Migraines

Migraines

Overview

What is a migraine headache?

A migraine is usually an intense pounding headache that can last for 2 hours or even up to 2 or 3 days. The pounding or pulsing pain usually begins in the forehead, the side of the head or around the eyes. The headache gradually gets worse. Just about any movement, activity, bright lights or loud noises seem to make it hurt more. Nausea and vomiting are common.

Some people see a pattern of lines or shadows in front of their eyes as the headache is beginning. This is called a "warning aura." Most people who have migraine headaches do not have this.

 Migraines may happen only once or twice a year, or as often as daily. Women are more likely to have migraines than men.

Do children get migraine headaches?

Yes. The most common cause of headaches in children is a viral infection such as a cold or the flu. As many as 5% of children in grade school have migraine headaches. During the high school years, about 20% of adolescents get migraine headaches. These headaches are more common in girls than in boys. Boys who get migraines have them more often when they are about 10 to 12 years of age. It is not unusual for them to have 2 to 3 migraine headaches a week.

Are there different kinds of migraine headaches?

Yes. The most common are classic migraine and common migraine.

Classic migraines start with a warning sign, called an aura. The aura often involves changes in the way you see. You may see flashing lights and colors. You may temporarily lose some of your vision, such as your side vision.

You may also feel a strange prickly or burning sensation, or have muscle weakness on one side of your body. You may have trouble communicating. You may also feel depressed, irritable and restless.

Auras last about 15 to 30 minutes. Auras may occur before or after your head pain, and sometimes the pain and aura overlap, or the pain never occurs. The head pain of classic migraines may occur on one side of your head or on both sides.

Common migraines don't start with an aura. Common migraines may start more slowly than classic migraines, last longer and interfere more with daily activities. The pain of common migraines may be on only one side of your head.

Symptoms

What does a migraine feel like?

The pain of a migraine headache can be intense. It can get in the way of your daily activities. Migraines aren't the same for all people. Possible symptoms of migraines are listed in the box below.

You may have a "premonition" several hours to a day before your headache starts. Premonitions are feelings you get that can signal a migraine is coming. These feelings can include intense energy, fatigue, food cravings, thirst and mood changes.

Possible symptoms of migraines

  • Intense throbbing or dull aching pain on one side of your head or both sides
  • Pain that worsens with physical activity
  • Nausea or vomiting
  • Changes in how you see, including blurred vision or blind spots
  • Being bothered by light, noise or odors
  • Feeling tired and/or confused
  • Stopped-up nose
  • Feeling cold or sweaty
  • Stiff or tender neck
  • Lightheadedness
  • Tender scalp

Causes & Risk Factors

What causes migraines?

Migraine headaches seem to be caused in part by changes in the level of a body chemical called serotonin. Serotonin plays many roles in the body, and it can have an effect on the blood vessels. When serotonin levels are high, blood vessels constrict (shrink). When serotonin levels fall, the blood vessels dilate (swell). This swelling can cause pain or other problems.

What can set off a migraine?

Things that can set off migraines include the following:

  • Strong or unusual odors, bright lights or loud noises
  • Changes in weather or altitude
  • Feeling tired, stressed or depressed
  • Changes in sleeping patterns
  • Certain foods (see the list below), especially those that contain tyramine, sodium nitrate or phenylalanine
  • Missing meals or fasting
  • Menstrual periods, birth control pills or hormonal changes (in women)
  • Intense physical activity, including sexual activity
  • Smoking
  • Fumes

Foods that may trigger migraines:

