What is a migraine headache?

A migraine headache is a special kind of headache that can last for hours to days. It can cause intense pain as well as other symptoms, such as feeling sick to your stomach or having changes in your vision.

How does it occur?

For years migraine headaches were thought to be caused when blood vessels in the head contract and then swell, producing pain. Recent research suggests that certain substances or events trigger an imbalance of brain chemicals (neurotransmitters).

Common migraine triggers include:

• stress
• tiredness
• changes in the weather
• certain foods
• MSG or food preservatives, such as nitrates
• red wine
• bright lights

Migraines tend to run in families. They affect women 3 times more often than men. They often occur during, or right before, a woman’s menstrual period.

What are the symptoms?

Before a migraine starts, there is often a warning period when you don’t feel well. Some people lose part of their vision or see bright spots or zigzag patterns in front of their eyes. These symptoms, which may precede and predict a migraine headache, are called migraine aura. The vision changes of the aura usually go away as the headache begins.

Migraine symptoms may include:

• throbbing or pounding headache
• extreme sensitivity of eyes to light
• blurred vision
• nausea and vomiting
• numbness or tingling of the face or one arm.

The pain is usually more severe on one side of the head but can affect the whole head.

How is it diagnosed?

Your health care provider will ask about your symptoms and medical history and examine you. There are no lab tests or x-rays for diagnosing migraine headaches.

A careful history of your headaches is very helpful.

Your health care provider may ask you to keep a headache diary in which you record the following:

• date and time of each attack
• how long the headache lasts
• type of pain (for example, dull, sharp, throbbing, or a feeling of pressure)
• location of pain
• any symptoms before the headache began
• foods and drinks you had before the headache began (This should include checking the ingredients in the product ingredient list of packaged foods you have eaten.)
• use of cigarettes, caffeine, alcohol, or carbonated drinks before the headache began
• time you went to bed and time you got up before the headache began
• if you are a woman, your menstrual periods and use of birth control pills or other female hormones

Depending on your headache symptoms, your health care provider may recommend tests to check for other, more serious causes of your symptoms. For example, you may have a brain scan or magnetic resonance imaging (MRI).

How is it treated?

Prevention is an important part of treatment. For example:

• You may need to change to a healthier diet.
• Relaxation exercises and biofeedback may help you manage stress.
• Your headache diary may suggest certain foods or activities you should avoid.
• You may need to take medicine regularly to prevent the severe and frequent headaches. Drugs your health care provider might prescribe include propranolol, verapamil, antidepressants, and ergot
• preparations such as ergotamine, ergonovine, or methysergide. You may need to try a medicine for several weeks to see if it works.

Your health care provider may prescribe other medicines to help keep migraines from becoming severe once they start. It’s best to take the medicine as soon as possible after a headache begins. This means you need to recognize the warning symptoms.

Medicines most often used for this purpose are:

• a group of drugs called triptans are available as tablets (including some that may be taken without water), a shot, and a nasal spray (Examples of triptans are almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan.)
• D.H.E. (dihydroergotamine), which is a shot your health care provider can give you, or you may learn how to give it to yourself.

How long will the effects last?

Symptoms last from a few hours to a few days. You may have migraines the rest of your life. However, attacks usually occur less often as you grow older.

How can I take care of myself?

When a migraine begins:

• As soon as possible after the headache symptoms begin, take a pain reliever such as aspirin, acetaminophen, ibuprofen, or the medicine prescribed by your health care provider.
• Rest in a quiet, dark room until the symptoms are gone. Putting a cool, moist washcloth on your forehead might help.

Call your health care provider right away if you have unusual symptoms such as:

• fever
• stiff neck
• nervous system symptoms such as difficulty speaking, arm or leg weakness, or paralysis.

You may do the following to help prevent migraines:

• Eat regular meals.

Avoid foods from the following list if eating them seems to cause your headaches:

• wine, ale, and beer
• aged and processed cheeses
• aged, canned, cured, and processed meats
• breads made with yeast and yeast extracts
• foods containing cheese, chocolate, or nuts
• Ask your health care provider about avoiding medicines that may trigger headaches.
• If you are taking birth control pills or other female hormones, ask your provider if you should stop taking them.
• Ask your provider about medicine that can be taken every day to try to prevent migraine headaches.
• Avoid smoking.
• Get regular rest.
• Try to balance work, relaxation, recreation, and rest in your life.
• Try to identify and avoid stress.
• Don’t drive a car during a migraine.

If your symptoms get worse, or if they don’t get better when you take medicine, make another appointment with your health care provider. It may take several visits to find the best way to control your headaches.