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MIGRAINES

More than 28 million Americans — three times more women than men — suffer from migraine, a type of headache that's often severe. Although any head pain can be miserable, migraines are often disabling. In about 15 percent of cases, these painful headaches are preceded by a sensory warning sign (aura), such as flashes of light, blind spots or tingling in your arm or leg. Migraines are also often accompanied by other 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.

SIGNS AND SYMPTOMS

A typical migraine attack produces some or all of these signs and symptoms:

·         Moderate to severe pain — 60 percent of migraine sufferers feel pain on only one side of their head, while 40 percent 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, migraines typically last from four to 72 hours, but the frequency with which they occur can vary from person to person. You may have migraine headaches several times a month or just once or twice a year.

Not all migraines are the same. Eighty-five percent of people suffer from migraines without auras, which were previously called common migraines. About 15 percent of adults have migraine headaches 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

CAUSES

 Migraine triggers: Whatever the exact mechanism of headaches, a number of things may trigger them. Common migraine triggers reported by some people 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 migraines. About 60 percent of women with a history of migraines report headaches immediately before or during their periods. Migraines are less likely to occur during the second and third trimesters of pregnancy, a time when estrogen levels are very high. Migraines are more likely to occur in the immediate postpartum period, when estrogen levels plummet. Migraines generally improve after menopause, when estrogen levels are low. Hormonal medications such as contraceptives and hormone replacement therapy also may worsen migraine headaches.

·         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. Stress at work or home also can instigate migraine headaches.

  • 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 be a problem.
  • Changes in the environment. A change of weather, season, altitude level, barometric pressure, or time zone can prompt a migraine.
  • Medications. Certain medications can aggravate migraine headaches.

 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 — those that reduce or prevent migraines (preventive medications), and those that stop pain once it has started (pain-relieving medications).

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 migraine signs or symptoms. It may help if you rest or sleep in a dark room after taking them:

·         Nonsteroidal antiinflammatory 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 70 percent to 80 percent of cases. However, 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 in 60 percent to 91 percent of patients, have fewer side effects, and cause fewer recurring headaches. Side effects of triptans include nausea, dizziness 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 triptans.

PREVENTION

Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you.

·         Avoid triggers. If certain foods seem to have triggered your headaches in the past, eat something else. If certain scents are a problem, try to avoid them. In general, try to establish a daily routine with regular sleep patterns and regular meals.

·         Exercise regularly. Aerobic exercise — about 30 minutes three times a week — reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming, and cycling. Warm up slowly, however, because sudden intense exercise can cause headaches.

·         Reduce the effects of estrogen. If you're a woman with migraines and estrogen seems to trigger or make your headaches worse, or if you have a family history of stroke or high blood pressure, you may want to avoid or reduce the amount of medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Talk with your doctor about the best alternatives or dosages for you.

·         Quit smoking. If you smoke, talk to your doctor about quitting. Smoking can trigger headaches or make headaches worse.

 

 





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