About 28 million Americans, approximately 12% of the population, suffer migraine headaches. A migraine headache is not the same thing as a tension headache, rather they are mild to severe bout of pain accompanied by other symptoms including nausea, distortions in vision, sensitivity to light and other afflictions. A migraine attack can last from four hours to three days, is most common in the 20 to 40 year old population and about three times more common in women than men.
Migraines are typically felt on one side of your head.
Moderate to severe throbbing pain.
Nausea, with or without vomiting.
Sensitivity to light, noise, or odors
Visual disturbances called “aura”, see below.
Frequent attacks, typically one to three a month.
Loss of appetite
Sensations of being very warm or cold
Identify migraine with aura. Also known as the classic migraine, a migraine with aura, which occurs in 10% to 30% of all migraine headaches, includes visual disturbances such as blurred vision, wavy lines, and patterns. Other symptoms of this migraine can include sensory disturbances, partial paralysis, and disorientation. The Aura typically develops 15 to 20 minutes before a migraine headache begins.
Nobody really knows what causes migraines, but current research suggests migraines may be caused by functional changes in the trigeminal nerve system, a major pain pathway in your nervous system, and by imbalances in brain chemicals, including serotonin, which regulates pain messages going through this pathway. What they know for sure is that causes and treatment are variable for each individual, which is why your neurologist will want to know as much about your history and symptoms as possible. There are two factors that are common in many migraine patients:<P>
Hereditary. Migraine headaches have a tend to run in families, 4 out of 5 people who suffer from migraine headaches have a family history. Statistically, if either of your parents has a history of migraine headaches, you'll have a 50% chance of developing migraine; if both of your parents have a history of migraine, your risk jumps to 75%.
Triggers. Researchers believe that people who suffer from migraine are hypersensitive to certain types of migraine "triggers". A migraine trigger can be a particular food, an environmental condition, or a hormonal factor.
While just about anything can trigger migraines, here is a list of the more frequently reported migraine triggers:<P>
Food Migraine Triggers
Sodium-nitrite-laden meat (hot dogs, deli meats, etc.)
MSG (monosodium glutamate) (see migraine glossary) (food additive found in some processed meats, soups, salad dressings, etc.)
Aspartame (artificial sweetener)
Tyramine (chemical found in aged cheese)
Caffeine (chemical found in coffee, tea, soda, chocolate, etc.)
If you suspect you suffer from migraine headaches, or are beginning to suffer from them, it is important to consult a qualified health care professional to rule out more serious conditions (like brain tumors) and develop a treatment program. You will want to visit a neurologist, a doctor who specializes in the brain. Your primary care physician can refer you to a specialist after making a diagnosis.
Understand that whatever treatment options you and your neurologist agree on they will fall into three broad categories: trigger avoidance, prevention, and pain management.<P>
Trigger avoidance. Identifying and avoiding any possible triggers is the first step in treating a migraine. Simply a process of trial and error, if you find the right trigger for you, you are very lucky. In addition most migraine sufferers begin treatment with readily available over the counter pain relievers including ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve) or aspirin. With most migraines however, these treatments will have little or no effect.
Migraine prophylaxis (prevention medicine). In this part of the treatment program medicines and other techniques are used to try to stop a migraine before it starts.
Acute migraine pain relief therapy. Here, the approach uses powerful pain relievers to try and attack the pain of a migraine while it is there. In recent years, great strides have been made in this area, particularly in the development of a new class of drugs know as Triptans.
Trigger avoidance and self-medication
Patients often attempt to identify and avoid triggers that promote or precipitate migraine episodes. Many begin with the basics like:<P>
Cutting back or eliminating drinking alcohol and smoking.
Getting enough regular sleep, but not too much.
Regular, healthy meals.
Moderation in caffeine intake.
