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Migraine is a neurological disorder that generally involves repeated headaches. Some people also have nausea, vomiting, and other symptoms.

Most people with migraines do not have any warning before it occurs. However, some people have a visual disturbance called an aura before the headache starts.

A migraine is caused by abnormal brain activity, which is triggered by stress, food, or something else. The exact chain of events is not known. However, it seems to involve various nerve pathways and chemicals in the brain. The changes affect blood flow in the brain and surrounding membranes.

Migraines occur in women more than men, most often between the ages of 10 and 46 years. In some cases, they appear to run in families.

Migraine attacks may be triggered by:

• Allergic reactions
• Bright lights
• Loud noises
• Physical or mental stress
• Changes in sleep patterns
• Smoking or exposure to tobacco smoke
• Missed meals
• Alcohol
• Hormonal fluctuations (related to menstrual cycles or use of birth control pills)

Foods associated with migraine include:

• Foods containing the amino acid tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, some beans)
• Chocolates
• Nuts and peanut butter
• Fruits (avocado, banana, citrus fruit)
• Onions
• Dairy products
• Baked goods
• Meats containing nitrates (bacon, hot dogs, salami, cured meats)
• Foods containing monosodium glutamate (MSG)
• Any processed, fermented, pickled, or marinated foods

True migraine headaches are not a result of underlying brain tumors or other serious medical problems. However, only an experienced health care provider can determine whether headache symptoms represent migraine or some underlying medical condition that requires further tests. This assessment can only be made after a review of a patient's history and a complete neurological exam.

Symptoms  

When a migraine begins with visual disturbances (aura), these warning symptoms may occur anywhere from a few minutes to 24 hours before the headache. The visual changes are common in one or both eyes. They may occur in any combination:

• Seeing zigzag lines
• Seeing flashing lights
• Other visual hallucinations
• Temporary blind spots
• Sensitivity to bright light
• Blurred vision
• Eye pain

Other symptoms that may precede or accompany the headache include:

• Loss of appetite
• Nausea
• Vomiting
• Chills
• Increased urination
• Increased sweating
• Swelling of the face
• Irritability
• Fatigue

The headache itself is often described as a "pounding" feeling that starts on one side of the head and may spread to the other side. For many patients, the headaches start on the same side each time. Many patients describe pain behind the eye or in the back of the head and neck.

The headache typically begins as a dull ache that progressively worsens over several minutes to hours to the point of disabling pain. The headache may last several hours to days, during which patients are sensitive to light or sound. Patients often wish to rest in a quiet, dark room.

Treatment  

To learn what may be triggering your migraine headaches, keep a headache diary. Write down:

• When your headaches occurred
• How severe they were
• Additional symptoms
• What you've eaten
• Sleep patterns
• Menstrual cycles
• Any other possible factors

For example, the diary may reveal that your headaches tend to occur more often on days when you awaken earlier than usual. Changing your sleep schedule may then result in fewer migraine attacks.

Some birth control pills and other medications may trigger headaches. Your health care provider should address questions regarding their use.

Even in the absence of a clear factor that triggers migraine attacks, try to keep a regular exercise and sleep schedule. Avoid smoking, caffeine, and alcohol. Some patients have found biofeedback and self-hypnosis to be effective at reducing the frequency of migraine attacks.

MEDICATION

Although there is no cure for migraine headaches, numerous medications are available. These medications are used to:

• Prevent migraines from occurring
• Stop the migraine once early symptoms develop
• Treat the symptoms of migraine

All medications have potential side effects and may be incompatible with other medications you are taking. Also, many migraine medications are associated with birth defects and are therefore not safe to use during pregnancy.

Often, a health care provider will try several classes of medications before one (or a combination) is found to be effective.

