MIGRAINE

General Information

DEFINITION--Migraine refers to a group of symptoms that may occur together. The most noted one is an incapacitating headache, usually on one side of the head, which can last from 2 to 72 hours. Episodes of migraines can occur weekly in some people; others may have less than one a year.

BODY PARTS INVOLVED--Blood vessels, central nervous system, gastrointestinal.

SEX OR AGE MOST AFFECTED

• Both sexes, but more common in females.
• Adolescents and adults.

SIGNS & SYMPTOMS--

The nature of attacks varies between persons and from time to time in the same person. Symptoms appear as follows:

• An aura that precedes the headache. This may affect vision, hearing or smell.
• The most common symptom is the inability to see clearly, followed by seeing bright spots and zig-zag patterns. Visual disturbances may last several minutes or hours, then disappear.
• Dull, boring pain in the temple that spreads to the side of the head. Pain becomes intense.
• Nausea and vomiting. In other types of migraine attack, the above symptoms (vision disturbances, headache or vomiting) may be absent, or other symptoms may be present.

CAUSES--

Exact cause is uncertain. A disturbance in blood circulation in the head accompanies migraine and may be a cause. Attacks may be triggered by:

• Tension. Emotional problems are probably the most common reason for migraine attacks, but headaches don't necessarily coincide with emotional upset. They often occur on weekends when stress is decreased.
• Menstruation; use of oral contraceptives.
• Fatigue; missing meals.
• Consumption of alcohol or certain foods.

RISK INCREASES WITH

Stress; family history of migraines; smoking; excess alcohol consumption; use of many prescription and non-prescription drugs.

HOW TO PREVENT

• Reduce stress in your life where possible (see How to Cope with Stress in Appendix).
• Take a prescription drug to help prevent attacks. Ask your doctor.
• Avoid those factors that trigger attacks.
• Learn to look for warning signs of a headache and do something different (take a walk,etc.).

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Laboratory blood studies or CT scan (See Glossary) of the head may be done to rule out other disorders.

APPROPRIATE HEALTH CARE

Self-care after diagnosis; doctor's treatment.

POSSIBLE COMPLICATIONS--None expected.

PROBABLE OUTCOME--Symptoms can be controlled with treatment.

How To Treat

GENERAL MEASURES--

• At the first sign of a migraine attack: Apply a cold cloth or ice pack to your head or splash your face with cold water. Lie down in a quiet, dark room for several hours. Wedge pillows to support head. Relax and sleep if possible. Minimize noise, light and odors (especially cooking odors and tobacco smoke). Don't read.
• See Resources for Additional Information.

MEDICATION--A wide variety of drugs can be prescribed for migraine symptoms and prevention. Follow all prescription instructions carefully. Your doctor may prescribe:

• Ergotamines (contain caffeine) in oral form, suppository or inhaler.
• Aspirin, acetominophen or ibuprofen.
• Drugs that combine acetominophen and a narcotic (codeine).
• Antihistamines to expand blood vessels.
• Antiemetics to decrease nausea and vomiting.
• Vasoconstrictors to narrow blood vessels.
• Sumatriptan (Imitrex) in self-administered subcutaneous (under the skin) injection or oral tablet.
• Beta-adrenergic or calcium channel blockers or tricyclic antidepressants to prevent attacks, if headaches are so frequent that you can't function normally. These medications may have undesir-able side effects and may not help everyone.

ACTIVITY--Rest during attacks; exercise regularly; keep a regular sleep pattern.

DIET--

• Don't skip meals. At least snack.
• Because some attacks are caused by foods, avoid or limit: cheese, chocolate, spicy foods, mixed spices, monosodium glutamate (MSG), nitrites or nitrates (used in preserved meats such as bacon, hot dogs or deli meats). Keep a record of what you ate before each attack. Avoid foods that may trigger migraine attacks.
• Avoid alcohol.

Call Your Doctor If

You have a migraine attack that persists longer than 24 hours, despite treatment.