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Migraine Headaches

more about Migraine Headaches


Migraines are recurring Headaches that are sometimes accompanied by Nausea, Vomiting, sensitivity to light, sound, throbbing pain(N), and blurred vision.

The two of the most common types are Migraine With Aura (Classic Migraine) and Migraine Without Aura (Common Migraine). The Migraine With Aura yields significant visual changes (bright curved or saw-tooth lines of light or flashing lights with partial vision loss and then returning to normal), sensation loss, or even weakness. The Common Migraine does not have these symptoms.

Other less common types of migraines are:

    1. Hemiplegic migraine - A temporary paralysis on one side of the body (hemiplegia). Vision problems and Vertigo may occur. Symptoms often begin minutes to 2 hours before the onset of Headache pain.

    2. Benign exertional Headache - Brought on by exertion due to activities such as running, lifting, coughing, Sneezing, or bending. The Headache begins at the onset of activity and rarely lasts more than several minutes.

    3. Ophthalmoplegic Migraine - pain(N) around the eye. A droopy eyelid, Double Vision, and other vision problems typically occur.

    4. Basilar artery migraine - Due to changes in the major brain artery at the base of the brain. Other symptoms that may precede the Headache include poor muscular coordination, Vertigo, and Double Vision. More common in adolescent and young adult women, and is often associated with the menstrual cycle.

    5. Status migrainosus - A severe, very pain(N)ful type of migraine that can last 72 hours or longer, and is associated with severe Nausea. Taking certain drugs may trigger it. Some reports suggest that patients were depressed and anxious before they experienced Headache attacks.
    6. Headache-free migraine - Visual Problems, Nausea, Vomiting, Constipation, or Diarrhea occur without head pain(N).

    7. Migraines associate with hormonal changes - It was recently reported that with women, migraines Headaches were significantly more likely to occur during the 2 days before, and the first 5 days following, the onset of menses. Duration is usually 4-72 hours, and it may occur 1-4 times a month (or more frequently, in some cases).


Common symptoms that accompany migraines are Nausea, Vomiting, sensitivity to light (photophobia), sound (phonophobia), throbbing pain(N), and blurred vision. Depending on the type of migraine, some sufferers may not experience any of the classic symptoms associated with migraines.


Recent theories suggest that some Headaches, particularly migraines, may occur when blood vessels overreact to various triggers, such as a certain foods or beverages, bright lights, odors, Anxiety, or weather changes. This causes spasms that close and severely constrict several arteries supplying oxygen-rich blood to the brain and the areas nearby. As the arteries narrow, blood clotting(N) elements, such as platelets, clump together - a process that is believed to release serotonin (a brain neurotransmitter).

Serotonin acts as a powerful constrictor of arteries, further reducing the blood supply to the brain. In response to this reduction of oxygen-rich blood, other arteries within the brain dilate (open wider) to meet the brain's required oxygen and energy levels. The dilation of arteries leads to the release of pain(N)-producing substances called prostaglandins and other chemicals that cause inflammation and swelling, and increase sensitivity to pain(N) by stimulating the nociceptors. This vicious cycle of events results in Headache and other symptoms associated with migraine.



Most Headaches are diagnosed and treated without diagnostic tests or a specialist.

The assessment of a Headache sufferer should start with the physician taking a complete history of the patient's condition. It should include when the Headache occurs, where they occur, how often, what aggravates and what retriggers them. Identifying the trigger factors may be helpful in treating and preventing further attacks.

Examples of some triggers are:

  • Emotional: family problems, work related problems, career changes, anticipation, Anxiety.
  • Stress: strenuous physical exercise(N) or work, illness, too much or too little sleep.
  • Environmental: bright lights, perfume, tobacco, loud noises, changes in altitude, weather, barometric pressure(N) changes.
  • Chemical: hormonal changes, low blood sugar.
  • Medication use
  • Food and beverages: hard cheese(N), hot dogs, chocolate, nuts, food additives such as monosodium glutamate, wheat, sugar, milk, coffee, alcohol(N) and other products.
  • Digestion problems

The evaluation then continues with a very thorough neurological exam and a detailed examination of the head and neck including scalp, blood vessels, eyes, ears, sinuses, temporomandibular joint, teeth, and the bones and muscles of the neck, shoulders and upper back.

If a diagnosis is uncertain, a number of tests can be useful, such as:

  • Blood tests - may include a complete blood count; a reading for levels of Electrolytes, sodium, chloride, bicarbonate, Potassium including Calcium Magnesium, and liver enzymes; an analysis of kidney(N) functions (BUN, Creatinine levels); and the rate of erythrocyte sedimentation.
  • Imaging tests - cervical spine X-Rays, sinus X-Rays, head CT scan, and head and neck MRI may be performed if necessary.
  • Lumbar puncture and Electroencephalography, only if necessary.


