Migraine Headache

Migraine Headache
Migraine is a recurrent headache disorder with intense pain that may be unilateral (one-sided) and accompanied
by nausea or vomiting as well as photosensitivity (sensitivity to light) and phonosensitivity (sensitivity to
sound). The lifetime prevalence is 25% in women and 8% in men. Migraine also affects about 5% to 10% of
children and adolescents. Some people who have migraine headaches experience an aura (temporary disturbance of
the senses or muscles) in the minutes before the onset of pain. The aura may consist of seeing flashing lights, having
numbness or tingling in the face or extremities, having a disturbed sense of smell, or having difficulty speaking. However,
only about one-third of individuals who have migraine headaches experience auras. Migraines are painful but fortunately
are not life-threatening. The June 24, 2009, issue of JAMA includes an article about migraine headache

CAUSES

The exact cause of migraine headaches is unknown. Current
research suggests that inflammation in the blood vessels of
the brain causes them to swell and press on nearby nerves,
causing pain. This inflammation may arise in or be stimulated
by signals from the trigeminal nerve (the main sensory nerve
of the face).
Many individuals with migraine headaches can identify
triggers that cause or aggravate the headache. Because there
is no cure, avoiding triggers may help to reduce the frequency
or severity of migraine headaches. Some triggers include
• Stress and anxiety
• Changes in the weather
• Caffeine (too much or too
little), chocolate, or alcohol
(often red wine)
• Lack of sleep or too much
sleep
• Hormonal changes during
the menstrual cycle
• Skipped meals
• Certain foods that contain
nitrates (such as luncheon
meats, hot dogs), tyramine
(such as aged cheeses,
smoked fish), monosodium
glutamate (MSG), or
aspartame

TREATMENT
There are 2 medication strategies used to treat migraine
headaches. Treating the pain at the onset offers the best relief.
• Over-the-counter analgesics (pain relievers) such as aspirin,
acetaminophen, or nonsteroidal anti-inflammatory drugs
(NSAIDS) such as ibuprofen
• Prescription drugs called triptans are used for headaches not
relieved by over-the-counter medications. These are generally
not used for people who have high blood pressure or heart
disease.
For those whose headaches are not adequately relieved with
these medications, the second medication strategy involves
medications prescribed prophylactically (taken everyday for
prevention). These medications are normally prescribed to
treat other disorders but have been successful at reducing the
frequency or severity of migraine headaches.
• Blood pressure medications such as beta blockers or calcium
channel blockers
• Antidepressant medications such as amitriptyline or venlafaxine
• Anticonvulsant medications such as divalproex or topiramate