More than 28 million Americans — three times more women than men — suffer
from migraine headaches, a type of headache that's often severe. Although
any head pain can be miserable, a migraine headache is often disabling. In
some cases, these painful headaches are preceded or accompanied by a
sensory warning sign (aura), such as flashes of light, blind spots or
tingling in your arm or leg. A migraine headache is also often accompanied
by other signs and symptoms, such as nausea, vomiting, and extreme
sensitivity to light and sound. Migraine pain can be excruciating and may
incapacitate you for hours or even days.
Fortunately, management of
migraine headache pain has improved dramatically in the last decade. If
you've seen a doctor in the past and had no success, it's time to make
another appointment. Although there's still no cure, medications can help
reduce the frequency of migraine headaches and stop the pain once it has
started. The right medicines combined with self-help remedies and changes
in lifestyle may make a tremendous difference for you.
Migraine headache
Signs and symptoms
A typical migraine headache attack produces some or all of these
signs and symptoms:
Moderate to severe pain — many migraine headache sufferers
feel pain on only one side of their head, while some experience
pain on both sides
Head pain with a pulsating or throbbing quality
Pain that worsens with physical activity
Pain that hinders your regular daily activities
Nausea with or without vomiting
Sensitivity to light and sound
When left untreated, a migraine headache typically lasts from
four to 72 hours, but the frequency with which they occur can vary
from person to person. You may have migraines several times a month
or just once or twice a year.
Not all migraine headaches are the same. Most people suffer from
migraines without auras, which were previously called common
migraines. Some have migraines with auras, which were previously
called classic migraines. If you're in the second group, you'll
likely have auras about 15 to 30 minutes before your headache
begins. They may continue after your headache starts or even occur
after your headache begins. These may include:
Sparkling flashes of light
Dazzling zigzag lines in your field of vision
Slowly spreading blind spots in your vision
Tingling, pins-and-needles sensations in one arm or leg
Rarely, weakness or language and speech problems
Whether or not you have auras, you may have one or more
sensations of premonition (prodrome) several hours or a day or so
before your headache actually strikes, including:
Feelings of elation or intense energy
Cravings for sweets
Thirst
Drowsiness
Irritability or depression
Migraine headache symptoms in children
Migraines typically begin in childhood, adolescence or early
adulthood and may become less frequent and intense as you grow
older. Children as young as age 1 can have these headaches. In
addition to physical suffering, severe headaches often mean missed
school days and trips to the emergency room, as well as lost work
time for anxious parents.
Children's migraines tend to last for a shorter time. But the
pain can be disabling and can be accompanied by nausea, vomiting,
lightheadedness and increased sensitivity to light. A migraine
headache tends to occur on both sides of the head in children, and
visual auras are rare. However, children often have premonition
signs and symptoms, such as:
Yawning
Sleepiness or listlessness
A craving for foods such as chocolate, hot dogs, sugary
snacks, yogurt and bananas
Children may also have all of the signs and symptoms of a
migraine headache — nausea, vomiting, increased sensitivity to light
and sound — but no head pain. These "abdominal migraines" can be
especially difficult to diagnose.
The good news is that some of the same medications that are
effective for adults also work for children. Your child doesn't have
to suffer the pain and disruption of migraines. If your child has
headaches, talk to your pediatrician. He or she may want to refer
your child to a pediatric neurologist.
Causes
Although much about headaches still isn't understood, some
researchers think migraines may be caused by functional changes in the
trigeminal nerve system, a major pain pathway in your nervous system,
and by imbalances in brain chemicals, including serotonin, which
regulates pain messages going through this pathway.
During a headache, serotonin levels drop. Researchers believe this
causes the trigeminal nerve to release substances called neuropeptides,
which travel to your brain's outer covering. There they cause blood
vessels to become dilated and inflamed. The result is headache pain.
Because levels of magnesium, a mineral involved in nerve cell
function, also drop right before or during a migraine headache, it's
possible that low amounts of magnesium may cause nerve cells in the
brain to misfire.
Migraine headache triggers
Whatever the exact mechanism of headaches, a number of things may
trigger them. Common migraine headache triggers include:
Hormonal changes. Although
the exact relationship between hormones and headaches isn't clear,
fluctuations in estrogen and progesterone seem to trigger headaches
in many women with migraine headaches. Women with a history of
migraines often have reported headaches immediately before or during
their periods. Others report more migraines during pregnancy or
menopause. Hormonal medications, such as contraceptives and hormone
replacement therapy, also may worsen migraines.
