• Migraine—Adult

    Definition

    Migraine is a type of recurring headache. It involves nerves and brain chemicals. Other sensations (eg, auras) may come before a migraine headache.
    There are two types of migraines:
    • Occurring with an aura (formerly called "classic")
    • Occurring without an aura (formerly called "common")
    Migraine may happen several times a week or once every couple of years. They can be so severe that they interfere with the ability to work and carry on normal activities.

    Causes

    While the precise cause is not known, many potential triggers have been identified. Common triggers include:
    • Environmental triggers (eg, odors, bright lights)
    • Dietary triggers (eg, alcohol)
    • Certain medicines
    • Changes in sleep patterns
    • Stress
    • Physiologic changes (eg, menstruation, puberty)
    • Weather changes
    A trigger sets the process in motion. It is possible that the nervous system reacts to the trigger by conducting electrical activity. This spreads across the brain. It leads to the release of brain chemicals, which help regulate pain.

    Risk Factors

    Factors that increase your chance for migraines may include:
    • Gender: more common in adult females
    • Age: most migraines occur by age 40
    • Family history of migraines
    • Menstruation

    Symptoms

    Migraines occur in phases that may include:

    Warning

    A warning may come before a migraine. In the hours or days before the headache, symptoms may include:
    • Changes in mood, behavior, and/or activity level
    • Fatigue
    • Yawning
    • Food craving or decreased appetite
    • Nausea, diarrhea
    • Sensitivity to light

    Aura

    The most common aura is visual. The aura lasts about 15-30 minutes. It may produce the following sensations:
    • Flashing lights, spots, or zig zag lines
    • Temporary, partial loss of vision
    • Speech difficulties
    • Weakness in an arm or leg
    • Numbness or tingling in the face and hands
    • Confusion
    • Dizziness, lightheadedness
    • Speech disturbances
    • Cognitive dysfunction
    It is important to seek medical attention to make sure the symptoms are not due to a more serious cause. This can include stroke or seizure.

    Headache

    Migraine pain starts within an hour of the aura ending. Symptoms include:
      A headache (usually on one side but may involve both sides) that often feels:
      • Moderate or severe intensity
      • Throbbing or pulsating
      • More severe with bright light, loud sound, or movement
    • Nausea or vomiting
    • Diarrhea
    • Lightheadedness or dizziness

    Post-Headache Period

    Migraines usually last from 4-72 hours. They often go away with sleep. After the headache, you may experience:
    • Trouble concentrating
    • Fatigue
    • Sore muscles
    • Irritability
    • Mood changes

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. You may also be given a neurological exam.
    To rule out other conditions your doctor may order tests, such as:
    CT Scan of the Head
    Breast self-exam, step 5
    Copyright © Nucleus Medical Media, Inc.

    Treatment

    Migraine therapy aims to:
    • Prevent headaches
    • Reduce headache severity and frequency
    • Restore your ability to function
    • Improve quality of life
    Treatment options include:

    Medications

    Pain medicines are often needed to ease or stop the pain. Over-the-counter pain pills may ease mild symptoms.
    Warning: Regular use of some over-the-counter medicines may cause a rebound headache.
    Some prescription medicines act directly to stop the cause of the migraine headache. These include drugs that:
    • Quiet nerve pathways
    • Reduce inflammation
    • Bind receptors for serotonin, a brain chemical
    These drugs can be taken by mouth. They may act more quickly in forms that dissolve in the mouth, are inhaled through the nose, or injected. They are more likely to be helpful if taken as soon as possible at the start of a migraine. Your doctor can help you choose the medicine best for you.
    Medicines that can help stop a migraine once it has begun include:
    • Triptans
    • Steroids
    • Acetaminophen (Tylenol)
    • Non-steroidal anti-inflammatory drugs (NSAIDS) (eg, naproxen)
    • Medicines for nausea
    • Ergots
    • Combination medicine that contains caffeine
    Other drugs can help prevent migraines for people with frequent migraines. Preventive drugs are taken every day. Classes of preventative medicines include:
    • Beta-blockers
    • Calcium channel blockers
    • Tricyclic antidepressants
    • Anticonvulsants
    • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blockers (ARBs)

    Procedures

    Botulinum Toxin Injections
    Botulinum toxin injections may be used as a way to prevent migraines and to reduce the duration and intensity of the headaches in people who have headaches often.
    Surgery
    In some people, migraines are triggered when a nerve in the head is stimulated. With this type of surgery, the doctor finds the nerve trigger point in the head and deactivates it. This surgery may reduce the number of migraines or completely eliminate them in sufferers who do not respond to conventional treatments. Most migraines are not treated with surgery.

