Migraine (also called a "sick headache") is a severe headache, which can last anywhere from two hours to two days. This headache is accompanied by disturbances of vision and/or nausea, extreme pain and vomiting.
Migraines affect over 23 million people, with roughly 75 percent of them being women. Migraines begin with the release of serotonin; a biochemical substance stored in the blood platelets produced naturally in the body. When serotonin is released, the blood vessels constrict (narrow). As serotonin is expelled by the kidneys, its level in the brain is depleted, causing the blood vessels to dilate (expand). This dilation causes pain in the surrounding nerves, which can lead to migraines. There are two predominant types of migraines - common migraine and classic migraine. The common migraine develops slowly and may be preceded by tiredness, cravings, yawning, depression, irritability and anxiousness. The common migraine usually occurs on one side of the head. The classic migraine develops in four stages - prodrome, aura, headache and postheadache. During the prodrome stage, the person may feel fatigued, irritable, have decreased concentration or experience depression. This stage will develop about 24 hours prior to the aura stage. The aura stage is a slowly expanding area of blindness surrounded by a sparkling edge that increases to involve up to one half of the field of vision of each eye. In addition to the aura, the migraine sufferer may see flashing lights, colors or zig-zags of light, experience a prickly or burning sensation and/or muscle weakness on one side of the body. The third stage is the headache itself, which is usually a severe throbbing pain on one side of the head that is often exaggerated by bright light or noise and may be accompanied by nausea and vomiting. The fourth stage is postheadache, which is characterized by exhaustion and fatigue. The classic migraine may occur on one or both sides of the head. The other types of migraines are: hemiplegic migraine, which involves muscle weakness or partial paralysis lasting less than an hour; ophthalmoplegic migraine, which involves temporary eye inconveniences, such as droopy eyelid and pupillary changes, lasting from several days to weeks; basilar artery migraine, which involves neurological spasm lasting for about six to eight hours; and status migraine; which involves a severe migraine attack, lasting longer than 24 hours.
Serotonin release, resulting in a migraine, can be triggered by a number of factors. These factors can be stress-related (such as anger, depression, shock, excitement or changes in routine), food-related (such as chocolate, cheese, red wine or fried foods), or sensory-related (such as bright lights, strong odors or loud noises). Additionally, migraines can be medication-related (medicines including nitroglycerin, lithium and certain anti-hypertensive, anti-inflammatory and bronchodilating drugs), or hormone-related (such as menstrual periods, hormonal treatments or birth control pills). Patients often have a family history of migraine.
The symptoms of a migraine may include:
- Throbbing or dull aching pain on one or both sides of the head
- Changes in how a person sees, including blurred vision or blind spots, zig-zags of light or light flashes
- Sensitivity to light, noise and odors
- Nasal congestion
- Feeling cold or sweating
- Stiff or tender neck
- Anxious or restlessness
- Tender scalp
- Cold hands and feet
No tests are available to reliably diagnose a migraine. The doctor will make a determination, based on a physical examination and a thorough medical history, including triggers, symptoms and family history.
Treatment of migraines is directed at preventing attacks (prophylactic or preventive therapy) and alleviating them when they occur (abortive therapy). Prophylactic Therapy Prophylactic therapy includes:
- eliminating the controllable triggers, such as chocolate or red wine
- improving the person's physical, mental and emotional health by exercising, biofeedback, relaxation techniques, rest and stress reduction
- taking medications to prevent the onset of an attack
The most widely used preventive drugs are beta blockers, such as propranolol hydrochloride (Inderal), nadolol (Corgard), timolol maleate (Blocadren), atenolol (Tenormin) and metoprolol tartrate (Lopressor, Toprol-XL). Beta blockers have an indirect effect on serotonin, preventing dilation of the blood vessels and decreasing overstimulating impulses from the brain. Other preventive medications include calcium channel blockers, such as verapamil and diltiazem hydrochloride (Cardizem), antidepressants, such as Elavil, aspirin and antiserotonin agents. Preventive medications must be taken every day, whether there is a headache present or not. They will not be helpful if taken only when an attack strikes.
Once the migraine has set in, there are two methods of reducing the pain: non-drug and drug-based methods. The non-drug methods include:
- lying in a dark quiet room with a cold compress or rag on the forehead
- massage or acupuncture
- using visualization techniques to direct blood flow away from the head
- putting pressure on the temples
The drug-based treatment includes medicines such as aspirin, acetaminophen (Datril, Panadol, Tylenol), ibuprofen (Advil, Medipren, Motrin, Nuprin), naproxen (Naprosyn), naproxen sodium (Anaprox), diflunisal (Dolobid), ketorolac (Toradol), sumatriptan (Imitrex) and ergotamine tartrate (Ergostat).