Migraine Headaches

A migraine is one of the most severe types of headache you can have. It is classified as a vascular (blood vessel-related) headache which can occur at any age and affects about one in 10 people. Generally they affect women more then men and often run in families.

Migraines typically strike during hormonal changes like throughout adolescence though you can have them unpredictably at any time. Women find that the attacks are worse around menstruation and they lessen in frequency and intensity during pregnancy and post-menopause.

Types of Migraines

Common migraine: This is the typical migraine. It consists of throbbing pain on one side of the head around the temples or behind one eye. You may become nauseated or even vomit and it can last anywhere from six hours to three days. Noise movement and bright light generally make the pain worse.

Classic migraine: This one is less common but better recognized; it is similar to a common migraine except before the headache you experience a strange symptom called an aura. An aura can take various forms – it can be vague uneasiness or anxiety nausea dizziness or numbness or tingling in the limbs. Most auras are visual and can be seen with your eyes open or closed. The aura may consist of bright or dark spots and zigzag patterns of pulsating lights. In a more frightening case a portion of your vision may disappear for a few minutes. Visual auras often last up to 20-30 minutes and are believed to be caused by sudden spasms of blood vessels in the brain.

Cluster headache (sometimes called Horton’s or a “histamine” headache): This type recurs several times over a few weeks or months sometimes starting at the same time of the day or night followed by long periods of freedom. It tends to cause a stabbing pain in or around one eye which can be severe enough to awaken you from sleep. It typically lasts for about an hour but can go on for as long as several days. A runny nose on one side a red eye and sometimes a drooping eyelid may accompany this headache.

Ophthalmic migraine: In this type the affected blood vessels are those providing circulation to the eye. Symptoms can include a temporary loss of vision and intense visual auras. These symptoms usually resolve spontaneously after several minutes and hardly ever last more than one hour. This type of migraine is not usually associated with a headache.

Ophthalmoplegic migraine: This migraine is a very rare form of headache that develops during childhood. It is felt near the eye and is often connected with weakness of the muscles around the eye. A person who has ophthalmoplegic migraine has specific symptoms involving the eyes. These symptoms may differ from person to person but most likely include double vision droopy eyelid (ptosis) eye paralysis and most notably severe headache pain.

What Causes A Migraine Headache?

The cycle begins with the tightening and narrowing of arterial blood vessels in your brain. Sometimes this produces an aura sometimes not. After about 20-30 minutes the constricted vessels begin to dilate and stretch creating an increase in blood flow. This is when the throbbing headache begins (many people especially post-menopausal women experience only the aura and no headache).

The exact cause of what starts the cycle of vascular spasm/dilation is not known but research has found a possible link to levels of a neurotransmitter called serotonin. Low levels of serotonin are normally associated with erratic emotions and mood but are thought to possibly have an activating effect on some forms of migraine.

Possible external triggers for migraine include

• tension
• stress
• fatigue
• loud noises
• glaring lights
• certain drugs
• alcohol
• caffeine
• and estrogen hormones such as in oral contraceptives and hormone replacement therapy.

A wide variety of foods and additives can provoke migraines in some people:

• citrus fruit
• chocolate
• red wine
• aged cheese
• smoked meat
• and products containing nitrates tyramine or monosodium glutamate (MSG).

Other triggers can be cigarette smoke strong odors sudden cold or even a drop in atmospheric pressure – as in high altitudes inside an airplane or near an approaching storm.

Examination

If you think your headaches are migraines chances are that you are correct. The symptoms are often so recognizable – and often so unmistakeably painful – that a diagnosis can be made from your history alone.

You should have an eye exam a general physical exam and possibly a neurological exam if you experience:

• a typical symptoms other than those described above your first migraine after age 40
• auras with no subsequent headache even a temporary loss of vision

Having the three exams makes sure you do not have a disease that causes symptoms that mimic those of migraine. These include vascular disease that produces high blood pressure certain neurological diseases and a type of glaucoma known as Angle-closure glaucoma.

An eye exam includes evaluation of your vision pupils eye movement retina and optic nerve. You may also have a visual field test to measure peripheral (side) vision and tonometry to check the pressure inside your eyes. All of these tests are painless.

Treatment

First think of prevention. Try to identify what might be triggering your attacks by keeping a log of when your headaches occur. Eliminate the possible triggers systematically. If you are taking any hormones including birth control pills the medication or its dosage may need to be changed. Women who have migraines and use birth control pills or other estrogens may have a slightly increased risk of having a stroke. In this case check with your general physician.

Once the headache begins a quiet darkened room will help you feel better. You may be able to decrease the pain severity by reducing blood flow to your head. Any of the following may help:

• Apply cold compresses to your head and neck
• Press your palms firmly against your temples
• Put your hand in hot (not burning) water
• Take a hot
• Lie down with your head higher then the rest of the body

Mild pain relievers such as aspirin acetaminophen (Tylenol) or ibuprofen (Advil) are worth a try. At least they may help you get to sleep which often works to relieve the pain.

There are new prescription medications that may help. Some are taken at the first sign of an attack. Taken early enough these can abort the attack or at least lessen the severity of the headache. Others taken regularly for several months may reduce the frequency of attacks. The effects of any medication will need to be carefully monitored.

Migraine headaches can be incapacitating but they rarely indicate a serious disease or cause any permanent damage. The more you understand about migraines and your own personal triggers the more likely you are to win the battle against them.