Migraine Headache

more about Migraine Headache

Description

  • Migraine Headache is a disease that affects 26 million Americans.  It is the second leading cause of primary headaches, and often afflicts individuals between the ages of 25-45.  It is a neurological illness with biological changes (see causes) that often start in childhood.  The number and severity of attacks decline after age 45.
  • There are two types of migraines: migraine with aura (15%) and migraine without aura (85%).  An aura is a warning sign (see symptoms) that often precedes the headache.  In a small number of patients with this condition, the lower portion of the brain (brain stem) is involved (i.e., basilar migraine).
  • Migraines are often missed as the cause of intense headaches.

Symptoms

  • Prodromal symptoms (24-48 hours before the headache):

– Mood swings (feeling depressed or unusually happy), weakness, fluid retention, craving certain foods

  • Aura or warning signs (1-2 hours before the headache):
    1. Flashing lights in one eye.
    2. Seeing things that are not really there (visual hallucinations).
    3. One side of the body or face may be numb or tingling (pins and needles sensation).
    4. Illusions of tastes or odors (not real).
    5. Double Vision, poor balance, dizziness and Ringing in the Ear.
    6. Aura symptoms disappear within one hour.
    7. There may be variety of other auras.
  • Severe pain over one side of head (both sides in 1/3 of the patients)
  • Sensitivity to light
  • Tenderness of the scalp
  • Sensitivity to sound and smells
  • Nausea or vomiting
  • Swelling or pain that overwhelms the face
    1. Pain can be disabling, and last anywhere from 4-72 hours

Cause

  • Most likely a combination of the following:
  • An abnormality of the blood vessels and blood flow in the superficial layer of the brain (cerebral cortex).  The blood vessels in the cortex first shrink (constrict), then swell (dilate), bringing about the pain.
  • Genetic factors — seems to run in families (especially in identical twins)
  • Platelet disorders — platelets are cell fragments  that help to stop bleeding after an injury
    1. Abnormal levels of brain chemicals (neurotransmitters) such as serotonin, enkephalins (natural painkillers), and chatecholamines.  Certain migraines result from changes in female hormones (i.e., estrogen and Progesterone) during menstruation, menopause, and when birth control pills are used.

How the diagnosis is made

  • Presently, there are no diagnostic tests available.
  • History of medical problems, family, medications, habits and symptoms are extremely important.
  • A medical exam and further laboratory tests may help rule out other diseases.
  • X-Rays and MRI (using magnetic energy to take a picture of the brain) may be done to rule out other diseases.

Risk Factors

  • A family history of migraines
  • Excessive and prolonged use of painkillers (analgesic medication or drugs)
  • There is a higher risk of developing migraines for women then there is for men.
  • Factors that can trigger an attack:
  • Foods — red wine, beer, iodine, fermented cheeses, MSG, and aspartame (food additives), and processed meats. (coffee is not a trigger.)
  • A woman’s menstrual cycle may trigger a migraine
  • Changes in the climate and the air
  • Sunlight
  • Florescent light
    1. Perfumes and other chemicals

Treatment

  • General measures:
    1. Dim lights, quiet environments, and sleeping may help to ease the pain.
    2. Avoid triggering factors
  • Medications:
    • Those that reduce the number of attacks (often taken by mouth daily):
      1. Propanolol, Depakote, Verapamil, Methysergide, and some of the
        newer anti-depressants
      2. Imitrex, Migranal, Stadol, Zomig, ergotamine tartrate, and Amerge are some examples of this class.  Can be given by self-injection, by mouth, rectally, or by nasal spray.
      3. For severe headaches that are not aborted, hospitalization and medication for nausea and vomiting (Vistaril), and strong painkillers such as Demerol can be given.
      4. Prescription painkillers such as Fiorinal with or without codeine, Percodan, and Ibuprofen are also used.  Some of these medications are addictive and must be used carefully.
      5. Tylenol and Excedrin Migraine are two over-the-counter medications that tend to be effective only in very mild cases.
      6. Herbal and nutritional treatments such as fever few, butter root, B-2 vitamins (400milligrams/day), and Magnesium (400milligrams/day) may help.

If You Suspect this Condition

  • Talk to your physician and ask about all your options.  If need be, seek a headache specialist.  Reliable information can be obtained from the National Headache Foundation at 1-888-NHF-5552.

 

Similar Conditions

  • These might have similar symptoms:
  • Tension headache
  • Cluster headache
  • Stroke
    1. Brain Tumor or Abscess