What Is a Migraine?
Migraine is a type of headache
that is often localized in a certain area of the head and is sometimes
accompanied by a pronounced sensitivity to light and sound. Other common
migraine symptoms include nausea and vomiting. Migraines are usually gradual in
onset, progressively more painful and then undergo a gradual resolution. When
migraines are mild to moderate, they are usually described as being dull, deep
and steady. When severe, migraines are throbbing or pulsating.
Some migraines are worsened by
head motion, sneezing, straining or physical exertion. Since many patients also
become sensitive to light and sound, some migraine sufferers will lie down in a
darkened and quiet room to relieve symptoms.
More common in women than in men,
migraine is a chronic condition, and migraine headaches may occur infrequently
or as often as several times a week. Although migraines can begin at any time,
the most common time is in the early morning. While migraines can begin during
sleep, this is uncommon and must be evaluated to rule out other conditions.
The onset of migraine usually
occurs between the ages of 5 and 35. It is treatable but not curable, and it is
not considered a life-threatening condition, though rarely a severe migraine
may cause a stroke. However, if the headaches are severe and frequent, migraine
can have a debilitating impact on a person’s life.
What Are the Symptoms and Types of
Migraine?
Depending on the symptoms, most
migraine headaches are categorized as “migraine with aura” (previously called
classic migraine) or “migraine without aura” (previously called common
migraine).
Migraine with aura begins with
certain neurologic symptoms, the most common of which are visual disturbances.
The typical visual aura presents as a flickering jagged (or zigzag) line,
usually at the side of the visual field. The next symptom in frequency is
numbness and tingling of the lips, lower face and fingers of one hand. Some
patients experience temporary paralysis on one side of the body. Auras rarely
last longer than an hour and are followed by a headache 93 percent of the time.
Migraine without aura has been
called common migraine because it has a greater incidence in the population
(accounting for 80 percent of cases) and is not preceded by an aura. It may be
preceded by mood changes, fatigue, mental fuzziness and fluid retention. In
common migraine, the patient also may have diarrhea, increased urination,
nausea and vomiting. The common migraine can persist three or four days,
depending on treatment.
Either type of migraine may also
be accompanied by nasal congestion, runny nose, tearing, and/or sinus pain or
pressure. This has sometimes led to the mistaken diagnosis of “sinus headache.”
True sinus headache is typically associated with an acute sinus infection, and
symptoms often also include fever and thick mucous discharge.
Are There Different Forms of Migraine?
Besides the categories of
migraine with or without aura, migraines also occur in other forms, such as:
Hemiplegic migraine:
Marked by temporary paralysis on one side of the body (hemiplegia), impaired
vision and vertigo
Ophthalmologic migraine:
The pain of this rare type of headache is localized around the eye; the
headache may be accompanied by a droopy eyelid and vision problems. It is now
thought that this may not actually be migraine, but another neurologic condition
entirely
Basilar artery migraine:
Occurs mostly in adolescent and young women. It results from a spasm to the
basilar artery, a major blood vessel at the base of the brain. Symptoms can
include vertigo, impaired vision, poor motor coordination, difficulty speaking
or hearing, and altered consciousness.
Benign exertional headache:
A type of vascular headache triggered by physical exertion, such as running,
bending and lifting, or even coughing or sneezing. This headache rarely lasts
more than several minutes.
Status migrainosus: A
rare, sustained and extremely severe type of migraine with pain and nausea so
intense that the person may have to be hospitalized.
Headache-free migraine: A
condition characterized by migraine symptoms, such as visual impairment,
nausea, vomiting, constipation or diarrhea, but no headache.
How Do Other Types of Headaches Differ
from Migraine?
Although other types of headaches
share some symptoms with migraines, they also come with distinctive symptoms of
their own. Other common headache types include:
Tension headache: Chronic
headache that is associated with stress or fatigue; physical ailments such as
arthritis; or psychological distress or depression. Tension headaches may be
precipitated by poor posture, eyestrain, abnormalities of muscles or bones in
the neck, misaligned teeth or jawbones, or unusual noise or light conditions.
A pattern of chronic tension
headaches may set in between the ages of 20 and 40; women have a greater
incidence of tension headache than men. Symptoms include muscle tightness in
the head and neck, especially in the temple and forehead areas; pressure
sometimes described as feeling like a band or vise around the head; and
continuous but not throbbing pain.
Cluster headache: A type
of vascular headache that sometimes occurs in a cluster of up to four separate
attacks a day and has been associated with an increased level of histamine in
the blood. Cluster headaches, which usually come on quite suddenly on one side
of the head, are thought be the most severe and intense headaches. Patients
describe excruciating, stabbing pain, often around one eye, as well as tearing
from that eye and a runny nose on the affected side. These headaches can last
less than an hour or for several hours or more, and they often stop as quickly
as they started. The onset of cluster headaches is usually between the ages of
20 and 45 and may be linked to smoking and alcohol use; more men than women
suffer from cluster headache.
What Are the Risk Factors for Migraine?
The propensity to get migraine
headaches may be genetic. Research is underway to identify the genes involved
in migraine headaches that run in families. Essentially, if members of your
immediate family (mother, father and siblings) suffer from migraine, you are at
risk too.
Migraine headaches may be
precipitated by a variety of factors called “triggers”:
·
Hunger (missed meals)
·
Drinking alcohol (especially red wine)
·
Eating foods containing monosodium glutamate
(MSG), or that are high in caffeine (coffee, tea, colas) or nitrates and
nitrites (preserved meats), or contain tyramine (aged cheeses)
·
Menstruation or oral contraception use
·
Getting too little or too much sleep
·
Stress in your work and personal life
·
Factors in the environment, such as glaring
lights, strong smells, weather changes or high altitude
Do Other Medical Conditions Increase
Your Migraine Risk?
Though many people who have
migraines also have co-existing health issues, it has not been established that
having other conditions causes migraines. Nor has it been established that
having migraines leads to other medical problems.
Two conditions found to exist in
a high proportion of people who have migraines are depression and anxiety,
though the reason for this is unclear. Doctors have also observed that in
people who have cardiovascular disease, there is a slightly increased incidence
of migraine. Also, many people who have conditions with nasal and sinus
inflammation appear to have migraines as well.
Certain medical events may also
put a person at risk for migraine, among them are trauma to the brain from head
or neck injury, and infections or hemorrhages in the brain. In addition,
certain medications can begin a headache pattern that can become migraine-like
in nature.
How Is Migraine Diagnosed?
Migraine can generally be
diagnosed from its clear-cut symptoms, which usually fall into a recognizable
pattern. A patient with suspected migraine will be asked how often the
headaches occur, where the pain is localized, how long the headaches last and
related questions. The physician also will take a full medical history,
including information about any past head injury, eye strain, sinus condition,
and dental or jaw problems.
The physician may order exams and
blood work to exclude other possible causes for the headache pain. It is
usually not necessary to do X-ray or other scans of the brain. This would be
recommended in certain situations such as unexplained onset at a later age, an
unexplained finding on neurologic exam or features that are atypical for
migraine. Patients with sudden onset of extremely severe headache must be
immediately scanned to rule out the possibility of an aneurysm. Other signals
for scanning are rapidly increasing frequency of headache or persistent
headache unresponsive to treatment.
What Medications Are Used to Treat
Migraine?
Migraine drugs fall generally
into two categories. Those for acute migraine headaches are considered abortive
treatments because they interrupt an attack or episode of migraine headache and
are given once the symptoms of a migraine have appeared. The second category is
preventive medications, which are taken regularly to keep headaches from
occurring.
Your doctor will assess you and
determine the best treatment for you.