  • Aged, canned, cured or processed meat, including bologna, game, ham, herring, hot dogs, pepperoni and sausage
  • Aged cheese
  • Alcoholic beverages, especially red wine
  • Aspartame
  • Avocados
  • Beans, including pole, broad, lima, Italian, navy, pinto and garbanzo
  • Brewer's yeast, including fresh yeast coffee cake, donuts and sourdough bread
  • Caffeine (in excess)
  • Canned soup or bouillon cubes
  • Chocolate, cocoa and carob
  • Cultured dairy products, such as buttermilk and sour cream
  • Figs
  • Lentils
  • Meat tenderizer
  • Monosodium glutamate (MSG)
  • Nuts and peanut butter
  • Onions, except small amounts for flavoring
  • Papaya
  • Passion fruit
  • Pea pods
  • Pickled, preserved or marinated foods, such as olives and pickles, and some snack foods
  • Raisins
  • Red plums
  • Sauerkraut
  • Seasoned salt
  • Snow peas
  • Soy sauce

Diagnosis & Tests

How is migraine diagnosed?

Your doctor can diagnose migraines by the symptoms you describe. Your doctor will perform a physical exam. Your doctor may also want to do blood tests or imaging tests, such as an MRI or CAT scan of the brain, to be sure that there are no other causes for the headache. You may also be asked to keep a "headache diary" to help your doctor identify the things that might cause your migraines.

Treatment

How are migraines treated?

There are 2 types of medicines for migraine treatments. One type focuses on relieving the headache pain. This type of treatment should be started as soon as you think you're getting a migraine. The other type includes medicines that are used to prevent headaches before they occur.

Can nonprescription medicines help relieve the pain?

Yes. Nonprescription medicines that can help relieve migraine pain include aspirin; acetaminophen (one brand name: Tylenol); an acetaminophen, aspirin and caffeine combination (one brand name: Excedrin Migraine); ibuprofen (one brand name: Motrin); naproxen (brand name: Aleve); and ketoprofen (brand name: Orudis KT).

What about prescription medicines?

People who have more severe pain may need prescription medicine. A medicine called ergotamine can be effective alone or combined with other medicines. Dihydroergotamine is related to ergotamine and can be helpful.

Other prescription medicines for migraines include sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan and frovatriptan.

If the pain won't go away, stronger medicine may be needed, such as a narcotic, or medicines that contain a barbiturate. These medicines can be habit-forming and should be used cautiously.

Tips on reducing the pain

  • Lie down in a dark, quiet room.
  • Put a cold compress or cloth over your forehead.
  • Massage your scalp using a lot of pressure.
  • Put pressure on your temples.

Prevention

Can medicine help prevent migraines?

Yes. Medicine to prevent migraines may be helpful if your headaches happen more than twice a month or if your headaches make it hard for you to work and function. Examples of medicines used to prevent migraines include propranolol, timolol, divalproex and some antidepressants.

Talk to your doctor about which medicine is best for you. Nonprescription and prescription medicines that are used often or in large doses may cause other problems.

What else can I do to prevent migraines?

While there are no sure ways to keep from having migraine headaches, here are some things that may help:

  • Eat regularly and do not skip meals.
  • Keep a regular sleep schedule.
  • Exercise regularly. Aerobic exercise can help reduce tension as well as keep your weight in check. Obesity can contribute to migraines.
  • Look for things that might trigger an attack, such as too much exercise or physical activity, certain activities or stress. Sometimes, life stresses are a trigger. Many psychologists can teach stress management and/or biofeedback to help you manage stress.
  • Look for foods that might trigger an attack, such as cheese, processed meats, chocolate, caffeine, MSG (a preservative in many foods), nuts, pickles or one of the other foods listed above. About one third of people with migraines can identify food triggers. Your child only needs to avoid eating these foods if one of them triggers headaches.

If you have frequent migraine headaches, your doctor may prescribe a daily preventive medicine to try to make the headaches less frequent and less severe.

Other Organizations

Questions to Ask Your Doctor

  • How can I prevent a migraine. Are there lifestyle habits I can change?
  • What about medicine? Can migraines be cured?
  • What are some possible side effects of migraine medicine?
  • What should I be writing in my headache journal?
  • Will my child grow out of having migraines?

Source

Headaches in Children and Adolescents by DW Lewis, M.D. (American Family Physician February 15, 2002, http://www.aafp.org/afp/20020215/625.html)

9/11/96