What is a migraine headache?

Migraine headaches are a special kind of headache. They often begin in childhood and then occur at different times for the rest of your life. Migraine headaches can cause severe headache pain. They may disable you for several hours.

How does it occur?

For years migraine headaches have been thought to be caused when blood vessels in the head contract and then swell, producing pain. Recent research shows that the chemicals our nerve and brain cells use to communicate (neurotransmitters) may be responsible. Changes in the concentrations of these chemicals may cause blood vessels to change size, causing migraine headaches.

What are the symptoms?

Symptoms may include:

• throbbing ache on one side of your head or throughout your head

• eye pain when exposed to bright light

• blurred vision

• loss of appetite

• nausea

• numbness or tingling of the face or one arm.

Before a migraine starts, there is usually a warning period when you don't feel well. Some people see bright spots or zigzag patterns in front of their eyes. These symptoms, which precede and predict a migraine headache, are called migraine aura. Then a throbbing pain begins and spreads to one side of the head or throughout the entire head. The vision changes of the aura usually disappear as the headache begins. The headache may last several hours or longer.

If you have any of the following symptoms with a migraine, call your health care provider immediately:

• fever

• stiff neck

• clumsiness

• change in awareness of your surroundings or disorientation

• change in personality

• vision problems that last more than 1 hour.

How is it diagnosed?

There is no single test for migraine headaches. Your health care provider bases the diagnosis on your symptoms, medical history, and physical exam.

A careful history of your headaches is very helpful. Keep a diary about your headaches and record the following:

• date and time of attack

• length of headache

• type of pain (for example, dull, sharp, throbbing; pressure)

• location of pain

• any unusual symptoms before the headache began

• foods and drinks you had before the headache began

• use of cigarettes, caffeine, alcohol, or carbonated drinks before the headache began

• time you went to bed and time you got up before the headache began

• if you are a woman, your menstrual periods and use of birth control pills or other female hormones.

How is it treated?

Treatment depends on the frequency and severity of your headaches.

Treatment may focus on preventing frequent headaches.

• Migraines can often be managed by taking care of yourself. You may need to change to a healthier diet. Relaxation exercises and biofeedback may help you manage stress.

• Your headache diary may suggest that specific foods or activities trigger your headaches. You may be able to prevent the headaches by avoiding the triggers (for example, alcohol, especially some wines, or fatigue).

• If your migraine headaches are severe and frequent, you may need to take medication regularly to prevent the headaches. Drugs your health care provider might prescribe include propranolol, verapamil, antidepressants, and ergot preparations such as ergotamine, ergonovine, or methysergide. You may need to try a medicine for several weeks to see if it is effective.

Other medications may be used to stop migraines from becoming severe. It's best to take the medication as soon as possible after a headache begins. This means you need to know the early warning symptoms. Three medications used for this purpose are:

• Midrin, an oral tablet containing isometheptene, dichloralphenazone, and acetaminophen

• a new group of drugs (the 'triptans'), of which Imitrex (sumatriptan) was the first, which are available as tablets (including some that may be taken without water), an injection, and a nasal spray

• D.H.E. (dihydroergotamine), which is an injection available at your health care provider's office.

How long will the effects last?

Symptoms last from a few hours to a day or two. You may be at risk of having migraines the rest of your life.

How can I take care of myself?

When a migraine begins:

• As soon as possible after the headache symptoms begin, take a pain reliever such as aspirin, acetaminophen, ibuprofen, or a medication prescribed by your health care provider.

• Rest in a quiet, dark room until the symptoms are gone.

• Call your health care provider if you have unusual symptoms: fever, stiff neck, or nervous system symptoms such as difficulty speaking, arm or leg weakness, or paralysis.

Also, you may do the following to help prevent migraines:

• Eat regular meals.

• Avoid foods from the following list if eating them seems to cause your headaches:
  • wine, ale, and beer

  • chocolate milk and buttermilk

  • aged and processed cheeses

  • aged, canned, cured, and processed meats

  • breads made with yeast and yeast extracts

  • foods containing cheese, chocolate, or nuts
• Ask your health care provider about avoiding medications that may trigger headaches.

• Ask your health care provider about discontinuing birth control or hormone pills if you have been taking them.

• Avoid smoking.

• Avoid drinking a lot of alcohol.

• Maintain your recommended weight.

• Get regular rest.

• Try to balance work, relaxation, recreation, and rest in your life.

• Try to identify and avoid stress.

Don't drive a car during a migraine.

If your symptoms get worse, or if they don't get better when you take medication, make another appointment with your health care provider. It may take several visits to find the best way to control your headaches.