PREVENTING MIGRAINES

Many medications can reduce the frequency of migraines. Generally, these need to be taken daily in order to be effective. These medications are less useful and tolerable to patients with infrequent headaches. Medications in this category include:

• Beta-blockers such as propanolol
• Anti-depressants such as amitriptyline
• Anti-convulsants such as valproic acid and topiramate
• Calcium-channel blockers such as verapamil
• Serotonin re-uptake inhibitors such as venlafaxine

STOPPING AN ATTACK

Other medications are taken when there is the first sign of an impending migraine attack. In the case of migraine with aura, this is typically when the visual disturbances are first noted. These medications can effectively stop the migraine in its tracks, preventing the progression to other migraine symptoms or reducing the severity of the attack.

Many of these medications cause constriction of blood vessels and cannot be given to patients at risk of heart attack or other conditions. These medications include:

• Ergots such as DHE-45
• Serotonin agonists / triptans such as sumatriptan
• Isometheptene

These medications come in various preparations to enable administration via different routes. For example, patients who have vomiting and cannot keep pills down may benefit from a nasal spray or injection.

Call for an appointment with your health care provider if you are taking an ergotamine-containing medication and you are likely to become pregnant. Such medications can have serious side effects to an unborn baby.

TREATING SYMPTOMS

Other medications are primarily given to treat the symptoms of migraine. Used alone or in combinations, these drugs can minimize pain, nausea, or emotional distress caused by the migraine. Some of these medications may also have some effect on the underlying process in addition to providing symptomatic relief. Medications in this group include:

• Anti-emetics such as prochlorperazine
• Sedatives such as butalbital ( Generic Fioricet, Fioricet brand )
• Non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen
• Acetaminophen (Tylenol)
• Narcotic pain relievers such as meperidine

angiography-an imaging technique that provides a picture, called an angiogram, of blood vessels.

aura-a symptom of classic migraine headache in which the patient sees flashing lights or zigzag lines, or may temporarily lose vision

basilar artery migraine-migraine, occurring primarily in young women and often associated with the menstrual cycle, that involves a disturbance of a major brain artery. Symptoms include vertigo, double vision, and poor muscular coordination.

benign exertional headache-headache brought on by running, lifting, coughing, sneezing, or bending.

biofeedback-a technique in which patients are trained to gain some voluntary control over certain physiological conditions, such as blood pressure and muscle tension, to promote relaxation. Thermal biofeedback helps patients consciously raise hand temperature, which can sometimes reduce the number and intensity of migraines.

cluster headaches-intensely painful headaches-occurring suddenly and lasting between 30 and 45 minutes-named for their repeated occurrence in groups or clusters. They begin as minor pain around one eye and eventually spread to that side of the face.

computer tomography (CT)-an imaging technique that uses X-rays and computer analysis to provide a picture of body tissues and structures.

dihydroergotamine-a drug that is given by injection to treat cluster headaches. It is a form of the antimigraine drug ergotamine tartrate.

electroencephalogram (EEG)-a technique for recording electrical activity in the brain.

electromyography (EMG)-a special recording technique that detects electric activity in muscle. Patients are sometimes offered a type of biofeedback called EMG training, in which they learn to control muscle tension in the face, neck, and shoulders.

endorphins-naturally occurring painkilling chemicals. Some scientists theorize that people who suffer from severe headache have lower levels of endorphins than people who are generally pain free.

ergotamine tartrate-a drug that is used to control the painful dilation stage of migraine.

hemiplegic migraine-a type of migraine causing temporary paralysis on one side of the body (hemiplegia)

inflammatory headache-a headache that is a symptom of another disorder, such as sinus infection, and is treated by curing the underlying problem.

magnetic resonance imaging (MRI)-an imaging technique that uses radio waves, magnetic fields, and computer analysis to provide a picture of body tissues and structures.

migraine-a vascular headache believed to be caused by blood flow changes and certain chemical changes in the brain leading to a cascade of events - including constriction of arteries supplying blood to the brain and the release of certain brain chemicals - that result in severe head pain, stomach upset, and visual disturbances.

muscle-contraction headaches-headaches caused primarily by sustained muscle tension or, possibly, by restricted blood flow to the brain. Two forms of muscle-contraction headache are tension headache, induced by stress, and chronic muscle-contraction headache, which can last for extended periods, involves steady pain, and is usually felt on both sides of the head.