Migraines are chronic headaches that can cause significant pain for hours or even days. Symptoms can be so severe that all you can think about is finding a dark, quiet place to lie down. Some migraines are preceded or accompanied by sensory warning symptoms or signs (auras), such as flashes of light, blind spots or tingling in your arm or leg. A migraine is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Although there's no cure, medications can help reduce the frequency and severity of migraines. If treatment hasn't worked for you in the past, it's worth talking to your doctor about trying a different migraine medication. The right medicines combined with self-help remedies and lifestyle changes may make a tremendous difference.
Complications of Migraine
Sometimes your efforts to control your pain cause problems.
Abdominal problems. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and aspirin, may cause abdominal pain, bleeding and ulcers — especially if taken in large doses or for a long period of time.
Rebound headaches. In addition, if you take over-the-counter or prescription headache medications more than nine days per month or in high doses, you may be setting yourself up for a serious complication known as rebound headaches. Rebound headaches occur when medications not only stop relieving pain, but actually begin to cause headaches. You then use more pain medication, which traps you in a vicious cycle.
Serotonin syndrome. This potentially life-threatening drug interaction can occur if you take migraine medicines called triptans, such as sumatriptan (Imitrex) or zolmitriptan (Zomig), along with antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Some common SSRIs include Zoloft, Prozac and Paxil. SNRIs include Cymbalta and Effexor. Fortunately, serotonin syndrome is rare.
Causes of Migraine
Although much about the cause of migraines isn't understood, genetics and environmental factors seem to both play a role.
Migraines may be caused by changes in the trigeminal nerve, a major pain pathway. Imbalances in brain chemicals, including serotonin — which helps regulate pain in your nervous system — also may be involved.
Serotonin levels drop during migraines. This may trigger your trigeminal system to release substances called neuropeptides, which travel to your brain's outer covering (meninges). The result is headache pain.
Whatever the exact mechanism of the headaches, a number of things may trigger them. Common migraine triggers include:
Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications — such as oral contraceptives and hormone replacement therapy — also may worsen migraines, though some women find it's beneficial to take them.
Foods. Some migraines appear to be triggered by certain foods. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; aspartame; overuse of caffeine; monosodium glutamate — a key ingredient in some Asian foods; salty foods; and processed foods. Skipping meals or fasting also can trigger migraines.
Stress. Stress at work or home can instigate migraines.
Sensory stimuli. Bright lights and sun glare can produce migraines, as can loud sounds. Unusual smells — including pleasant scents, such as perfume, and unpleasant odors, such as paint thinner and secondhand smoke, can also trigger migraines.
Changes in wake-sleep pattern. Either missing sleep or getting too much sleep may serve as a trigger for migraine attacks in some individuals, as can jet lag.
Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
Medications. Certain medications can aggravate migraines.
Signs & Symptoms of Migraine
Migraines usually begin in childhood, adolescence or early adulthood. A typical migraine attack produces some or all of these signs and symptoms:
Moderate to severe pain, which may be confined to one side of the head or may affect both sides
Head pain with a pulsating or throbbing quality
Pain that worsens with physical activity
Pain that interferes with your regular activities
Nausea with or without vomiting
Sensitivity to light and sound
When untreated, a migraine typically lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or much less frequently. Not all migraines are the same. Most people experience migraines without auras, which were previously called common migraines. Some people have migraines with auras, which were previously called classic migraines. Auras can include changes to your vision, such as seeing flashes of light and feeling pins and needles in an arm or leg. Whether or not you have auras, you may have one or more sensations of premonition (prodrome) several hours or a day or so before your headache actually strikes, including:
Feelings of elation or intense energy
Cravings for sweets
Irritability or depression
Diagnosis of Migraine
If you have typical migraines or a family history of migraines, your doctor will likely diagnose the condition on the basis of your medical history and a physical exam. But if your headaches are unusual, severe or sudden, your doctor may recommend a variety of tests to rule out other possible causes for your pain.
Computerized tomography (CT). This imaging procedure uses a series of computer-directed X-rays that provides a cross-sectional view of your brain. This helps doctors diagnose tumors, infections and other possible medical problems that may be causing your headaches.
Magnetic resonance imaging (MRI). MRIs use radio waves and a powerful magnet to produce very detailed cross-sectional views of your brain. MRI scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.
Spinal tap (lumbar puncture). If your doctor suspects an underlying condition, such as meningitis — an inflammation of the membranes (meninges) and cerebrospinal fluid surrounding your brain and spinal cord — he or she may recommend a spinal tap (lumbar puncture). In this procedure, a thin needle is inserted between two vertebrae in your lower back to extract a sample of cerebrospinal fluid (CSF) for laboratory analysis.
Treatments of Migraine
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
Stronger pain relievers like narcotics
Many of the prescription medications used for migraines are designed to narrow your blood vessels. Therefore, these drugs should not be used if you have heart disease unless specifically instructed by your doctor. If you experience side effects from medications and would like to consider an alternative, feverfew is an herb that is quite popular for migraines. Several studies, but not all, have supported the value of feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, it is important to know that (unlike medications) herbal remedies sold in drugstores and health food stores are not regulated. Therefore, it is best to work with a trained herbalist when selecting such substances.
Prevention of Migraine
Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you:
Avoid triggers. If certain foods seem to have triggered your headaches in the past, avoid those foods. If certain scents are a problem, try to avoid them. In general, establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.
Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches. Obesity is also thought to be a factor in migraines, and regular exercise can help you keep your weight down.
Reduce the effects of estrogen. If you're a woman with migraines and estrogen seems to trigger or make your headaches worse, you may want to avoid or reduce the amount of medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Talk with your doctor about the best alternatives or dosages for you.
When to seek Medical Advice
Migraines are often undiagnosed and untreated. If you experience signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches and decide on a treatment plan.
Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.
See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems:
An abrupt, severe headache like a thunderclap.
Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking.
Headache after a head injury, especially if the headache gets worse.
A chronic headache that is worse after coughing, exertion, straining or a sudden movement.