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Migraine Headache

A migraine can be disabling — with symptoms so severe, all you can think about is finding a dark, quiet place to lie down. Up to 17 percent of women and 6 percent of men have experienced a migraine.

In some cases, these painful headaches are preceded or accompanied by a sensory warning sign (aura), such as flashes of light, blind spots or tingling in your arm or leg. A migraine is also often accompanied by other signs and symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. Migraine pain can be excruciating and may incapacitate you for hours or even days.

Fortunately, management of migraine pain has improved dramatically in the last decade. If you've seen a doctor in the past and had no success, it's time to make another appointment. Although there's still no cure, medications can help reduce the frequency of migraine and stop the pain once it has started. The right medicines combined with self-help remedies and changes in lifestyle may make a tremendous difference for you.

Migraine Headache Causes

The exact cause of migraine headaches is not clearly understood, though experts believe they are due to a combination of the expansion of blood vessels and the release of certain chemicals, which causes inflammation and pain.

The chemicals dopamine and serotonin are among those involved in migraine. These chemicals are found normally in the brain and can cause blood vessels to act abnormally if they are present in abnormal amounts or if the blood vessels are unusually sensitive to them.

Various triggers are thought to bring about migraine in certain people prone to developing migraine. Different people may have different triggers:

• Certain foods, especially chocolate, cheese, nuts, alcohol, and MSG, bring on headaches in some people. (MSG is a food enhancer used in many foods including Chinese food.)
• Missing a meal may bring on a headache.
• Stress and tension are also risk factors. People often have migraines during times of increased emotional or physical stress.
• Birth control pills are a common trigger. Women may have migraines at the end of the pill cycle as the estrogen component of the pill is stopped. This is called an estrogen-withdrawal headache.
• Smoking may cause migraines or interfere with treatment.

What are the symptoms of migraine headaches?

Migraine is a chronic condition of recurrent attacks. Most (but not all) migraine attacks are associated with headaches. Migraine headaches usually are described as an intense, throbbing or pounding pain that involves one temple. (Sometimes the pain can be located in the forehead, around the eye, or the back of the head). The pain usually is unilateral (on one side of the head), although about a third of the time the pain is bilateral. The unilateral headaches typically change sides from one attack to the next. (In fact, unilateral headaches that always occur on the same side should alert the doctor to consider a secondary headache, for example, one caused by a brain tumor). A migraine headache usually is aggravated by daily activities like walking upstairs. Nausea, vomiting, diarrhea, facial pallor, cold hands, cold feet, and sensitivity to light and sound commonly accompany migraine headaches. As a result of this sensitivity to light and sound, migraine sufferers usually prefer to lie in a quiet, dark room during an attack. A typical attack lasts between 4 and 72 hours.

An estimated 40%-60% of migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days. The symptoms may include sleepiness, irritability, fatigue, depression or euphoria, yawning, and cravings for sweet or salty foods. Patients and their family members usually know that when they observe these warning symptoms that a migraine attack is beginning.

An estimated 20% of migraine headaches are associated with an aura. Usually, the aura precedes the headache, although occasionally it may occur simultaneously with the headache. The most common auras are 1) flashing, brightly colored lights in a zigzag pattern (fortification spectra), usually starting in the middle of the visual field and progressing outward and 2) a hole (scotoma) in the visual field, also known as a blind spot. Some elderly migraine sufferers may experience only the visual aura without the headache. A less common aura consists of pins-and-needles sensations in the hand and the arm on one side or pins-and-needles sensations around the mouth and the nose on the same side. Other auras include auditory (hearing) hallucinations and abnormal tastes and smells.

Complicated migraines are migraines that are accompanied by neurological dysfunction. The part of the body that is affected by the dysfunction is determined by the part of the brain that is responsible for the headache. Vertebrobasilar mgraines are characterized by dysfunction of the brainstem (the lower part of the brain that is responsible for automatic activities like consciousness and balance). The symptoms of vertebrobasilar migraines include fainting as an aura, vertigo (dizziness in which the environment seems to be spinning) and double vision. Hemiplegic migraines are characterized by paralysis or weakness of one side of the body, mimicking a stroke. The paralysis or weakness is usually temporary, but sometimes it can last for days.

For approximately 24 hours after a migraine attack, the migraine sufferer may feel drained of energy and may experience a low-grade headache along with sensitivity to light and sound. Unfortunately, some sufferers may have recurrences of the headache during this period.

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