Migraine is a severe, recurring headache that is often accompanied
by nausea, vomiting, as well as light and sound sensitivities.
It is a very common condition and affects about 16 to 18 million
people in the United States.
Cause of Migraine
Doctors used to think that migraine was caused by constriction
and dilation of blood vessels, which then triggered neurons that
detect pain. However, the current thinking is that nerve cells
in the brain stem release a certain type of inflammation-causing
protein into the blood stream in the back of the head. These proteins
cause inflammation of the blood vessels, which trigger the sensory
neurons to signal pain.
The symptoms of migraine headache can vary from person to person
but usually include:
- Severe headache
- Headache on one side of the head
- Headache on both sides of the head
About 20% of migraine sufferers experience an aura or sensory
warning about 5 to 45 minutes before the onset of migraine pain.
These sensory warnings include:
- Seeing a haze or bright jagged lines
- Tingling sensation or numbness in the arms, legs and face
- Speech impairment
- Sense of confusion
Some people actually experience a generalized feeling called
migraine prodome that a migraine is about to attack. This feeling
usually occurs about 1 to 2 hours before the onset of pain, but
can occur as early as 24 hours beforehand. Migraine prodome includes:
Certain types of food may trigger migraines. These include:
- Red wine
- Caffeine (or withdrawal from caffeine)
- Certain vegetables, such as beans, lentils, and snowpeas
- Monosodium glutamate (MSG, a flavor enhancer)
Other triggers of migraine include:
- Bright lights
- Loud noises
- Changes in weather
- Carbon monoxide
- Missing a meal or delaying a meal
- Changes in sleep pattern
- Changes in altitude (e.g. flying on an airplane, traveling
to a mountain top)
Prevention of Migraine
Avoiding a migraine trigger is a key part of preventing a migraine
attack. If you are susceptible to getting migraine when you stay
up late or sleep late, making sure that you stick to a regular
sleeping pattern may help. If a certain food triggers migraine,
then obviously avoiding eating that food would help.
In addition to helping you sleep better, exercise can also help
by increasing the level of endorphin, enkephalin, and serotonin,
which help with pain tolerance. Regular aerobic exercise 20 to
30 minutes a day, 3 days a week can help keep migraines away.
There are two general types of treatment for migraine: abortive
(treating a current headache) and prophylactic (preventing future
Abortive or treatment of a current migraine includes:
- Over-the-counter pain killers or analgesics, such as aspirin
and acetaminophen (Tylenol)
- Non-steroidal anti-inflammatory drugs or NSAIDs
- Ergot derivatives
These include sublingual tablets that dissolve quickly under
the tongue and injectable drugs. Ergot derivatives (which are
derived from a fungus) can be habit-forming and can have serious
side effects such as crampings, nausea, muscle pain, coldness,
and loss of color.
- Triptan medications
These include prescription oral, nasal, and injectable drugs
such as sumatriptan (brand name Imitrex), zolmitriptan and aratriptan.
Triptans are a class of drugs that promote the release of serotonin
neurotransmitter in the brain.
Corticosteroid pain killers, such as prednisone, are often used
for prolonged migraines that are resistant to other medications.
Prophylactic treatment that can prevent future migraines includes:
- Beta blockers and calcium channel blockers
Originally developed as heart and blood pressure medications,
these drugs were also found to help prevent migraines.
- Tricyclic anti-depressants (TCAs)
These include amitriptyline and nortriptyline.
- Anti-epileptic drugs
These include valproic acid, divalproex sodium, and topiramate.
- Methysergide maleate
Discontinued in the United States due to its side effects, this
drug is still prescribed in other countries.