars are lost because of migraines in the way of lost work, poor job performance, and medical expenses. Migraine pain usually develops gradually with increasing intensity and can be debilitating for hours or days at a time, making it difficult for most people to work and continue with normal activities. Some people may only have a migraine a few times in their lifetime, other people may experience one or more migraine headaches each month.

Migraines are not a tension headache but a vascular headache, a type of headache where swelling or disturbance of the blood vessels causes the pain. While there are many common characteristics to migraines, not all migraine sufferers will necessarily experience all of these factors. Migraines are often accompanied by nausea, vomiting, and an extreme sensitivity to light and sound. Migraine pain is often pulsating or throbbing and usually more prominent on one side of the body. The pain is moderate to severe and can be aggravated by physical activity.

There are two types of migraines - migraine occurring with an aura (formerly called a classic migraine) and migraine occurring without an aura (formerly called common migraine).

Auras are sensations and visual changes that may precede or accompany a migraine, including flashes of light, blind spots, numbness or tingling, or a feeling of heaviness. Only twenty percent of migraine sufferers experience migraine with an aura, while approximately eighty percent of migraine sufferers experience migraine without an aura.

Causes and Risk Factors of Migraine

Although the exact causes of migraine headaches are not completely understood, many researchers believe it is due to an imbalance of serotonin (a brain chemical which regulates pain messages) and functional changes in the trigeminal nerve system (a major pain pathway in the nervous system). Another theory is that low levels of magnesium (a mineral involved in nerve cell function) may be a factor since it has been observed that magnesium levels drop right before or during a migraine.

Genetics and a family history of migraine seem to play a part in who develops migraines, but not in all cases. Migraine headaches typically start in a person during childhood, adolescence or early adulthood. Migraine attacks usually become less frequent and less intense with age and rarely occur after age sixty. Migraines affect boys and girls equally during childhood, but after puberty migraines affect three times more women than men.

For those susceptible to migraines, there are many factors called triggers that may set off a migraine attack. Triggers vary widely and are not the cause of migraines, but they can affect the onset in people who are genetically predisposed to them.

Common triggers include (but are not limited to) hormonal changes in women during menstruation, pregnancy or menopause, birth control pills, hormone replacement therapy (HRT), stress, skipping meals or fasting, certain foods (including aged cheeses, chocolate, pickled or marinated foods, many canned and processed foods), beer, red wine, caffeine, monosodium glutamate (MSG - an Asian food ingredient), certain seasonings, aspartame (an artificial sweetener), bright lights, sun glare, pleasant scents such as perfume and flowers, unpleasant smells such as paint thinner and smoke, intense physical activity or sexual activity, too much sleep, too little sleep, changes in environment, and certain medications. Learning one's triggers is key to preventing and reducing migraines.

Symptoms of Migraine

The signs and symptoms of a migraine vary from person to person and cannot be defined exactly, but a typical migraine causes some or all of these symptoms: moderate to severe pain, often on only one side of the head; pulsating or throbbing head pain; pain that worsens with physical activity or makes it difficult to continue with regular daily activities; nausea with or without vomiting; sensitivity to light and sound. About twenty percent of migraine sufferers experience auras, such as seeing flashes of light or blind spots in vision or feeling a tingling sensation in an arm or leg. Other sensations that may precede a migraine include feelings of elation, intense energy, thirst, sweet cravings, drowsiness, irritability or depression.

Children who suffer from migraines tend to have pain on both sides of the head that can be accompanied by nausea, vomiting, lightheadedness and an increased sensitivity to light. Visual auras are rare in children, but they often have preceding signs and symptoms such as yawning, sleepiness, or a craving for foods such as chocolate, hot dogs, sweet snacks, bananas, or yogurt. Children may also experience abdominal migraines that have all the symptoms of migraine (nausea, vomiting, sensitivity to light and sound), but no head pain.

Diagnosis of Migraine

A diagnosis of migraine is usually determined by medical history. A doctor will ask about your history of migraine episodes and your family history of migraine. A physical exam and lab tests may be done, not to necessarily diagnose migraine, but to rule out other causes for the headaches. Imaging tests that can produce an image of your brain such as computed tomography (CT scan) and magnetic resonance imaging (MRI) help to rule out brain tumor or other structural causes of headaches, but are not useful for identifying migraine.

If you suspect you are suffering from migraines, keep a journal to track and record your migraine attacks, any accompanying signs and symptoms, and how you treated them. This information will be useful to your doctor in diagnosing migraine and working out a treatment plan. A doctor will want to rule out any other diseases and have a history of at least four to five migraine attacks in order to be confident of the diagnosis.

Treatment of Migraine

Migraine treatment will depend on the frequency and severity of a persons headaches and any other medical conditions that affect treatment options. Medications are available to either relieve migraine pain once it starts or help prevent a migraine from occurring. Many medications are specifically designed to treat migraines, while other drugs were designed to treat other conditions but bring migraine relief in some people. Some medications are available over-the-counter that are marketed specifically for migraine, while other migraine medications are by prescription only. Some medications are not recommended for pregnant women or children. It is important to read all medication labels and to talk to your doctor for help in finding the right medication.

When you feel a migraine developing, if possible, try to rest in a dark, quiet room. Some people find that it helps to place an ice pack wrapped in a towel on the back of the neck while applying gentle pressure to the painful areas on the head. If you have migraine medication, it should be taken as soon as you feel the migraine forming.

Prevention of Migraine

There is no cure for migraines, but there are measures a person can take to help reduce the frequency, severity, or length of a migraine. Preventive measures include preventative medications if advised by your doctor, lifestyle changes, and recognizing one's own triggers.

Lifestyle changes include avoiding any known triggers (food, scents, environments), muscle relaxation exercises, activities that are enjoyable and relaxing (music, gardening, baths), regular aerobic exercise (warm up slowly because sudden intense activity can cause headaches), quit smoking, get enough sleep (but not too much sleep), and reduce the effects of estrogen medications if a woman.

Some migraine sufferers may find relief with non-traditional therapies, such as acupuncture, biofeedback, herbs feverfew and butterbur (do not take if pregnant), high doses of vitamin B-2, and magnesium sulfate supplements. Ask you doctor if these options are right for you.

External Resources

The National Migraine Association

National Institutes of Health

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