Headache - migraine

Alternative names
Migraine

Definition

Migraine headaches are a type of headache that some people get repeatedly over time. Migraines are different from other headaches because they occur with symptoms such as nausea, vomiting, or sensitivity to light.

Some people who get migraines have warning symptoms, called an aura, before the actual headache begins. Most people, however, do not have such warning symptoms.

See also:

     
  • Common migraine (which have no warning symptoms or aura)  
  • Classic migraine (which have an aura consisting of visual disturbances before the headache starts)  
  • Mixed tension migraine (has features of both migraines and tension headache)

Causes, incidence, and risk factors

A lot of people get migraines - about 6 out of 100. The headaches tend to start between the ages of 10 and 46, may run in families, and occur in women more often than men.

Migraines are classified as either “common” or “classic”. Common migraines do not have any warning symptoms, while classic migraines do have a warning (the aura). Most migraine patients have the common type.

The exact cause of migraine is not known. Migraine headaches are related to problems with blood flow through parts of the brain. At the start of a migraine, blood vessels in certain areas of the brain constrict (narrow), leading to symptoms like visual disturbances, difficulty speaking, weakness, or numbness. Minutes to hours later, the blood vessels dilate (enlarge), leading to increased blood flow in the brain and a bad headache.

Why these changes in blood vessels and blood flow occur in the brain is not understood. Certain triggers, however, make it more likely for you to get migraines:

     
  • Allergic reactions  
  • Bright lights, loud noises, and certain odors or perfumes  
  • Physical or emotional stress  
  • Changes in sleep patterns  
  • Smoking or exposure to smoke  
  • Skipping meals  
  • Alcohol or caffeine  
  • Menstrual cycle fluctuations, birth control pills  
  • Tension headaches  
  • Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)  
  • Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods

Symptoms

Migraine headaches, which can be dull or severe, usually:

     
  • Feel throbbing, pounding, or pulsating  
  • Are worse on one side of the head  
  • Last 6 to 48 hours

Symptoms accompanying migraines include:

     
  • Nausea and vomiting  
  • Sensitivity to light or sound  
  • Loss of appetite  
  • Fatigue  
  • Numbness, tingling, or weakness

Warning signs that a migraine is coming include seeing stars or zigzag lines, having tunnel vision, or temporary blind spot.

Symptoms that may linger even after the migraine has gone away include:

     
  • Feeling mentally dull, like your thinking is not clear or sharp  
  • Increased need for sleep  
  • Neck pain

Signs and tests

Migraine headache may be diagnosed by your doctor based on your symptoms, history of migraines in the family, and your response to treatment. Your doctor will take a detailed history to make sure that your headaches are not due to tension, sinus inflammation, or a more serious underlying brain disorder. On physical examination, your doctor is likely to find nothing wrong with you.

Sometimes an MRI or CT scan is obtained to rule out other causes of headache like sinus inflammation or a brain mass. In the case of a complicated migraine, an EEG may be needed to exclude seizures. Rarely, a lumbar puncture (spinal tap) might be performed.

Treatment

There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or altering triggers. When you do get migraine symptoms, try to treat them right away. The headache may be less severe.

A good way to identify triggers is to keep a headache diary. See headache.

When migraine symptoms begin:

     
  • Rest in a quiet, darkened room.  
  • Drink fluids to avoid dehydration (especially if you have vomited).  
  • Try placing a cool cloth on your head.

Over-the-counter pain medications like acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. If these don’t help, ask your doctor about prescription medications.

Your doctor will select from several different types of medications, including:

     
  • Ergots like ergotamine, dihydroergotamine, or ergotamine with caffeine (Cafergot)  
  • Triptans like sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), and zolmitriptan (Zomig); these are available as a tablet, nasal spray, or self-administered injection  
  • Isometheptene (Midrin)  
  • Stronger pain relievers like narcotics

Many of the prescription medications for migraines narrow your blood vessels. Therefore, these drugs should not be used if you have heart disease, unless specifically instructed by your doctor.

If you wish to consider an alternative, feverfew is a popular herb for migraines. Several studies, but not all, support using feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, know that herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.

Expectations (prognosis)

Every person responds differently to treatment. Some people have rare headaches that require little to no treatment. Others require the use of several medications or even occasional hospitalization.

Complications

     
  • Migraine headaches generally represent no significant threat to your overall health. However, they can be chronic, recurrent, frustrating, and they may interfere with your day-to-day life.  
  • Stroke is an extremely rare complication from severe migraines. This risk may be due to prolonged narrowing of the blood vessels, limiting blood flow to parts of the brain for an extended period of time.

Calling your health care provider

Call 911 if:

     
  • You have unusual symptoms not experienced with a migraine before, like speech or vision problems, loss of balance, or difficulty moving a limb.  
  • You are experiencing “the worst headache of your life.”

Call your doctor immediately if:

     
  • Your headache pattern or intensity is different.  
  • Your headache gets worse when you lie down.

Also, call your doctor if:

     
  • Previously effective treatments no longer help.  
  • Side effects from medication occurs (irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, extreme thirst, or others).  
  • You are likely to become pregnant. (Some medications should not be taken when pregnant.)

Prevention

     
  • Avoid smoking, caffeine, and alcohol.  
  • Exercise regularly.  
  • Get enough sleep each night.  
  • Learn to relax and reduce stress. Try progressive muscle relaxation (contracting and releasing muscles throughout your body), meditation, biofeedback, or joining a support group.

If you get at least three headaches per month, your doctor may prescribe medication for you to prevent recurrent migraines.

Such prescription drugs include:

     
  • Beta-blockers, such as propranolol (Inderal)  
  • Anti-depressants, including tricyclics like amitriptyline (Elavil) or SSRIs like fluoxetine (Prozac, Sarafem), paroxetine (Paxil), or sertraline (Zoloft)  
  • Anti-convulsants, like valproic acid (Depacon, Depakene) or divalproex sodium (Depakoate)  
  • Calcium channel blockers, such as verapamil

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.