HCA Virginia Physicians January 22, 2018

by Daniel Hardy, MD

Migraine is a type of recurring headache that involves nerves and brain chemicals. Certain sensations, known as auras, may occur before the headache begins. There are 2 types of migraines:

  1. Occurring with an aura—formerly called a classic migraine
  2. Occurring without an aura—formerly called a common migraine

Migraine may happen several times a week or once every couple of years. They can be so severe that they interfere with the ability to work and carry on normal activities.

What causes a migraine?

According to the Migraine Research Foundation®, “Migraine is an extraordinarily prevalent neurological disease, affecting 39 million men, women and children in the U.S. and 1 billion worldwide.” Some facts the foundation provides about migraine are:

  • Migraine is the 3rd most prevalent illness in the world.
  • Nearly 1 in 4 U.S. households includes someone with migraine.
  • Amazingly, 12% of the population – including children – suffers from migraine.
  • 18% of American women, 6% of men, and 10% of children experience migraines.
  • Migraine is most common between the ages of 25 and 55.
  • Migraine tends to run in families. About 90% of migraine sufferers have a family history of migraine.

While the precise cause is not known, many potential triggers have been identified. Common triggers include:

  • Environmental triggers, such as odors and bright lights
  • Dietary triggers, such as alcohol
  • Certain medications
  • Changes in sleep patterns
  • Stress
  • Physiologic changes, such as menstruation and puberty
  • Weather changes

A trigger sets the process in motion. It is possible that the nervous system reacts to the trigger by conducting electrical activity. This spreads across the brain. It leads to the release of brain chemicals, which help regulate pain.

What risk factors increase your chance of developing migraines?

A risk factor is something that increases your odds of contracting a condition or disease. Migraines are more common in women, especially before the age of 40. Other factors that increase your risk for migraines may include:

  • Family history of migraines
  • Menstruation
  • Obesity
  • Presence of patent foramen ovale, a type of congenital heart defect

What are the symptoms of migraines?

Migraines occur in phases that may include:

  1. Warning Phase

    A warning may come before a migraine. In the hours or days before the headache, symptoms may include:

    • Changes in mood, behavior, and/or activity level
    • Fatigue
    • Yawning
    • Food craving or decreased appetite
    • Nausea
    • Diarrhea
    • Sensitivity to light
  2. Aura Phase

    Auras are perceptions of strange light, unpleasant smells, or confusing thoughts and experiences. The most common aura is visual. The aura lasts about 15-30 minutes and may produce the following sensations:

    • Flashing lights, spots, or zig zag lines
    • Temporary, partial loss of vision
    • Speech difficulties
    • Weakness in an arm or leg
    • Numbness or tingling in the face and hands
    • Confusion
    • Lightheadedness
    • Speech disturbances

    It is important to seek medical attention to make sure the symptoms are not due to a more serious cause like stroke or seizure.

  3. Headache Phase

    Migraine pain starts within an hour of the aura ending. A headache is usually on one side of the head, but may involve both sides. Headaches may feel:

    • Moderate or severe in intensity
    • Throbbing or pulsating
    • More severe with bright light, loud sound, or movement

    Other symptoms during the headache phase can include:

    • Nausea or vomiting
    • Diarrhea
    • Lightheadedness
  4. Post-Headache Phase

    Migraines usually last from 4-72 hours. They often go away with sleep. After the headache, you may experience:

    • Trouble concentrating
    • Fatigue
    • Sore muscles
    • Irritability
    • Mood changes

How are migraines diagnosed?

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You will be asked about your symptoms and medical history and a physical exam will be done. Other tests may include:

  • A neurological exam.
  • Examination of body fluids, usually done with blood tests.
  • Images of your brain taken by CT scan or MRI scan are rarely necessary.

What treatment options are available for migraines?

Migraine therapy aims to:

  • Prevent headaches
  • Reduce headache severity and frequency
  • Restore your ability to function
  • Improve quality of life

Treatment options may include:

  1. Medications

    Pain medications often are needed to ease or stop the pain. Over-the-counter pain pills may ease mild symptoms. Some pain relievers have caffeine as an ingredient, which may help improve pain relief. If yours does not, talk to your doctor about taking a caffeine supplement with your pain reliever.

