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A migraine is one of many different types of headaches. Close to 20% of Canadians are afflicted with migraines. The typical migraine headache is described as being pulsatile on one side of the head with mild to severe pain that interferes with daily routines. It is often associated with nausea, vomiting and photophobia which is a tendency to avoid light. Migraines tend to have prodromes and auras. Prodromes are symptoms that precede the headache such as irritability, depression, loss of appetite and restlessness. Prodromes may disappear or lessen as the headache starts. An aura is a neurological symptom that precedes the headache and defines a Classical Migraine. An aura may consist of visual changes such as flashes or tunnel vision, tingling, numbness, and, in some cases, actual paralysis may occur. Migraines without auras are called Common Migraines. The exact mechanism of migraine headaches involves minor swelling and inflammation within the brain structures. This is accompanied by constriction of the blood vessel supplying blood to the brain itself. Migraines tend to start early in life and affect women to a greater extent than men. But the migraine mechanism can extend to other body parts. For example, some people suffer severe ocular migraines involving one eye only, while others, a minority, suffer abdominal migraines with excruciating stomach pain. Many different substances have been implicated in having a role as migraine triggers. Common food triggers include: chocolate, alcohol and red wine, freshly baked goods containing yeast, certain cheeses, pickled meats containing nitrites or amines, and certain beans. Many non-food triggers also exist. Emotional states, menstruation, hunger, intense sexual activity, smoking, computer screens and sleep deprivation can all trigger migraines. Migraines are linked to strokes. Migraine sufferers who experience auras are twice as likely to suffer a stroke. Women who use birth control pills and suffer aura associated migraines increase their risk by almost sevenfold. If you smoke, take birth control pills, and suffer from classical migraines, your risk for strokes increases even more. Migraines tend to cluster in family groups. Menopause certainly improves the migraine prone state, and it is rare to see a new onset of migraines in older people.
Two general approaches are used in migraine treatment. The more sensible approach involves identifying a person's migraine triggers and trying to avoid them. This is sometimes coupled with using medications to prevent onset such as beta-blockers (Propranolol), calcium channel blockers (Flunarazine), anti-epileptics (Valproate), and even low dose amitriptyline. For persons who only get the occasional migraine, a different approach makes more sense. In that strategy, over the counter medications such as Advil and Tylenol are ingested at the first sign of the headache. The sooner, the better. Often the effect of these medications can be enhanced by adding cold compresses, massaging the temples and avoiding bright light. Sometimes stronger narcotics are required such as Tylenol with codeine, Percodan, Fiorinal, Talwin or Demerol. Doctors tend to refrain from encouraging the regular use of narcotics for migraines. These drugs are potentially addictive and can cause rebound headaches which fuel a vicious cycle. A new class of agents appeared on the horizon several years ago that made a wonderful impact in the early phase of migraine evolution. They are designed to abort the vasoconstriction of cerebral blood vessels. Most of them do this by binding to specific serotonin receptors in these vessels. Common triptans include Zomig, Amerge, Imitrex and Maxalt. Recently, caution has been raised about heart patients using these medications. Sometimes migraines are so disabling that hospitalization is required and various intravenous cocktails are employed in the hopes of relieving them.
When dealing with migraines, taking a good history is the key to making a diagnosis, but an examination to rule out other more sinister causes is essential. Tension headaches are more common than migraines and originate when the neck and upper back muscles constantly pull on the scalp muscles. This produces a band like headache that is mostly felt in the temple areas. Before deciding that it is a migraine that plagues you, make sure that you have been evaluated by a qualified physician.