Foods. Certain foods appear
to trigger headaches in some people. Common offenders include
alcohol, especially beer and red wine; aged cheeses; chocolate;
fermented, pickled or marinated foods; aspartame; caffeine;
monosodium glutamate — a key ingredient in some Asian foods; certain
seasonings; and many canned and processed foods. Skipping meals or
fasting also can trigger migraines.
Stress. A period of hard
work followed by relaxation may lead to a weekend migraine headache.
Stress at work or home also can instigate migraines.
Sensory stimulus. Bright
lights and sun glare can produce head pain. So can unusual smells —
including pleasant scents, such as perfume and flowers, and
unpleasant odors, such as paint thinner and secondhand smoke.
Physical factors. Intense
physical exertion, including sexual activity, may provoke migraines.
Changes in sleep patterns — including too much or too little sleep —
also can initiate a migraine headache.
Changes in the environment.
A change of weather, season, altitude level, barometric pressure or
time zone can prompt a migraine headache.
Medications. Certain
medications can aggravate migraines.
Risk factors
Many people with migraines have a family history of migraine. If
both your parents have migraines, there's a good chance you will too.
Even if only one of your parents has migraines, you're still at
increased risk of developing migraines.
You also have a relatively higher risk of migraines if you're young
and female. In fact, women are three times as likely to have migraines
as men are. Headaches tend to affect boys and girls equally during
childhood but increase in girls after puberty.
If you're a woman with migraines, you may find that your headaches
worsen during menstruation. They may also change during pregnancy or
menopause. Many women report improvement in their migraines later in
pregnancy, but others report that their migraines worsened during the
first trimester. If pregnancy or menstruation affects your migraines,
your headaches are also likely to worsen if you take birth control
pills or hormone replacement therapy (HRT).
When to seek medical advice
Migraines are a chronic disorder, but they're often undiagnosed
and untreated. If you experience signs and symptoms of migraine,
track and record your attacks and how you treated them. Then make an
appointment with your doctor to discuss your migraines and decide on
a treatment plan.
If you don't have a treatment plan when a migraine headache
strikes, try over-the-counter (OTC) medications such as ibuprofen
(Advil, Motrin, others), naproxen sodium (Aleve) or aspirin, or
other self-care measures for a day or two. If you don't get relief,
see your doctor. Don't give aspirin to children under 16 because of
the risk of Reye's syndrome, a rare but potentially fatal disease.
Even if you have a history of headaches, see your doctor if the
pattern changes or your headaches suddenly feel different. See your
doctor immediately or go to the emergency room if you have any of
the following signs and symptoms, which may indicate another, more
serious medical problem such as a concussion:
An abrupt, severe headache like a thunderclap
A new severe headache that isn't just on one side of your head
Headache with fever, stiff neck, rash, mental confusion,
seizures, double vision, weakness, numbness or trouble speaking
Headache after a recent sore throat or respiratory infection
Headache after a head injury, especially if the headache gets
worse
A chronic headache that is worse after coughing, exertion,
straining or a sudden movement
New headache pain if you're older than 55
It's likely your headaches don't signal a serious medical
condition. But in a small number of cases, headaches may be a
symptom of a blood clot or brain tumor. They may also signal
temporal arteritis — a rare, headache-related condition that usually
affects people older than 55 and, if not treated, may lead to
blindness or stroke.
Treatment
At one time, aspirin was almost the only available treatment for
headaches. Now there are drugs specifically designed to treat
migraines. Several drugs commonly used to treat other conditions
also may help relieve migraines in some people. All of these
medications fall into two classes:
Pain-relieving medications.
These stop pain once it has started.
Preventive medications.
These reduce or prevent a migraine headache.
Choosing a preventive strategy or a pain-relieving strategy
depends on the frequency and severity of your headaches, the degree
of disability your headaches cause and other medical conditions you
may have. You may be a candidate for preventive therapy if you have
two or more debilitating attacks a month, if you use pain-relieving
medications more than twice a week, if pain-relieving medications
aren't helping or if you have uncommon migraines.
Some medications aren't recommended if you're pregnant or
breast-feeding. Some aren't used for children. Your doctor can help
find the right medication for you.
Pain-relieving medications
For best results, take pain-relieving drugs as soon as you
experience signs or symptoms of a migraine headache. It may help if
you rest or sleep in a dark room after taking them:
Nonsteroidal anti-inflammatory
drugs (NSAIDs). These medications, such as ibuprofen
(Advil, Motrin, others) or aspirin, may help relieve mild
migraines. Drugs marketed specifically for migraine, such as the
combination of acetaminophen, aspirin and caffeine (Excedrin
Migraine), also may ease moderate migraines, but aren't effective
alone for severe migraines. If over-the-counter medications don't
help, your doctor may suggest a stronger, prescription-only
version of the same drug. If taken too often or for long periods
of time, NSAIDs can lead to ulcers, gastrointestinal bleeding and
rebound headaches.