    Self-Care During the Migraine

    • Apply cold compresses to painful areas of your head.
    • Lie in a dark, quiet room.
    • Try to fall asleep.

    Lifestyle Changes

    • Keep a diary. It will help identify what triggers migraines and what helps relieve them.
    • Learn stress management and relaxation techniques.
    • Consider talking with a counselor. They can help you learn new coping skills and relaxation techniques.
    • Exercise regularly.
    • If you are a smoker, quit. Smoking may worsen a migraine.
    • Avoid foods that trigger migraines.
    • Eat regular meals.
    • Maintain your regular sleep pattern even during the weekend or on vacation.
    If you are diagnosed with a migraine, follow your doctor's instructions.

    Prevention

    Methods for preventing migraine include:
    • Avoiding those things that trigger the headache
    • Following your doctor's recommendations—The doctor may consider using medicines to prevent headaches such as:
      • Butterbur extract
      • Antidepressant
      • Antiseizure
      • Medications that lower blood pressure
    Healthy lifestyle habits that may help prevent migraines include:
    • Maintain regular sleep patterns.
    • Learn stress management techniques.
    • Do not skip meals.
    • Avoid alcohol.
    • Exercise regularly. Consider yoga as one type of activity.
    • Ask your doctor if acupuncture is right for you. It may help you to have more headache-free days, as well as lessen the intensity of headaches when they do occur.
    Therapy that may decrease migraine or migraine pain include:
      Mind-body therapies such as:
      • Biofeedback
      • Cognitive behavioral therapy
      • Guided imagery (may improve pain coping)
    • Massage therapy
    Foods are not proven to trigger migraine. But consider keeping a diary of migraine and diet to identify foods that may trigger migraines for you. Foods suspected to trigger migraine include:
    • Nuts and peanut butter
    • Beans (eg, lima, navy, pinto, and others)
    • Aged or cured meats
    • Aged cheese
    • Processed or canned meat
    • Caffeine (intake or withdrawal)
    • Canned soup
    • Buttermilk or sour cream
    • Meat tenderizer
    • Brewer's yeast
    • Avocados
    • Onions
    • Pickles
    • Red plums
    • Sauerkraut
    • Snow peas
    • Soy sauce
    • Anything with MSG (monosodium glutamate), tyramine, or nitrates

    RESOURCES

    American Headache Society http://www.americanheadachesociety.org/

    The National Migraine Association http://www.migraines.org/

    CANADIAN RESOURCES

    The College of Family Physicians of Canada http://www.cfpc.ca/

    Health Canada http://www.hc-sc.gc.ca/

    References

    Epilepsy symptoms. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/epilepsy/ds00342/dsection=symptoms . Updated April 28, 2011. Accessed July 24, 2012.

    Gilmore B, Michael M. Treatment of acute migraine headache. Am Fam Physician. 2011:83(3):271-280.

    Migraine in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 13, 2012. Accessed July 24, 2012.

    Migraine prophylaxis: prescription medications. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 10, 2012. Accessed July 24, 2012.

    NINDS migraine information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/migraine/migraine.htm . Updated July 6, 2012. Accessed July 24, 2012.

    Warning signs of stroke. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=symp . Accessed July 24, 2012.

    12/16/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Jena S, Witt CM, Brinkhaus B, Wegscheider K, Willich SN. Acupuncture in patients with headache. Cephalalgia. 2008;28:969-979.

    2/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White A. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009;CD001218.

    11/10/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S. A placebo-controlled surgical trial of the treatment of migraine headaches. Plast Reconstr Surg. 2009;124(2):461-468.

    10/25/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : US Food and Drug Administration. FDA approves Botox to treat chronic migraine. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229782.htm . Published October 15, 2010. Accessed October 25, 2010.

    3/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Chankrachang S, Arayawichanont A, Poungvarin N, et al. Prophylactic botulinum type A toxin complex (Dysport) for migraine without aura. Headache. 2011;51(1):52-63.

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