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Migraine Headache

What is a migraine headache?
A migraine headache is a special kind of headache that can last for hours to days. It can cause intense pain as well as other symptoms, such as feeling sick to your stomach or having changes in your vision.

How does it occur?
The exact cause of migraines is not known. Migraines may be related to a problem with the blood flow in your brain or they may happen when brain chemicals don't stay balanced. Migraine headaches tend to run in families and often are triggered by specific things. Common migraine triggers include:

  • stress
  • tiredness
  • changes in the weather
  • certain foods, such as wine, cheese, or chocolate
  • MSG or food preservatives, such as nitrates red wine
  • bright lights

Migraines tend to run in families. They affect women 3 times more often than men. They often occur during, or right before, a woman's menstrual period. Or they may happen when a woman is taking hormone pills.

What are the symptoms?
Before a migraine starts, there is often a warning period when you don't feel well. Some people lose part of their vision or see bright spots or zigzag patterns in front of their eyes. These symptoms, which may precede and predict a migraine headache, are called migraine aura. The vision changes of the aura usually go away as the headache begins. Many people with migraines do not have the visual symptoms.

Migraine symptoms may include:

  • throbbing or pounding headache
  • extreme sensitivity to light and noise
  • nausea and vomiting

The pain is usually more severe on one side of the head but can affect the whole head.

Sometimes a migraine can cause symptoms such as numbness or even weakness. However, these can also be symptoms of a stroke. If you have these other symptoms along with problems with your vision, do not assume a migraine is the cause. Call your health care provider right away.

How is it diagnosed?
Your health care provider will ask about your symptoms and medical history and examine you. There are no lab tests or X-rays for diagnosing migraine headaches. However, your provider may order an imaging study of the brain to rule out problems in the brain that can cause other types of headaches.

A careful history of your headaches is very helpful. Your health care provider may ask you to keep a headache diary in which you record the following:

  • date and time of each attack
  • how long the headache lasted
  • type of pain (for example, dull, sharp, throbbing, or a feeling of pressure)
  • location of pain
  • any symptoms before the headache began
  • foods and drinks you had before the headache began (This should include checking the ingredients in the product ingredient list of packaged foods you have eaten.)
  • use of cigarettes, caffeine, alcohol, or carbonated drinks before the headache began
  • time you went to bed and time you got up before the headache began
  • if you are a woman, your menstrual periods and use of birth control pills or other female hormones

Depending on your headache symptoms, your provider may recommend tests to check for other, more serious causes of your symptoms. For example, you may have a brain scan or magnetic resonance imaging (MRI).

How is it treated?
Your health care provider may prescribe medicine that you can take as soon as you start having symptoms of a migraine. The medicine will help keep headaches from becoming severe once they start. Medicines most often used for this purpose are:

  • A group of drugs called triptans available as tablets (including some that may be taken without water), a shot, and a nasal spray. Examples of triptans are almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan.
  • Ergot medicines such as ergotamine, dihydroergotamine, ergonovine, and methysergide. Some of these medicines are shots your provider can give you, or you may learn how to give them to yourself.

It's best to take these medicines as soon as possible after a headache begins. This means you need to recognize the warning symptoms.

You may need to take other medicine every day to prevent severe and frequent headaches. Examples of drugs your provider may prescribe for this purpose are propranolol, verapamil, and antidepressants. You may not know if the medicine works for you until you have tried it for several weeks.

How long will the effects last?
The headache may last from a few hours to a few days. You may tend to get migraines for the rest of your life. However, many people find that they have migraines less often as they get older.

How can I take care of myself?
When a migraine begins:

  • As soon as possible after headache symptoms begin, take the medicine recommended or prescribed by your health care provider.
  • Rest in a quiet, dark room until the symptoms are gone. Putting a cool, moist washcloth on your forehead might help.

Don't drive a car while you are having a migraine headache.

If your symptoms don't get better when you take medicine, make another appointment with your health care provider. It may take several visits to find the best way to control your headaches. Also, if you are having headaches more often, make a follow-up appointment with your provider to see if you need more testing or preventive medicine.

Call your health care provider right away if: You have symptoms that are not usually part of your migraines, such as:

  • trouble talking or slurred speech
  • arm or leg weakness

You have other symptoms such as:

  • fever
  • stiff neck
  • repeated vomiting for several hours
  • inability to move a body part (paralysis)

You are pregnant and your headache is particularly bad or it seems different from your usual migraines, particularly in the last half of pregnancy. This is especially important if you have problems with your vision such as flashing lights, difficulty focusing or blurriness, any nausea or vomiting, or weakness in any part of your body. These may be signs of a developing pregnancy problem that needs immediate attention.

How can I help prevent migraine headaches?
Prevention is an important part of treatment. To help prevent migraine headaches: You may need to take medicine prescribed by your health care provider. You may need to avoid certain foods or activities suggested by your headache diary as possible triggers of headaches. Avoid foods from the following list if eating them seems to cause your headaches:

  • wine, ale, and beer
  • aged and processed cheese
  • aged, canned, cured, and processed meats
  • breads made with yeast and yeast extracts
  • foods containing cheese, chocolate, or nuts

Ask your provider about avoiding medicines that may trigger headaches.

  • If you are taking birth control pills or other female hormones, ask your provider if you should stop taking them.
  • Avoid smoking.
  • Eat regular, healthy meals. Don't go too long without eating.
  • Get regular rest and exercise.
  • Try to reduce stress. Relaxation exercises and biofeedback may help you manage stress.