Headache - migraine (common)

Alternative names
Migraine - common; Common migraine

Definition
Common migraine is a disorder involving recurrent headaches, which may be accompanied by symptoms other than headache but which rarely include a preliminary warning (called an aura).

Causes, incidence, and risk factors

Migraine headaches affect about 6 out of 100 people. They are a common type of chronic headache. They most commonly occur in women and usually begin between the ages of 10 and 46. In some cases, they appear to run in families.

Migraines occur when blood vessels of the head and neck spasm or constrict, which decreases blood flow to the brain. Minutes to hours later, the blood vessels dilate (enlarge), resulting in a severe headache. Inflammation around the blood vessels also occurs in some cases.

Common migraine accounts for almost all migraine headaches. Common migraine may be accompanied by symptoms other than headache but only rarely includes any preceeding symptoms (aura). Migraine may also appear as classic migraine (a migraine preceded by other symptoms) and other rare forms.

Multiple mechanisms trigger the spasm and subsequent blood vessel dilation. Attacks of migraine headache may be associated with:

     
  • Allergic reactions  
  • Bright lights and loud noises  
  • Relaxation after a period of physical or mental stress  
  • Prolonged muscle tension (or tension headache)  
  • Lack of sleep  
  • Smoking or exposure to tobacco smoke  
  • Missed meals  
  • Specific foods  
  • Alcohol use and caffeine  
  • Menstrual periods  
  • Use of oral contraceptives (birth control pills)  
  • Other conditions

Foods that have been associated with migraine in some people include those containing the amino acid tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, some beans), chocolates, nuts, peanut butter, fruits (avocado, banana, citrus fruit), onions, dairy products, baked goods, meats containing nitrates (bacon, hot dogs, salami, cured meats), foods containing monosodium glutamate (an additive in many foods), and any processed, fermented, pickled, or marinated foods.

Symptoms

     
  • headache       o throbbing, pulsating       o usually worse on the sides of the forehead       o may be on only one side of the forehead       o may be severe or dull       o commonly lasts 6 to 48 hours  
  • dizziness  
  • feeling that the room or oneself is moving (vertigo)  
  • loss of appetite  
  • nausea  
  • vomiting  
  • fatigue

Symptoms after an attack:

     
  • dullness  
  • need for increased sleep  
  • neck pain

Signs and tests

A health care provider should be consulted to rule out other disorders that may be causing the headache if the headache:

     
  • Disturbs sleep  
  • Occurs whenever the person is active  
  • Is severe (especially in a previously well person) or persistent  
  • If other symptoms accompany the headache (such as drowsiness, vision changes, changes in movement or sensation, seizures, changes in alertness, nausea and vomiting, or other symptoms)

Migraine headache may be diagnosed by the health care provider based on the pattern of symptoms, history of migraines in the family and response to treatment. A physical examination will reveal no detectable abnormalities.

Treatment

There is no cure for common migraine. The goals of treatment include controlling the symptoms and preventing further attacks.

Rest in a quiet, darkened room often will reduce the severity of the symptoms. Drinking fluids to prevent dehydration is important, especially if vomiting occurs.

Several medications may be advised for relief of symptoms, because the response of migraine to medications is highly variable. If a medication has been effective in relieving a previous migraine, it may be tried before others.

Over-the-counter analgesics may reduce pain if they are taken early in the development of the headache. If mild analgesics are ineffective, vasoconstricting or other medications may be beneficial.

Ergotamine tartrate preparations constrict the arteries of the head and may be used alone or in combination with other drugs such as caffeine (Cafergot), phenobarbital, or Fioricet.

Propoxyphene or other medications that relieve pain or inflammation may provide relief for some people. Nausea should be treated early with Reglan, Compazine, or other anti-emetics.

Any factors that have triggered a migraine in the past should be avoided.

Preventive medications include propranolol, amitriptyline, ergonovine, cyproheptadine, clonidine, methysergide, calcium channel antagonists, valproic acid, carbamazepine, topamax, and many others.

Several medications may need to be tried before one is found to be effective. A class of drugs known as triptans can relieve a migraine once it starts.Various triptans can be injected, taken as a pill, or dissolved under the tongue.

Support Groups
For other organizations that provide information about migraine, see migraine resources.

Expectations (prognosis)

Common migraine does not indicate a life-threatening disorder. It usually is painful and annoying at the time it occurs. It may be chronic and recurrent, which can interfere with a person’s lifestyle.

Rarely, severe migraine may result in a stroke, possibly due to prolonged constriction of blood vessels. Some people may have side effects of medications. A physician should choose the appropriate medications based on symptoms and other conditions.

Complications

     
  • Frequent, recurrent attacks may interfere with lifestyle  
  • Side effects of medications  
  • Permanent neurologic impairments including stroke (rare)

Calling your health care provider

See your health care provider if symptoms of migraine are severe, persistent, or recurrent. Call if any other new symptoms develop or there is a change in the severity or pattern of symptoms.

Call your health care provider if previously effective treatments no longer are helpful, or if symptoms indicating side effects of medications occur, including irregular heartbeat, pale or blue skin color, extreme sleepiness or sedation, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain or cramps, dry mouth, extreme thirst, or others.

Also, call if you are taking an ergotamine-containing medication, and you are likely to become pregnant (these medications should not be taken when pregnant).

Prevention
The occurrence of common migraine may be reduced in high-risk people who avoid factors that have been associated with previous migraine. Preventive (prophylactic) medications may be advised for some people

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, 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.