Migraine is a type of recurring headache. It involves blood vessels, nerves, and brain chemicals. Sensations may come before a migraine. This can include visual changes, called auras.
There are two types of migraines:
The precise cause is unknown. Among the suspected causes are:
A trigger sets the process in motion. It is possible that the nervous system reacts to the trigger by conducting electrical activity. This spreads across the brain. It leads to the release of brain chemicals. These make blood vessels swell. It may be this inflammation that causes pain and other symptoms.
The risk of having a migraine over a lifetime is up to 20%-25%.
Factors that increase your chance for migraines may include:
Migraines occur in phases that may include:
A warning may come before a migraine. In the hours or days before the headache, symptoms may include:
The most common aura is visual. The aura lasts about 15-30 minutes. It may produce the following sensations:
More rarely, an aura can occur by itself. In these cases, it is important to seek medical attention to make sure the symptoms are not due to a more serious cause. This can include stroke or seizure.
Migraine pain starts within an hour of the aura ending. Symptoms include:
Migraines usually last from 4-72 hours. They often go away with sleep. After the headache, you may experience:
The doctor will ask about your symptoms and medical history. A physical exam will be done. You may also be given a neurological exam.
To rule out other conditions your doctor may order a:
The doctor may order blood tests or other tests before starting treatment.Migraine therapy aims to:
Treatment options include:
Pain medications are often needed to ease or stop the pain. Over-the-counter pain pills may ease mild symptoms.
Warning: Regular use of some over-the-counter medications may cause a rebound headache.
Some prescription medications act directly to stop the cause of the migraine headache. These include drugs that:
These drugs can be taken by mouth. They may act more quickly in forms that dissolve in the mouth, are inhaled through the nose, or injected. Your doctor can help you choose the medication best for you.
Medications that can stop a migraine once it has begin include:
Other drugs can help prevent migraines for people with frequent migraines. Preventive drugs are taken every day. Classes of preventative medications include:
In some people, migraines are triggered when a nerve in the head is stimulated. With this type of surgery, the doctor finds the nerve trigger point in the head and deactivates it. This surgery may reduce the number of migraines or completely eliminate them in sufferers who do not respond to conventional treatments.
If you are diagnosed with a migraine, follow your doctor's instructions .
Methods for preventing migraine include:
Suggestions include:
RESOURCES:
American Headache Society
http://www.americanheadachesociety.org/
The National Migraine Association
http://www.migraines.org/index.htm/
CANADIAN RESOURCES:
The College of Family Physicians of Canada
http://www.cfpc.ca/
Health Canada
http://www.hc-sc.gc.ca/index_e.html/
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html . Accessed July 20, 2009.
American Academy of Neurology website. Available at: http://www.aan.com/ . Accessed July 20, 2009.
Benoliel R, Birman N, Eliav E, Sharav Y. International Classification of Headache Disorders . 2nd ed. London, England: The International Headache Society; 2003.
Boes CJ, Capobianco DJ, Cutrer FM, Dodick DW, Garza I, Swanson JW. Headache and other craniofacial pain. Neurology in Clinical Practice website. Available at: http://www.expertconsultbook.com/expertconsult/o/login.do?method=display . Accessed February 3, 2009.
Cephalalgia: An International Journal of Headache . 2004;24(suppl 1).
Dambro MR. Griffith's 5-Minute Clinical Consult . Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
Gladstone JP. Migraine. Medlink website. Available at: http://www.medlink.com . Accessed February 23, 2008.
Goetz CG, Pappert EJ. Textbook of Clinical Neurology . Philadelphia, PA: WB Saunders Co; 1999.
Migraine in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 2009. Accessed February 3, 2009.
Migraine prophylaxis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 2009. Accessed February 3, 2009.
National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/ . Accessed July 20, 2009.
Silberstein SD, Lipton RB. Headache in Clinical Practice . London, England: Martin Dunitz Ltd; 2002.
The Vestibular Disorders Association website. Available at: http://www.vestibular.org/migraine.html . Accessed November 15, 2004.
12/16/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Jena S, Witt CM, Brinkhaus B, Wegscheider K, Willich SN. Acupuncture in patients with headache. Cephalalgia. 2008;28:969-979.
2/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White A. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009;CD001218.
11/10/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S. A placebo-controlled surgical trial of the treatment of migraine headaches. Plast Reconstr Surg. 2009;124(2):461-468.
Last reviewed October 2009 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.