    Warning: Regular use of some over-the-counter medications may cause a rebound headache.

    Some prescription medications act directly to stop the cause of the migraine headache. These include drugs that:

    • Quiet nerve pathways
    • Reduce inflammation
    • Bind receptors for serotonin, a brain chemical

    These drugs can be taken by mouth, but may act more quickly in forms that dissolve in the mouth, are inhaled through the nose, or injected. They are more likely to be helpful if taken as soon as possible at the start of a migraine. Your doctor can help you choose the medication best for you.

    Medications that can help stop a migraine once it has begun include:

    • Triptans
    • Steroids
    • Acetaminophen
    • Non-steroidal anti-inflammatory drugs (NSAIDS)
    • Medications for nausea
    • Ergots
    • Combination medication that contains caffeine

    Other drugs can help prevent migraines for people with frequent migraines. Preventive drugs are taken every day. Classes of preventive medications include:

    • Beta-blockers
    • Calcium channel blockers
    • Tricyclic antidepressants
    • Anticonvulsants
    • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blockers (ARBs)
  2. Therapy

    Therapy sometimes reduces the length and frequency of migraine headaches. It may be used with or without medication and may include cognitive behavioral therapy, biofeedback, or relaxation methods.

  3. Procedures

    Botulinum toxin injections may be used as a way to prevent migraines and to reduce the duration and intensity of the headaches in people who have headaches often.

  4. Surgery

    In some people, migraines are triggered when a nerve in the head is stimulated. With this type of surgery, the nerve trigger point is located in the head and is deactivated. This surgery may reduce the number of migraines or completely eliminate them in sufferers who do not respond to conventional treatments. Most migraines are not treated with surgery.

    Transcranial magnetic stimulation surgery also may be used in patients suffering from migraine with aura who have not responded to other treatments.

  5. Self-Care During the Migraine
    • Apply cold compresses to painful areas of your head.
    • Lie in a dark, quiet room.
    • Try to fall asleep.
  6. Lifestyle Changes
    • Keep a diary to help identify what triggers your migraines and what helps relieve them.
    • Learn stress management and relaxation techniques.
    • Consider talking with a counselor to learn new coping skills and relaxation techniques.
    • Regular exercise can help with depressive and other symptoms.
    • If you are a smoker, talk to your doctor about ways to quit. Smoking may worsen migraines.
    • Avoid foods that trigger migraines.
    • Eat regular meals.
    • Maintain your regular sleep pattern even during the weekend or on vacation.

Are there any ways to prevent migraines?

Methods for preventing migraine include:

  • Avoiding those things that trigger the headache
  • Following your doctor's recommendations to accurately take medications that can help prevent headaches, such as:
    • Antidepressants
    • Antiseizures
    • Medications that lower blood pressure
    • Butterbur extract

Healthy lifestyle habits that may help prevent migraines are:

  • Maintaining regular sleep patterns.
  • Learning stress management techniques.
  • Not skipping meals.
  • Avoiding alcohol.
  • Exercising regularly. Yoga has been found to be an effective activity.
  • Asking your doctor if acupuncture is right for you. It may help you to have more headache-free days, as well as lessen the intensity of headaches when they do occur.

Therapies that may decrease migraine or migraine pain include:

  • Mind-body therapies like:
    • Biofeedback
    • Cognitive behavioral therapy
    • Guided imagery—may improve pain coping
  • Massage therapy

Foods are not proven to trigger migraine. But consider keeping a diary of migraine and diet to identify foods that may trigger migraines for you. Foods suspected to trigger migraine include:

  • Nuts and peanut butter
  • Beans
  • Aged or cured meats
  • Aged cheese
  • Processed or canned meat
  • Caffeine—intake or withdrawal
  • Canned soup
  • Buttermilk or sour cream
  • Meat tenderizer
  • Brewer's yeast
  • Avocados
  • Onions
  • Pickles
  • Red plums
  • Sauerkraut
  • Snow peas
  • Soy sauce
  • Anything with MSG (monosodium glutamate), tyramine, or nitrates

Sources:

American Academy of Family Physicians: www.familydoctor.org/condition/migraines

Migraine Research Foundation®: www.migraineresearchfoundation.org

National Institute of Neurological Disorders and Stroke: www.ninds.nih.gov/Migraine-Information-Page