Migraine Headache

General Illness Information

Medical Term: Migraine headache

Common Name: None Specified

Description: A migraine headache is a recurring, throbbing, intense pain that most commonly affects one side of the head but may affect both sides. The pain is of sudden onset and may be preceded or accompanied by visual, neurologic, or gastrointestinal symptoms. It is a type of vascular headache: a genetically based, neuro-chemical instability of the nervous system triggered by various factors. Usual onset is from childhood to early adulthood.  Sometimes they disappear after age 50. There may be a familial tendency.

A disorder in which the blood vessels are extraordinarily sensitive to various stimuli. More common in women and often associated with the menstrual cycle. (occurs in 15 to 17% of women as opposed to 5% of men). This disorder affects millions of people.  Migraine headaches can be totally disabling but once resolved have no impact on normal state of health of the affected person.

Causes: Pathophysiology of migraine is still poorly understood.

It is believed that nerve impulses trigger release of substances in the blood vessels which in time are thought  to cause the pain of migraine headache. A neuro-transmitter called Serotonin has been implicated as a causative factor. It is believed that these same nerve impulses cause the aura of migraine. An aura is a set of symptoms that sometimes precede a migraine headache.

Prevention:

  • By avoidance of the trigger (precipitating) factors.
  • Prophylactic treatment with medication to reduce frequency and severity of the headache.

PRECIPITATING FACTORS:

  • Emotional and/or physical stress;
  • Changes in behavior;
  • Lack of or excess of sleep Missed meals;;
  • hypoglycemia Environmental factors: Bright or flickering lights;
  • Loud noise;
  • Weather changes;
  • Strong odors Allergens;
  • Foods and beverages: Specific foods e.g. Chocolates, nuts, aged cheese, yogurt, preserved meats (hot dogs, bacon) certain fruits (e.g. red plums, oranges) and alcohol and red wine. Chemicals: Aspartame Monosodium glutamate (MSG, natural flavor, hydrolyzed vegetable protein) Benzene Insecticides Nitrites as in preserved meats.
  • Drugs: Caffeine (and caffeine withdrawal); Cimetidine; Danazol; Dicloflenac; H2 receptor blocker; Hydralazine Indomethacine; Nifedipine; Nitrofurantoin; Nitroglycerine; Oral contraceptives (ethinyl estradiol +) Reserpine.

Signs & Symptoms

There are two types of migraine headaches.

Common migraine (80 – 85 % of migraines) is migraine without aura.

Classic migraine (account for 15-20% of all migraines). In this form of migraine, the headache is preceded by an aura (brain malfunction presenting with one or more of these symptoms, flashing lights, blurred vision, numbness, weakness or difficulty with speech.)

Both types of migraines can be associated with:

  • Severe throbbing headache – usually one sided but may affect both sides of the head.
  • Other most commonly associated symptoms are nausea and vomiting.
  • May last from a few hours to days – and may be mild or so severe as to be debilitating.
  • Aggravated by bright lights, noise and activity and sometimes by certain odors.
  • Occasionally some patients may experience an aura but no headache
  • Sometimes headache may be associated with difficulty with balance, double vision, hearing and/or one-sided weakness of the face & body.
  • May come in clusters and may awaken the individual from sleep each night at about the same time for several nights.
  • Pain is aggravated by walking up and down the stairs or similar routine physical activity.
  • Relief of headache with sleep.
  • Often preceded by irritability or often mood variations, hyperactivity, inability to think or concentrate, food cravings and enhanced sense of smell.

Risk Factors

Family history of migraine.

Diagnosis & Treatment

Diagnosis is by history and examination. Routine tests are performed. CT scans may be ordered.

General Measures:

  • Lying down in a dark, quiet room.
  • Cool wash cloth or ice bag may help diminish the pain.

Medications:

  • Analgesics: Acetaminophen may be useful in mild to moderate migraine. Feverfew may also be of benefit, both for treatment and prevention. Use of narcotic analgesics such as meperidine (Demerol), Codeine and hydrocodone and sedatives such as butalbital (FIORINAL/ and diazepam (VALIUM) should be avoided if at all possible. These drugs have a great potential for abuse and/or addiction.
  • Non steroidal anti-inflammatory drugs are quite useful in treatment of many moderate attacks (e.g. naproxen, ibuprofen).
  • Ergotamine preparations e.g. Cafergot available in tablet, suppository and  injectable forms.  Dihydroerogtamine (eg migranal) available in nasal spray.
  • Sumatriptan (imitrex), Zomig and other 5-HT agonists are available in tablet, injectable and nasal spray preparations. These are newer medications, and are formulated to reverse the biochemical processes involved in migraine.
  • Because migraine headaches and the medications for its treatment are often associated with nausea and vomiting, anti-emetic drugs (medication that stop nausea and vomiting) are frequently prescribed in addition to the above medications e.g. dimenhydrinate (gravol), prochlorperazine, hydroxyzine and metoclopramide.
  • In rare instances, corticosteroids may have to be used to abort a severe attack.
  • Several classes of medication have proven to be beneficial in the prevention of migraine headaches:
  • Betablockers e.g. Propranolol (Inderal) and atenolol (Tenormin)- this is the most frequently used class of drugs. Calcium Channel Blockers e.g. Verapamil, Diltiazem. Anticonvulsant medication e.g. Valproic Acid (Depakene) Natural remedies such as Feverfew. Other drugs used in prevention of migraines includes Clonidine, Cyproheptadine and Tricyclic Antidepressants and some of the non-steroidal anti-inflammatory drugs.

Activity:

No restrictions, except during an attack of migraine patient should rest in a dark quiet room.

Diet:

Avoid foods that trigger migraine headache.

Possible Complications:

Nil.

Prognosis

If treated and well controlled has no impact on normal state of health. However 80% of migraine sufferers have some degree of headache related disability.

Other

Nothing Specified.

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