Migraine

Definition

A migraine is an extremely painful type of throbbing headache.

Description

Migraines are a type of vascular headache, meaning that they result from an abnormal reaction of the arteries that supply blood to the brain (cerebral arteries). People who experience migraines overwhelmingly describe them as intensely painful with an onset often characterized by an “aura,” which is a sensory warning described as seeing flashes of light, or spots, or feeling a tingling in limbs. Migraines can be extremely incapacitating and can last for hours or even days. For instance, “status migrainosus” is a severe migraine that can last 72 hours or longer and often results in hospitalization. For many sufferers, migraine is associated with other illnesses such as depression , anxiety , stroke , irritable bowel syndrome , epilepsy, and hypertension .

Demographics

The World Health Organization (WHO) considers migraines to be one of the most debilitating diseases in the world. In the United States, some 17% of women and 6% of men have experienced a migraine. According to the National Headache Foundation, an estimated 28 million Americans have migraine headaches . A 2005 survey, sponsored by the National Headache Foundation, reported that 90% of people with migraines could not function normally on the day of a migraine attack, 80% experienced abnormal sensitivity to light and noise, 75% experienced nausea and vomiting, 30% required bed rest, and 25% missed at least 1 day of work due to migraine in past 3 months. In Canada, more than 3 million people suffer from migraine headaches. Women tend to develop migraines three times more often than men. Migraine headaches start in childhood or adolescence and continue throughout adult life.

Causes and symptoms

The cause of migraines is presently unknown. They are believed to be sparked by spasms in the cerebral arteries which constrict or widen abnormally as a result of serotonin imbalance. Although the precise cause is still being researched, migraine-triggering factors have been documented. For example, women often report that their migraine occurs during or right before the onset of their menstrual cycle. Other triggers include:

• stress
• lack of sleep
• changes in weather
• use of contraceptives
• use of hormone replacement therapies
• environmental chemicals
• liver problems
• dental infections
• some foods including cured meats, red wine, onion, freshly baked yeast products, eggs, alcohol, nuts, and aged cheese
• medical conditions
• medications

Migraines commonly develop in three distinct stages:

• The aura phase: This stage marks the onset of migraine and commonly lasts from 15 to 30 minutes with symptoms that may involve visual disturbances, numbness, dizziness, ringing in the ear, weakness on one side of the body, and sensitivity to light, smells, and noises.
• The headache phase: This phase is characterized by an excruciating headache that may last from hours to days with symptoms such as nausea, sensitivity to light, diarrhea, vomiting, excessive perspiration and chills. It often occurs only on one side of the head.
• The post—headache phase: After the headache has subsided, the skull often remains very tender and the person feels totally exhausted.

Diagnosis

Diagnosis is commonly established on the basis of the patient's medical history and a physical exam. The following tests may also be prescribed to rule out other possible causes of headache:

• Computerized tomography (CT) scan: A CT scan uses computer-directed x rays that provide a view of the brain to identify possible conditions that may also cause headache, such as tumors, infections and other medical problems.
• Magnetic resonance imaging (MRI): This imaging technique uses radio waves and a powerful magnet to produce very detailed views of the brain and its blood vessels. It may also help diagnose tumors, strokes, aneurysms, and other brain abnormalities.
• Spinal tap: In this procedure, a thin needle is inserted between two vertebrae in the lower back to extract a sample of cerebrospinal fluid for laboratory analysis. It may eliminate other diseases such as meningitis that also cause intense headaches.

Treatment

Treatment of migraine starts by removing the afflicted person from noisy, or brightly lit rooms to a dark, quiet room. Bed rest in a dark, quiet room helps to decrease the intensity of the headache. The application of an ice pack or a cold, wet cloth to the forehead is also beneficial.

QUESTIONS TO ASK YOUR DOCTOR

• What is the cause of my migraine?
• Is there a cure?
• Are there any side effects associated with the medications?
• How can I best prevent migraine attacks?
• Is nutrition a factor?
• Can medicine help prevent migraines?

The medications used to treat mild to moderate migraine include pain-relieving nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aspirin or ibuprofen (Advil, Motrin), as well as Tylenol or Anaprox. An anti-nausea medication is often prescribed in conjunction with a NSAID medication. Some medications are available specifically for migraine, such as the combination of acetaminophen , aspirin and caffeine (Excedrin Migraine). These medications can be obtained over-the-counter, or by prescription for stronger dosage. Triptans are another class of medications used for severe migraine attacks. Other prescribed medications include beta-blockers, anti-depressants, and divalproex Sodium .

Nutrition/Dietetic concerns

Magnesium and calcium have been shown to be of benefit to migraine sufferers, as these minerals maintain healthy blood vessels. Pantothenic acid is also considered helpful, as it helps the body produce serotonin. Care should accordingly be taken to ensure that the diet includes their daily recommended intake.

Therapy

Migraine sufferers are encouraged to keep track of their personal triggering factors since avoiding them can decrease the occurrence of migraine attacks. For some people, it may mean avoiding certain foods associated with previous migraine headaches, for others it may mean the avoidance of stressful situations. Stress management therapies, such as relaxation and biofeedback , may also reduce the occurrence and intensity of migraine headaches.

Prognosis

As of today, there is no cure for migraines. Taking a combination of medications when migraine attacks occur brings some amount of relief to most people and allows them to limit the disabling effects of these headaches. In some persons, migraine can resolve on its own and disappear completely as they age. Some researchers believe that women after menopause may experience fewer migraines due to the decline in estrogen levels.

KEY TERMS

Anti—inflammatory —A drug used to reduce inflammation, the body's response to surgery, injury, irritation, or infection,

Anti—nausea —A drug that is effective against vomiting and nausea.

