ABSTRACT – Migraine is a severe, frequent and throbbing condition which results in painful headache on one side of...
Migraine can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.
For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.
Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, might help.
Migraines, which often begin in childhood, adolescence or early adulthood, can progress through four stages: prodrome, aura, attack and post-drome. Not everyone who has migraines goes through all stages.
One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including:
Mood changes, from depression to euphoria
Increased thirst and urination
For some people, aura might occur before or during migraines. Auras are reversible symptoms of the nervous system. They’re usually visual, but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes.
Examples of migraine aura include:
Visual phenomena, such as seeing various shapes, bright spots or flashes of light
Pins and needles sensations in an arm or leg
Weakness or numbness in the face or one side of the body
Hearing noises or music
Uncontrollable jerking or other movements
A migraine usually lasts from four to 72 hours if untreated. How often migraines occur varies from person to person. Migraines might occur rarely or strike several times a month.
During a migraine, you might have:
Pain usually on one side of your head, but often on both sides
Pain that throbs or pulses
Sensitivity to light, sound, and sometimes smell and touch
Nausea and vomiting
After a migraine attack, you might feel drained, confused and washed out for up to a day. Some people report feeling elated. Sudden head movement might bring on the pain again briefly.
Though migraine causes aren’t fully understood, genetics and environmental factors appear to play a role.
Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. So might imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system.
Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).
There are a number of migraine triggers, including:
Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.
Hormonal medications, such as oral contraceptives and hormone replacement therapy, also can worsen migraines. Some women, however, find their migraines occurring less often when taking these medications.
Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.
Stress. Stress at work or home can cause migraines.
Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — including perfume, paint thinner, secondhand smoke and others — trigger migraines in some people.
Sleep changes. Missing sleep, getting too much sleep or jet lag can trigger migraines in some people.
Physical factors. Intense physical exertion, including sexual activity, might provoke migraines.
Weather changes. A change of weather or barometric pressure can prompt a migraine.
Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skipping meals or fasting.
Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods.
Migraine treatment is aimed at stopping symptoms and preventing future attacks.
Many medications have been designed to treat migraines. Medications used to combat migraines fall into two broad categories:
Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms.
Preventive medications. These types of drugs are taken regularly, often daily, to reduce the severity or frequency of migraines.
Your treatment choices depend on the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have.
Medications for relief
Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine — as soon as signs and symptoms of a migraine begin. Medications that can be used to treat it include:
Pain relievers. These over-the-counter or prescription pain relievers include aspirin or ibuprofen (Advil, Motrin IB, others). When taken too long, these might cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract.
Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain.
Triptans. These are prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt) are prescription drugs used for migraine because they block pain pathways in the brain. Taken as pills, shots or nasal sprays, they can relieve many symptoms of migraine. They might not be safe for those at risk of a stroke or heart attack.
Dihydroergotamines (D.H.E. 45, Migranal). Available as a nasal spray or injection, these are most effective when taken shortly after the start of migraine symptoms for migraines that tend to last longer than 24 hours. Side effects can include worsening of migraine-related vomiting and nausea.
People with coronary artery disease, high blood pressure, or kidney or liver disease should avoid dihydrogergotamines.
Opioid medications. People who have migraines who can’t take other migraine medications, narcotic opioid medications, especially those that contain codeine, might help. Because they can be highly addictive, these are usually used only if no other treatments are effective.
Anti-nausea drugs. These can help if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea drugs include chlorpromazine, metoclopramide (Reglan) or prochlorperazine (Compro). These are usually taken with pain medications.