OTC (over the counter) pain relief drugs are often used in combination with caffeine. Caffeine is recognized by the U.S. FDA as an OTC treatment for migraine, and often the first thing tried by doctors. In addition to pain reliever some patients have had encouraging results with OTC antihistamines and anti-nausea agents. Excedrin is an example of an aspirin with caffeine product.
Visualization, biofeedback and self-hypnosis are also alternative treatments and prevention approaches.
Bruxism or the clenching or grinding of teeth, especially at night, is a trigger for many migraineurs. A device called a nociceptive trigeminal inhibitor (NTI) can be fitted by dentists and clips over the front teeth at night, preventing contact between the back teeth. It has a success rate similar to butterbur and co-enzyme Q10, although it has not been subjected to the same rigorous testing as the supplements. Massage therapy of the jaw area can also reduce such pain.
Create an ice cream headache to directs cooling to the hypothalamus, which is suspected to be involved with the migraine feedback cycle:<P>
Place a couple of spoonfuls of ice cream on the soft palate at the back of the mouth.
Hold them there with your tongue until they melt or become intolerable.
Many physicians believe that exercise for 15-20 minutes per day is helpful for reducing the frequency of migraines.
Migraine prophylaxis (preventive medicines)
Preventive medication, taken under the supervision of a neurologist, is often taken daily for a few weeks before it can be determined if it has a preventative effect. The sheer number of different medications, combined with the fact that every migraine case in is many ways unique, means that finding the right combination of medicines for migraine prevention can take a while. The most effective prescription medications include several drug classes:<P>
Beta blockers like propranolol and atenolol.
Anticonvulsants such as valproic acid and topiramate.
Antidepressants including tricyclic antidepressants (TCAs) such as amitriptyline and the newer selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) have proven effective in many cases.
Sansert was withdrawn from the US market, but is still available in Canadian pharmacies. Although highly effective, it has rare but serious side effects, including retroperitoneal fibrosis.
Namenda, memantine HCI tablets are used in the treatment of Alzheimer's Disease. Some Doctors are beginning to investigate the effect of these drugs on migraine sufferers. Namenda has not yet been approved by the FDA for the treatment of migraines.
Acute migraine pain relief therapies
In recent years new classes of powerful drugs have been developed to treat migraine pain while it is present.
Serotonin Agonists also known as Triptans, are a new class of drugs that are effective in treating migraine pain while it is happening. 70-80% of patients taking triptans report a reduction of symptoms or an aborted attack within 30 to 90 minutes. Triptans have few side effects if used in correct dosages and frequency. These drugs have been available only by prescription (US, Canada and UK), but sumatriptan became available over-the-counter in the U.K in June, 2006 and others are due to follow in the coming years.
Ergot alkaloids. Until the introduction of sumatriptan in 1991, ergot derivatives were the primary drugs available to abort a migraine once there. These drugs can be used to avoid migraines, but like Triptans they are very expensive, and have side-effects, and so are used as pain rescue drugs for the most part. Ergot drugs come in tablets, suppositories, tablets or pills and injections. They are hard to obtain in the USA but commonly used in Asia. Often these medicines are accompanied by caffeine which often makes them unsuitable for nighttime use, or patients experiencing sleeping difficulties.
Fioricet or Fiorinal are a cocktail of butalbital (a barbiturate), acetaminophen (in fioricet) or acetylsalicylic acid (more commonly known as aspirin and present in fiorinal), and caffeine. While the risk of addiction is low, butalbital can be habit-forming if used daily, and it can also lead to rebound headaches. Barbiturate-containing medications are not available in many European countries.
Narcotic pain killers including codeine, morphine or other opiates provide variable relief, but their side effects, the possibility of causing rebound headaches or analgesic overuse headache, and the risk of addiction contraindicates their general use.
Amidrine (a cocktail of a pain reliever, a sedative, and a vasoconstrictor) is sometimes prescribed for migraine headaches.
Anti-emetics by suppository or injection may be needed in cases where vomiting dominates the symptoms. The earlier these drugs are taken in the attack, the better their effect.