Aura —A sensation of a cold breeze or bright light that precedes the onset of disorders such as a migraine attack or epileptic episode.

Beta—blockers —Drugs that act on the nervous system by blocking certain receptors at nerve endings.

Cerebral arteries —The arteries carrying oxygen—carrying blood to the brain.

Epilepsy —A brain disorder involving recurrent seizures.

Meningitis —An infection of the lining of the brain.

Serotonin —A substance produced by the body that regulates many functions, including mood, appetite, and sensory perception.

Spinal tap —A procedure used to isolate cerebrospinal fluid for evaluation or diagnosis of disease.

Prevention

Lifestyle changes can help prevent migraine. Besides avoiding triggers, regular aerobic exercise has been shown to help reduce stress. Women who have identified estrogen as a trigger may select to avoid this type of medication or consult with their physician to modify dosage.

Caregiver concerns

Treatment of migraine presents special problems in the elderly. The presence of other diseases may prevent the use of some medications. Another concern is that older patients are more likely than younger ones to experience adverse side effects. Older migraine patients accordingly require cautious treatment that takes into account possible pharmacological interactions associated with their greater use of drugs for other medical conditions. Paracetamol (acetaminophen) is considered the safest medication for symptomatic treatment of migraine in the elderly.

The increase in the number of persons in older age groups is expected to also lead to an increase in the total number of migraine patients. However, migraine in older age groups has been neglected, although many subjects older than 50, 60 and even 70 years old suffer from migraine. Drug efficacy studies are also lacking for this age group.

Resources

books

Delaune, Valerie. Trigger Point Therapy for Headaches & Migraines: Your Self-Treatment Workbook for Pain Relief. Ypsilanti, MI: New Harbinger Publications, 2008.

Diamond, Seymour. Conquering Your Migraine: The Essential Guide to Understanding and Treating Migraines for all Sufferers and Their Families. New York, NY: Fireside, 2001.

Foster, Carol A. Migraine: Your Questions Answered. New York, NY: DK Publishing, 2007.

Marcus, Dawn A. 10 Simple Solutions to Migraines: Recognize Triggers, Control Symptoms, And Reclaim Your Life. Ypsilanti, MI: New Harbinger Publications, 2006.

Quinn, V. R. Check-Up Chart Migraine Journal & Workbook. Zebulon, NC: Concise Concepts, 2004.

Robert, Teri. Living Well with Migraine Disease and Headaches: What Your Doctor Doesn't Tell You…That You Need to Know. New York, NY: Harper Collins Publishers, 2005.

Sharp, Michelle. The Migraine Cookbook: More than 100 Healthy and Delicious Recipes for Migraine Sufferers. Washington, DC: Marlowe & Company, 2002.

Young, William B., and Stephen D. Silberstein. Migraine and Other Headaches. New York, NY: Demos Medical Publishing, 2004.

periodicals

Evans, R. W., and K. Bruining. “New onset migraine in the elderly.” Headache 42, no. 9 (October 2002): 946–947.

Haan, J., et al. “Migraine in the elderly: a review.” Cephalagia 27, no. 2 (February 2007): 97–106.

Jelicic, M., et al. “Does migraine headache affect cognitive function in the elderly?” Headache 40, no. 9 (October 2000): 715–719.

Martins, K. M., at al. “Migraine in the elderly: a comparison with migraine in young adults.” Headache 46, no. 2 (February 2006): 312–316.

Mosek, A., et al. “A history of migraine is not a risk factor to develop an ischemic stroke in the elderly.” Headache 41, no. 4 (April 2001): 399–401.

Rankin, L. M., and M. Bruhl. “Migraine in older patients: a case report and management strategies.” Geriatrics 55, no. 7 (July 2000): 70–74.

Sarchielli, P., et al. “Practical considerations for the treatment of elderly patients with migraine.” Drugs and Aging 23, no. 6 (2006): 461–489.

other

Commonly Used Acute Migraine Treatments. American headache Society, Information Sheet. (March 08, 2008) http://www.achenet.org/education/patients/CommonlyUsedAcuteMigraineTreatments.asp

Migraine. Mayo Clinic, Information Page. (March 08, 2008) http://www.mayoclinic.com/print/migraineheadache/DS00120/DSECTION=all&METHOD= print

Migraine. NINDS Information Page. http://www.ninds.nih.gov/disorders/migraine/migraine.htm

Migraine Headaches: Ways to Deal With the Pain. American Academy of Family Physicians, FamilyDoctor.org Information (March 08, 2008) http://familydoctor.org/online/famdocen/home/common/brain/disorders/127.printerview.html

Trigger Avoidance Information. American Headache Society, Information Page (March 08, 2008) http://www.achenet.org/tools/TriggerAvoidanceInformation.asp

Triptans: Summary of affordable alternatives. Consumer Reports (March 08, 2008) http://www.consumerreports.org/health/treatment-centers/brain-and-nervous-system/migraine-in-adults/best-buy-drugs/triptan.htm#Migraine%20Drugs

organizations

American Headache Society (AHS), 19 Mantua Road, Mount Royal, NJ, 08061, (856)423-0258, (856)423-0082, http://www.achenet.org.

American Pain Foundation, 201 North Charles St., Suite 710, Baltimore, MD, 21201-4111, (888)615-PAIN, [email protected], http://www.painfoundation.org.

National Institute of Neurological Disorders and Stroke (NINDS), P.O. Box 5801, Bethesda, MD, 20824, (301) 496-5751, (800) 352-9424, http://www.ninds.nih.gov.

Monique Laberge Ph.D.