Migraines

Migraines are a type of headache that affects nerves and blood vessels (neurovascular). The 2 most common types of migraines are migraine with aura and migraine without aura.

• Migraine with aura. This type of migraine includes an aura. You may see flashing lights or zigzag lines or lose your eyesight for a short time. This usually happens 5 to 60 minutes before the headache starts. The aura may also happen during the headache.
• Migraine without aura. With this type the headache begins without any preceding aura.

Here are some facts about migraines:

• Migraine is a neurologic disease with incapacitating neurologic symptoms.
• Migraines are typically characterized by a severe throbbing pain, usually on one side of the head. In some cases, both sides of the head are affected.
• Attacks often are accompanied by one or more of these symptoms: nausea, vomiting, sensitivity to sound, light, and smell.
• About 25 percent of people with migraines also have a visual disturbance called an aura, which typically lasts less than an hour.
• Attacks tend to last between four and 72 hours.

Older theories about migraines suggested that symptoms were possibly due to fluctuations in blood flow to the brain. Today many headache researchers realize that changes in blood flow and blood vessels don't initiate the pain.

Current thinking is that when the headache begins the trigeminal nerve, the main sensory nerve of the head, becomes activated and then releases a protein called calcitonin gene related peptide or CGRP.  This protein then activates other nerve cells and blood vessels to cause a migraine attack. 

What causes an aura is different.  It is thought that there is a wave of electricity that first activates nerve cells in the brain and then spreads across it surface.  When this electrical wave involves the part of the brain for vision you get a visual aura (flashing lights or zig zag lines in your vision).  When it involves the part of the brain involved in sensation then you get a sensory aura (pins and needles of your face, arms or legs).

People who get migraines may be able to identify triggers that seem to kick off the symptoms. Some possible triggers include the following:

• Stress and other emotions.
• Hormones in women.
• Changes in one's sleep pattern.
• Odors.
• Glaring or flickering lights.
• Weather changes.
• Certain foods and drinks.

The National Headache Foundation suggests documenting triggers in a headache diary. Taking this information with you when you visit your healthcare provider helps him or her to identify headache management strategies.

In order to get an accurate diagnosis it is important to be able to describe your migraine symptoms to your healthcare provider. It is helpful to track migraine occurrences (dates and times) and the details associated with migraines.

Take note of the following:

• What time of day do the headaches happen?
• What is the specific location of the headaches?
• What do the headaches feel like?
• How long do the headaches last?
• Have there been changes in behavior or personality?
• Do changes in position cause the headaches?
• Do you have trouble sleeping?
• Do you have a history of stress?
• Are you currently experiencing an unusual amount of stress in your work, family, or personal life? 
• Is there a history of head trauma?

Blood work, X-rays and other procedures are generally used to rule out other possible causes of headache. They include:

• Blood tests. Various blood chemistry and other laboratory tests may be run to check for underlying conditions.
• Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radio-frequencies, and a computer to produce detailed images of organs and structures within the body.
• Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include:

• Medicine therapy.
• Stress reduction.
• Dietary evaluation.
• Regular exercise.
• Cold packs applied to the skin.
• Pressure applied to the head.
• Biofeedback training.

The goal of treatment is to stop headaches from happening. Adequate headache management depends on the accurate identification of the type of headache and may include:

• Avoiding known triggers, such as certain foods and beverages, lack of sleep, and fasting.
• Changing eating habits.
• Exercise.
• Resting in a quiet, dark environment.
• Medicines, as recommended by your healthcare provider.
• Stress management.

Migraine headaches may need specific medicine management including:

• Abortive medicines. Medicines, that are over-the-counter or prescription medications,  can stop a headache in progress. They are used to get rid of the pain “right now.”
• Preventive medicines. Medicines, prescribed by your healthcare provider, to reduce the onset or frequency of severe migraine headaches.  The medicines can be given by pill or shot. Pills are given daily and shots are given every 1-3 months to prevent migraine attacks. 

Treatment is individualized, depending on the severity and frequency of symptoms.

The first step in preventing migraines is to learn what triggers them. You may then be able to control your triggers to avoid or reduce the severity of your migraines.

Know your triggers

Be aware that you may have more than one trigger, and that some triggers may work together. Common migraine triggers include:

• Food and nutrition. Skipping meals or not drinking enough water can trigger headaches. So can certain foods, such as caffeine, chocolate, artificial sweeteners, monosodium glutamate (MSG), aged cheese, or sausage.
• Alcohol. Red wine and other alcoholic beverages are common migraine triggers.
• Chemicals. Scents, cleaning products, gasoline, glue, perfume, and paint can be triggers. So can tobacco smoke, including secondhand smoke.
• Emotions. Stress can trigger headaches or make them worse once they start.
• Sleep disruption. Staying up late, sleeping late, and traveling across time zones can disrupt your sleep cycle, triggering headaches
• Hormones. Many women notice that migraines tend to happen at a certain point in their menstrual cycle. Birth control pills or hormone replacement therapy may also trigger migraines.
• Environment and weather. Air travel, changes in altitude, air pressure changes, hot sun, or bright or flashing lights can be triggers.
• Medicine overuse. Frequent use of pain medicines for headache pain can also cause a headache. This may also be called rebound headache.

Control your triggers

These are some of the things you can do to try to control triggers:

• Avoid triggers if you can. For example, stay clear of alcohol and foods that trigger your headaches. Use unscented household products. Keep regular sleep habits. Manage stress to help control emotional triggers.
• Change your behavior at times when triggers can't be avoided. For example, make sure to get enough rest and drink plenty of water while you're traveling. Make sure to carry a hat, sunglasses, and your medicines. Be alert for migraine symptoms, so you can treat a migraine early if it happens.

Try these suggestions:

• Take your acute medication as early in the attack as possible as it will work better.  
• Stay quiet and rest.
• Use cold to numb the pain. Wrap ice or a cold can of soda in a cloth. Hold it against the site of pain for 10 minutes. Repeat every 20 minutes.
• Stay out of the light. Wear dark glasses, turn out the lights, and close the curtains. When outdoors, wear a brimmed hat.
• Drink lots of fluids. Sip caffeine-free flat soda to help relieve nausea.
• See your doctor if you get migraines or cluster headaches often. There are effective medicines to help treat or prevent them.
• Hormone therapy. This may help women whose migraines are related to hormonal changes during menstruation.

Because you have migraines, getting a bad headache is not new to you. If your migraine pattern changes or your headaches suddenly feel different, it could be a sign of a more serious medical condition.

Call your healthcare provider right away if you experience any of the following:

• A severe headache that comes out of the blue, sometimes described as a "thunderclap." This type of headache reaches peak intensity in less than one minute and is often described as the “worst headache of your life”. 
• A headache with confusion, seizures, double vision, weakness, numbness, or trouble speaking.
• A headache associated with seizures.
• A headache with a fever and stiff neck.  This can sometimes indicate an infection of the lining of the brain called meningitis.
• A headache that follows a head injury, especially if it keeps worsening in intensity.