Prednisone tablets, an adrenal hormone and a non-anabolic steroid, stimulates the creation of proteins from your DNA that include enzymes that cure migraines through various metabolic boosts. Due to the intensity of side effects (bone loss, osteoporosis) and other risks with these medicines they are usually reserved for "Status migraines" an extremely rare but life-threatening condition
For many years conventional approaches to migraine relief offered little hope for many patients. Given that, and the fact that the first migraine was reported over 9000 years ago, a wide range of alternative therapies have developed over the years. These treatments, much like their governmentally regulated cousins are effective for some, but not for others. Alternative migraine therapies include:<P>
Acupuncture and acupressure are the treatment of choice for many, although no tests have shown these treatments will help, migraines are a type of vascular headache, so your results may vary. Usually acupuncture is considered a preventive treatment particularly, not a way to treat the actual pain as acupuncture deals in slow restabalizing of the body. To subdue pain with acupressure:<P>
Use the thumb and index finger and apply pressure to the depression at the base of the occiput 1 inch lateral to the spine.
Incense and scents help in some cases, especially peppermint and lavender. Nobody knows why, but it has been proven.
Magnesium supplements can reduce the frequency of migraine headaches. To use Epsom salts to help migraines:<P>
Place a heaped teaspoonful of Epsom salts in the palm of one hand as soon as the first signs of a migraine begin.
Have some water ready in a glass in the other hand.
Toss the Epsom salts into the mouth with one hand and then with the other hand drink some water to wash it down.
If tossing the Epsom salt and washing it down is done in quick succession one will experience nothing of the extreme bitterness of the Epsom salt.
Darken the room and lie down for an hour or so.
Riboflavin (vitamin B2), co-enzyme Q10 and butterbur extract have been subjected to double-blind studies that suggest they have a positive effect on migraine pain.
Coenzyme Q10 has been found to have a beneficial effect in a well-controlled trial.
Feverfew (Tanacetum parthenium) is a traditional herbal remedy believed to reduce the frequency of migraine attacks.
Kudzu root (Pueraria lobata) has been demonstrated to help with menstrual migraine headaches.
Ice applied directly to the throbbing area of the temple is a very simple and effective remedy. Migraines are caused by the dilation of blood vessels and the coldness will constrict them.
In most cases, if you drink caffeine (coffee, soda, ect.) it will help your migraine.
Carry a small sachet of Epsom salts with you wherever you go.
Take a little Epsom salt before eating butter or cream or whatever triggers a migraine attack.
Avoid the bright sun especially at mid morning.
Massaging the back portion of the neck is very helpful as it allows more blood to flow into the head. In combination with Epsom salts, it helps to stop a migraine in its track.
Listening to light music is also very helpful.
If your migraine comes with nausea w/ vomiting. Sometimes it helps not to hold it back. Vomiting actually sometimes helps relieve some of your migraine pain.
If the migraine was not arrested at the very beginning, double the dosage of Epsom salts.
Take a fresh bay leaf, crush it in your fingers, hold it up to your nose, breathe in deep, wait, breathe in deep, wait, repeat this until you feel a sharp, cool pain in your sinuses. Stop. You'll feel as though you have to sneeze, but won't. This should make the migraine go away.
Get away from electronic screens, light (especially fluorescent), and noise. Take a nap. Then eat something if your blood sugar feels low.
Light physical activity (tidying, walking) therapeutic during a migraine attack. One wants to lie down and remain stationary, but ironically, light activity seems more beneficial.
Heat applied to the center of pain, rather than cold, can be very therapeutic and ease the pain. Both of these factors suggest that in some migraines, an increase in circulation helps.
Epsom salt is taken orally as a laxative and acts as an osmotic.
Do not give aspirin to children under 16 because of the risk of Reye's syndrome.
Taking a triptan while also taking an SSRI or SNRI can produce a dangerous condition known as serotonin syndrome.