Migraines

Learn About Migraines

Migraine is a type of headache that can be quite severe. A migraine is usually an intense, throbbing pain on one, or sometimes both, sides of the head. Besides pain, migraine also can cause nausea and vomiting and sensitivity to light (photophobia) and sound (phonophobia). Some people also may see spots or flashing lights (scotoma) or have a temporary loss of vision (amaurosis). Migraine can occur any time of the day, though it often starts in the morning. The pain can last a few hours or up to one or two days. Some people get migraines once or twice a week. Others, only once or twice a year. Still others are disposed to get migraines during their menstrual period (catamenial migraine).

Characteristically, migraine affects people between the ages of 15 and 55. Most people have a family history of migraine or of disabling headache. They are more common in women than men after puberty; but boys are more likely to have them than girls before. Women tend to report more painful and longer lasting headaches and more symptoms, such as nausea and vomiting, than do men. Migraine often becomes less severe and less frequent with age. Migraine is the most common form of disabling headache that sends patients to see their doctors.

The exact cause of migraine is not fully understood; but it appears that the beginning of a migraine is in the brain and brainstem. Although the central nervous system itself does not feel pain, the chemical imbalance in the brain causes the blood vessels in the tissue surrounding the brain to become inflamed and swollen, which causes pain receptors in those tissues to become activated. One chemical central to the production of a migraine is serotonin; it is hypothesized that high levels of serotonin within the brain spread out to involve the blood vessels. Initially the serotonin causes the blood vessels to constrict; this constrictive phase is followed by a relaxation phase which is associated with migrainous pain. Genes also have been linked to migraine. People who get migraines (migraineurs) may have abnormal genes that control the functions of certain brain cells.

Migraineurs are more likely to experience a migraine when exposed to triggers, some of which include:

  • Lack of or too much sleep
  • Skipped meals
  • Bright lights, loud noises, or strong odors
  • Hormone changes during the menstrual cycle
  • Stress and anxiety, or relaxation after stress
  • Weather changes
  • Alcohol (often red wine)
  • Caffeine (too much or withdrawal)
  • Foods that contain nitrates, such as hot dogs and lunch meats
  • Foods that contain MSG (monosodium glutamate), a flavor enhancer found in fast foods, broths, seasonings, and spices
  • Foods that contain tyramine, such as aged cheeses, soy products, fava beans, hard sausages, smoked fish, and Chianti wine
  • Aspartame (NutraSweet® and Equal®)

Some migraineurs experience an aura preceding the onset of migraine pain (classic migraine), although not necessarily (common migraine). An aura may include the following:

  • Seeing flashing lights, zigzag lines, or blind spots
  • Numbness or tingling in the face or hands
  • Disturbed sense of smell, taste, or touch
  • Feeling mentally “fuzzy”

While migraine is not the only kind of headache, it has characteristics that distinguish it from other kinds of head pain. One feature is the distinctly “psychological” aspects of the pain; a certain kind of “misery” that is more than can be accounted for by the pain alone. And migraine can become a constant occurrence, with background pain always present with waves of migrainous pain occurring on top of this; the transformed migraine. Finally, rebound migraines can occur when certain aspirin and caffeine preparations used to excess; the medication overuse migraine.

Migraine treatments are divided into those taken when a migraine strikes (abortive treatment) and those taken to keep migraines from occurring (preventative treatments). Triptans, which mimic the action of serotonin on blood vessels causing them to contract (recall that it is the relaxed, swollen phase of the blood vessels that causes the pain of migraine), include sumatriptan (Imitrex®), rizatriptan (Maxalt®), zolmitriptan (Zomig®), almotriptan (Axert®), eletriptan (Relpax®), naratriptan (Amerge®), and frovatriptan (Frova®). Triptans can come as tablets that are swallowed, tablets that dissolve under the tongue, nasal sprays, and as injections. These are abortive treatments, along with over-the-counter preparations of aspirin, acetaminophen, and caffeine, such as Excedrin. Preventative therapies are medications taken daily keep migraines from getting started; they include antidepressants, such as amitriptyline (Elavil®) or venlafaxine (Effexor®); anticonvulsants, such as divalproex sodium (Depakote®) or topiramate (Topamax®); beta-blockers, such as propranolol (Inderal®) or timolol (Blocadren®); and calcium channel blockers, such as verapamil (Calan). Hormone therapy may help prevent attacks in women whose migraines seem to be linked to their menstrual cycle; birth control pills may be prescribed expressly for this purpose – although how they are taken may differ from contraceptive dosing.

Sorting out migraine from other forms of headache is an exercise that the physicians of North Star Medical Research can assist you with. Contact us to arrange a no-cost, no-obligation consultation!

Adapted from:
NINDS Migraine Information Page
Migraine Research Foundation
Family Doctor - Migraines Overview


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