Triptans. Sumatriptan (Imitrex)
was the first drug specifically developed to treat migraines. It
mimics the action of serotonin by binding to serotonin receptors
and causing blood vessels to constrict. Sumatriptan is available
in oral, nasal and injection form. Injected sumatriptan works
faster than any other migraine-specific medication — in as little
as 15 minutes — and is effective in most cases. But injections may
be inconvenient and painful.
Since the introduction of sumatriptan, a number of similar
drugs have become available, including rizatriptan (Maxalt),
naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert),
frovatriptan (Frova) and eletriptan (Relpax). These newer agents
provide pain relief within two hours for most people, have fewer
side effects and cause fewer recurring headaches. Side effects of
triptans include nausea, dizziness, and muscle weakness and,
rarely, stroke and heart attack.
Ergots. Drugs such as
ergotamine (Ergomar) and dihydroergotamine (D.H.E. 45) and
dihydroergotamine nasal spray (Migranal) help relieve pain. These
drugs may have more side effects than do triptans.
Medications for nausea.
Metoclopramide (Reglan) is useful for relieving the nausea and
vomiting associated with migraines, not the migraine pain itself.
It also improves gastric emptying, which leads to better
absorption and more rapid action of many oral drugs. It's most
effective when taken early in the course of your migraine or even
during the aura before your headache begins. The drugs
prochlorperazine (Compazine), chlorpromazine (Thorazine),
promethazine (Phenergan) and hydroxyzine (Vistaril) also may
relieve nausea, but don't affect gastric emptying.
Preventive medications
Preventive medications can reduce the frequency, severity and length
of migraines and may increase the effectiveness of pain-relieving
medicines used during migraine attacks. In most cases, preventive
medications don't eliminate headaches completely, and some can have
serious side effects. For best results, take these medications as
your doctor recommends:
Cardiovascular drugs.
Beta blockers — which are commonly used to treat high blood
pressure and coronary artery disease — can reduce the frequency
and severity of migraines. These drugs are considered among
first-line treatment agents. Calcium channel blockers, another
class of cardiovascular drugs, especially verapamil (Calan,
Isoptin), also may be helpful. In addition, the antihypertensive
medications lisinopril (Prinivil, Zestril) and candesartan (Atacand)
are useful migraine prevention medications. Researchers don't
understand exactly why all of these cardiovascular drugs prevent
migraines. Side effects can include dizziness, drowsiness or
lightheadedness.
Antidepressants. Certain
antidepressants are good at helping prevent all types of
headaches, including migraines. Most effective are tricyclic
antidepressants, such as amitriptyline, nortriptyline (Pamelor)
and protriptyline (Vivactil). These medications are considered
among first-line treatment agents and may reduce migraines by
affecting the level of serotonin and other brain chemicals. Newer
antidepressants, however, generally aren't as effective for
migraine prevention. You don't have to have depression to benefit
from these drugs.
Nonsteroidal anti-inflammatory
drugs (NSAIDs). Regularly taking over-the-counter NSAIDs
such as ibuprofen (Advil, Motrin, others) and naproxen sodium
(Aleve) may reduce the frequency of migraines. If these
medications don't help, your doctor may suggest a stronger,
prescription-only version of the same drug. However, NSAIDs may
increase your risk of cardiovascular events, such as heart attack
and stroke. In addition, long-term use of these
medications can lead to ulcers and other gastrointestinal
problems, such as stomach bleeding. Talk to your doctor before
taking these medications regularly — even the nonprescription
varieties.
Anti-seizure drugs.
Although the reason is unclear, some anti-seizure drugs, such as
divalproex sodium (Depakote), valproic acid (Depakene) and
topiramate (Topamax), which are used to treat epilepsy and bipolar
disease, seem to prevent migraines. Gabapentin (Neurontin),
another anti-seizure medication, is considered a second-line
treatment agent. Taken in high doses, however, these anti-seizure
drugs, depending on which one you take, may cause side effects
such as nausea and vomiting, diarrhea, cramps, hair loss and
dizziness.
Cyproheptadine. This
antihistamine specifically affects serotonin activity. Doctors
sometimes give it to children as a preventive measure.
Botulinum toxin type A (Botox).
Some people receiving Botox injections for their facial wrinkles
have noted improvement of their headaches. However, it's unclear
what effect Botox actually has on headaches. It may cause changes
in your nervous system that modify your tendency to develop
migraines. Additional research is necessary.
