Anyone experiencing severe and/or prolonged headaches should seek immediate medical attention, as a headache can be a symptom of a variety of serious conditions other than migraine.
What Are Migraine Headaches?
Approximately 36 million Americans suffer from migraine headaches, which are one of the most common reasons doctors see their patients. Migraine headaches are 3 times more common in women than in men. The World Health Organization places migraine headaches as one of the 20 most disabling medical conditions.
Migraines were once thought to be caused by dilation and constriction of blood vessels in the head, but recent research indicates that it is more likely that migraine headaches are the result of a genetic abnormality in cell clusters in the brain.
Migraine headaches may occur with symptoms such as nausea, vomiting, sinus pain, neck pain, dizziness, difficulty concentrating, and mood changes.
A throbbing pain can be felt on one or both sides of the head.
Migraine head pain can be made worse with routine activity and is exacerbated by environmental stimuli like light and sound.
Migraine headaches typically last 24 hours, but a migraine attack can last for many days.
Some migraine sufferers experience warning symptoms, called auras, before a headache begins.
Auras are neurological symptoms that occur 10 to 30 minutes before a migraine begins.
Types of Migraines:
Migraine Without Aura: the most common type of migraine. Can occur on one or both sides of the head and is often accompanied by nausea, vomiting, and photophobia. Tiredness and mood changes may happen the day before the migraine.
Migraine with Aura: an aura (auras are typically described as a bright shimmering lights, zigzag lines, castles, temporary vision loss, motor weakness, dizziness or vertigo, or hallucinations) is typically experienced 10 to 30 minutes before the migraine.
Menstrual Migraines: migraines experienced by women just before or during menstruation. Menstrual Migraines are thought to be caused by hormonal changes.
Opthamaloplegic Migraine: starts with a headache, proceeds to vomiting, and during the headache, the eyelid droops as the nerves responsible for eye movement are paralyzed. Ptosis (eye droop) can last days or weeks.
Carotidynia Migraine: also known as facial migraine. Causes deep dull aching and occasional piercing pain in the neck or jaw. Swelling and tenderness is usually felt over the carotid artery, even though doppler studies of the carorid artery is normal. Typically happens in older people.
Abdominal Migraines: common in children with family history of migraines. Children may experience abdominal pain (without reason), vomiting, nausea, and paleness. Children with abdominal migraines often develop migraines as adults.
Basilar Artery Migraine: disturbance of the basilar artery located in the brainstem that typically occurs in young people. Symptoms include headache, dizziness, double vision, impaired muscle coordination, and slurred speech.
Status Migraine: rare type of migraine headache that involves intense pain for over three days and may require hospitalization.
Causes of Migraines:
The exact cause for migraine headaches is unknown. Migraines are thought to result from a series of central nervous system reactions from changes within the body or the environment. Migraines often have a family history, suggesting a genetic link.
Migraine Headache Triggers:
Doctors suggest a record of potential food and behavior triggers in a headache diary to help identify possible causes of migraine headaches.
People suffering from migraines should keep a record of headaches using a headache diary to accurately track the frequency and duration of migraines. A headache diary will assist in an accurate diagnosis and effective treatment.
Common migraine triggers include:
- Eye strain
- Environmental changes (pressure systems, weather, altitude)
- Certain foods (including chocolate)
- Glare or patterns
- Certain prescription or over-the-counter medications
- Hormonal changes in women
- Strong scents, like perfume
- Alcohol consumption
A diagnosis of migraine headaches is based upon the symptoms, physical examination, and neurological tests.
Physical and neurological tests are able rule out other reasons (intercranial hemorrhage, cerebral stroke, cerebral aneurysm, hydrocephalus, meningitis, low cerebrospinal fluid, tumors) for migraine headaches.
These tests include CT scans, EEG readings, spinal taps, and MRI.
Prophylactic Migraine Treatment:
Prophylactic migraine treatments are given to reduce or prevent migraines. Preventative migraine medications may be prescribed for people who have three or more migraines a month.
Prophylactic treatment may require a combination of medications:
1) Beta blockers are the preferred prophylactic migraine treatment.
2) Anticonvulsants or antiseizure medications.
3) Calcium Channel Blockers inhibit artery dilation and block serotonin release.
4) Tricyclic Antidepressants block serotonin receptors.
5) Selective Serotonin Reuptake Inhibitors are often better tolerated than tricyclic antidepressants but less effective.
6) Methysergide Malate prescribed for people with frequent, severe migraines.
Abortive Migraine Treatment:
Infrequent migraines are often treated with over-the-counter medications.
More severe migraine headaches may require prescription medications.
1) Analgesics (ibuprofen, Tylenol) can provide pain relief and should be taken when the first signs of a migraine appear. Analgesics are used for people who get less than three migraines in a month and breakthrough headaches.
2) Serotonin Receptors are fast-acting medications used to treat migraines and available in oral, injectable, and nasal sprays. Serotonin Receptors can be used at any time during the migraine.
3) Ergots should be taken at the first sign of migraine, can be administered orally, through the nose, or as a suppository, and are often combined with anti-nausea medications.
Headache Avoidance and Maintenance:
- Health care providers recommend that migraine sufferers maintain regular sleep patterns, going to bed and rising at approximately the same times each day, and not getting too little or too much sleep. Most adults need between 6-8 hours of sleep per night.
- Limit caffeine, alcohol, and other medications.
- Reduce stress.
Additional Migraine Headache Resources:
EMedicine Health Migraine Headaches: high-level explanation of migraine headaches, their pathophysiology, causes, treatments, and other facts.
National Headache Foundation: aims to enhance the healthcare of headache sufferers. NHF is also a source of help to sufferers' families, physicians, allied healthcare professionals and the public. The NHF provides educational and informational resources, supporting headache research and advocating for migraines to be seen as a legitimate neurobiological disease.
KidsHealth: provides information and resources for parents of children who suffer from migraine headaches.