    1. Beta-blockers such as Timolol or Propranolol (may not be used if there is Asthma or diabetes(N), or other contraindications to this family of drugs).

    2. Calcium channel blockers such as Verapamil (side effects may include Constipation).

    3. Non-steroidal anti-inflammatories (NSAIDs) such as Advil or Aspirin (not good if you have Stomach(O) problems, such as ulcers, or other medical contraindications to this family of drugs).

    4. Anticonvulsants (anti-seizure medicines) such as Valporic acid (not a good choice for women who are attempting to get pregnant).

Some studies have shown the benefits of using intravenous Magnesium, Vitamin B2 (riboflavin), the herb Feverfew, and even an injection of Botulinum toxin. More studies are on the way regarding the efficacy of these and other prevention therapies.

The treatment of an acute attack depends on the severity of the pain(N):

    1. High doses of non-steroidal anti-inflammatories (NSAIDs) for mild to moderate attacks. They include:

    • Preparations, such as Excedrin Migraine or Motrin Migraine, which are effective over-the-counter medications (However they contain the same active ingredients as regular Excedrin and Motrin).
    • analgesics containing codeine are effective, but there is the risk of addiction if abused.
    • Tylenol can be used alone or in combination with NSAIDs and opiates, such as codeine.
    • injectable NSAIDs, such as Ketorolac.
    • COX 2 enzyme inhibitors, such as Celebrex or Vioxx.

    2. MIDRIN, which is a combination of Isometheptene (a sympathomimetic amine, which acts by constricting dilated cranial and cerebral arterioles, thus reducing the stimuli that lead to vascular Headaches), Dichloraiphenazone (a mild sedative that reduces the patient's emotional reaction to the Headache pain(N) of both vascular and tension headaches), and Acetaminophen (Tylenol), may be used as treatment.

    3. The Triptan class of drugs (e.g. Imitrex Amerege, Zomig and Maxalt) act on specific serotonin receptors (serotonin receptor agonists) in the brain and relieve the Headache, Nausea and light sensitivity soon after onset. They can be found in nasal spray, injectable, or pill form. Triptans cause vasoconstriction (narrowing) of blood vessels, which may be dangerous to those with a history of heart(N) or vascular disease.

    4. The ergotamine class of drugs, which narrow blood vessels, relieve pain(N) of migraines and other Headaches caused by dilated blood vessels. Ergotamine may come in suppositories (Wigraine, Cafegot, Cafergot PB), oral inhaler, sublingual (under the tongue and quick dissolving), ergotamine plus caffeine(N) (Wigraine, Cafegot), and ergotamine plus belladonna and phenobarbital (Bellergal-S, Cafegot PB). In its nasal spray form, Dihydroergotamine (DHE or Migranal) has been known to stop migraine attacks in up to 90% of sufferers.

    Side effects may include Dizziness, Tingling sensations, Muscle Cramps, and chest or abdominal pain(N). Ergotamines are toxic at high levels. It is not recommended for those suffering from arterial or vascular diseases (heart(N) problems or Stroke) and for pregnant women. When taken more than twice a week, the patient is at risk of rebound Headaches (attacks that erupt when the drug is not taken) and for severe dependency with withdrawal symptoms when the drug is stopped.

    5. Since the nerves in the face and head are affected by the neurochemical (neurotransmitter) serotonin-boosting anti-depressants such as Prozac (Fluoxetine), Zoloft (Sertraline) or other antidepressant such as Elavil (Amitriptyline) may be useful to some migraine sufferers.

    6. Medications for Nausea such as Reglan or Prochlorperazine (taken intravenously) may be used for Nausea and Vomiting. Both cause extreme drowsiness.

    7. Fiorinal (Aspirin plus Butalbital), Fioricet (acetaminophen plus butalbital), and Fiorinal # 3 (aspirin plus butalbital plus codeine) are often prescribed, but no reliable studies support their use for treatment of migraines.

    8. Corticosteroids may be used for prolonged migraines.

    9. Lidocaine taken intranasally has been used, but has not been found to be effective in clinical studies.

Non-medical treatments such as Biofeedback, relaxation training, acupuncture, herbs, guided imagery, dietary changes (to avoid trigger factors), exercise(N) and other lifestyle changes should be included in the treatment of problematic and recurring Headaches.


  • Headaches - general
  • Tension headaches
  • Cluster Headaches
  • Ophthalmoplegic Migraine
  • Stroke
  • Subarachnoid Hemorrhage
  • Brain Tumor
  • Headaches due to Brain Tumor
  • Brain Aneurysm
  • Headaches due to brain hemorrhage or aneurysm
  • Headaches due to substance abuse
  • Headaches due to post-traumatic injuries or Concussion(P)
  • sinus infection or Sinusitis
  • Headaches due to sinus infections
  • Headaches due to changes in intracranial pressure(N)
  • Meningitis
  • Shingles
  • Temporal Arteritis




  • more about Migraine Headaches


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