Migraine headaches are a type of headache that some people get repeatedly over time. Migraine headache is a very common condition that varies remarkably from person to person. It can be very mild in some but can be totally disabling in others. Migraine is more common in women than in men.

There are two forms of migraine: with aura (formerly called classic) and without aura (formerly called common). When a migraine with aura occurs, the patient experiences an aura approximately 10 to 30 minutes before the onset of the headache. Aura is a brief period of a neurological disturbance, usually of colored or flashing lights, squiggly lines, or loss of vision. Less common auras include weakness in an arm or leg, funny feelings (tingling, pins and needles) in an arm or leg, and trouble speaking or understanding other's speech. Auras typically last less than one hour and completely resolve. With a migraine without aura, no aura occurs.

Migraine headache causes and risk factors

A migraine is caused by abnormal brain activity, which is triggered by stress, food, or some other factor. The exact chain of events is not known. However, it seems to involve various nerve pathways and chemicals in the brain. The changes affect blood flow in the brain and surrounding membranes.

Bright lights, loud noises, and certain odors or perfumes
Physical or emotional stress
Changes in sleep patterns
Smoking
Skipping meals
Alcohol or caffeine
Menstrual cycle fluctuations, birth control pills
Tension headaches
Hormonal fluctuations
Low blood sugar levels and dehydration
Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)F
Foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented

Signs and symptoms

Feel throbbing, pounding, or pulsating
Are worse on one side of the head
Last 6 to 48 hours
Nausea and vomiting
Sensitivity to light or sound
Sensitivity to odors
Loss of appetite
Numbness, tingling, or weakness

Care & Prevention

When Prevention symptoms begin:

Rest in a quiet, darkened room
Drink fluids to avoid dehydration
Try placing a cool cloth on your head

To prevent Prevention:

Avoid smoking, caffeine, and alcohol
Get enough sleep each night
Exercise regularly
Learn to relax and reduce stress

Treatment. Drug Therapy

Drug therapy is the most often recommended treatment for migraine (with and without aura). There are two ways to approach the treatment of migraine headache with drugs: relieve the symptoms during the attacks or prevent the attacks. Many people with migraine use both approaches by taking medications originally developed for epilepsy and depression to prevent future attacks, and treating attacks when they happen with drugs called triptans that relieve pain and restore function. Stress management strategies, such as exercise, relaxation, biofeedback, and other therapies designed to help limit discomfort, may also reduce the occurrence and severity of migraine attacks.

Drugs for headache are divided into two types:

symptomatic medications
prophylactic medications

Symptomatic headache medications are those drugs that are taken at the onset or during a headache attack in the hopes of stopping the headache from occurring or decreasing the symptoms associated with the headache. If symptomatic medication is used excessively, the development of Rebound Headache Syndrome (headache that is actually worsened by the overuse of short-acting abortive medication) can result.

Such drugs include:

over-the-counter analgesics: aspirin, acetaminophen, ibuprofen, naproxen
prescription nonsteroidal anti-inflammatory drugs: diclofenac, ketorolac
barbiturates (such as butalbital)
triptans: sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), and zolmitriptan (Zomig)
ergots like ergotamine, dihydroergotamine, or ergotamine with caffeine (Cafergot)
stronger pain relievers like narcotics

Prophylactic headache medications are those drugs that are taken every day, regardless of whether a headache is being experienced, in the hopes of preventing headache attacks. These daily medications should only be prescribed when patients have frequent headaches (e.g., three or more times per month) that are significantly interfering with quality of life.

Such drugs include:

beta-blockers, such as propranolol (Inderal), nadolol, atenolol
asnti-depressants, including tricyclics like amitriptyline (Elavil) or SSRIs like fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft)
snti-convulsants, like valproic acid (Depacon, Depakene) or divalproex sodium (Depakoate)
calcium channel blockers, such as verapamil

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