Migraine Headaches

Signs and Symptoms

Signs and symptoms of migraine headaches include:

• Abnormal body sensations, called paresthesias, such as tingling, numbing or prickling
• Diarrhea
• Dizziness or vertigo
• Lightheadedness
• Nausea and vomiting
• Scalp tenderness
• Sensitivity to light
• Visual disturbances, such as flashes of light or blind spots in your vision

Migraines are the most common cause of vascular headache, affecting 26 million Americans. About 15 percent of women and 6 percent of men experience these headaches. They are characterized by recurrent attacks, with pain most often on one side of the head, accompanied by other symptoms such as nausea, vomiting and sensitivity to light and sound. Although migraines can occur at any time of day or night, they tend to be more frequent in the morning. Routine activity or slight head movement typically makes the pain worse.

Episodes can last from several hours to several days and often are disabling. During the attack, pain may travel from one part of the head to another and may radiate down the neck into the shoulder. Scalp tenderness occurs in the majority of patients during or after an attack. Migraines tend to run in families and often are hereditary. If you have migraines, chances are another family member does as well.

Diagnosis

Migraines generally are diagnosed by the symptoms you describe to your doctor, for there is no medical test that can specifically diagnose migraines. Your doctor will ask you about the severity, frequency and duration of your headaches as well as other symptoms you experience and any medications you take.

If your headache is associated with flashing lights, blindness or numbness on one side of the head, it is called "classic" migraine or migraine with "aura." Only 20 percent of people with migraines have auras.

Migraines can be triggered by certain factors including the following:

• Diet -- Certain foods seem to trigger migraines in some people. Alcohol, especially red wine; the sugar substitute aspartame; caffeine; monosodium glutamate (MSG), a seasoning; foods that contain tyramine, such as aged cheeses; and preserved meats with nitrates and nitrites may cause migraines.

• Sleep -- Too much or too little sleep can trigger a migraine in some people.

• Hormones -- Many women with migraine headaches have attacks linked to their menstrual cycles. Fluctuating estrogen may play a role. Menstrual migraines can be more debilitating, difficult to treat and last longer than other migraines. This condition may worsen in early pregnancy, but then improve in later pregnancy. Migraines typically subside as women age. Oral contraceptives or estrogen-replacement therapy can provoke or worsen migraines in some women.

• Stress and Anxiety -- Emotional stress or daily pressure can trigger a migraine attack in some people/ In turn, managing the stress in your life could help alleviate migraines. To reduce stress, it might help to complete large jobs in small increments over time instead of all at once. Learning to relax and "let go" of events beyond your control also may help. Exercise and meditation can modestly improve migraine pain.

• Environmental Factors -- Migraine headaches can be triggered by environmental conditions including weather or temperature changes, glaring or fluorescent lights, computer screens, strong odors and high altitude.

Treatment

Migraines can be managed by identifying and then avoiding the "trigger factors" that affect you. People who suffer from migraines tend to be sensitive to stress. Since the stresses of everyday life can't be avoided, practicing stress-relieving techniques -- such as yoga, transcendental meditation, hypnosis and biofeedback -- may be helpful.

Drugs also are available to treat migraines. Typically, pain relievers such as aspirin, acetaminophen and ibuprofen are recommended as initial treatments. If they don't relieve the pain, your doctor may prescribe other drugs or drug combinations. Your doctor will work with you to determine which drugs are best for you, based on the severity of your attacks.

Some medications, used to treat other conditions -- such as beta-blockers for hypertension and tricyclic for depression -- are effective in treating migraines as well. Beta-blockers, which open up blood vessels, can have a soothing effect on the nerve cells that cause migraines. And antidepressant drugs, which have pain-relieving qualities, also have been effective in relieving migraines. Even though you may not be depressed, antidepressant drugs may be prescribed for headache pain. The benefits and dosages of these drugs when used for migraines, however, are different than those in the treatment of other conditions.

Many drugs for acute migraine attacks work best when taken as soon as you feel a migraine coming on. But don't take these medications more often or in higher doses than your doctor recommends.

If you experience frequent attacks, medication to prevent migraines may be prescribed so that headaches will strike less often and last for shorter periods of time. Be sure to continue taking your preventive medications even while being treated for an acute attack.

If your doctor prescribes medication, be sure to ask for the following information:

• How often the medication should be taken
• If the medication should be taken with meals or on an empty stomach
• What to do if pain or other symptoms persist

Drugs, however, don't cure the condition. As you age, though, your migraines may subside. Studies show that migraine attacks peak between the age of 35 and 45 and then begin to decline.