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The Basics
- What is a migraine?
- What causes migraines?
- What are the different types of migraines?
- Migraines and women: the statistics
- How do migraines affect women differently?
Ask Your Healthcare Provider
Empower Yourself
References
Migraines
Discuss all medical advice, diagnosis, and treatment with your healthcare provider.
Migraines Resources
The Basics
What is a migraine headache?
A migraine headache is a severe pain on either one or both sides of the head although it is commonly localized to one side. The pain is usually toward the front of the head, near the temples, or behind one eye or ear. It can also occur in the face, sinus, jaw, or neck areas. Migraines can sometimes cause nausea and vomiting as well as pain. When people suffer from a migraine, they are usually very sensitive to light and sound. Migraines usually start in the mornings, and can last from a few hours to 1 or 2 days. Any activity that involves touching the head, like combing the hair or shaving, can exacerbate migraine pain.
Symptoms
- Pain typically on one side of the head
- Pain has a pulsating or throbbing quality
- Moderate-to-intense pain affecting daily activities
- Nausea or vomiting
- Sensitivity to light or sound
- Attacks lasting 4 to 72 hours, sometimes longer
- Visual disturbances or aura
- Exertion, such as climbing stairs, can make headaches worse
Some people can sense that a migraine headache is coming on because of a visual disturbance that precedes it. These visual disturbances can appear as flashing lights, zig-zag lines, or temporary loss of vision. People with migraine headaches often experience recurring attacks that are triggered by various factors.
Triggers:
- Lack of food or sleep
- Exposure to light
- Loud noises
- Hormonal irregularities (in women)
- Stress
- Anxiety
- Depression
- Weather changes
- Chocolate, alcohol, or nicotine
- Certain foods or additives, such as MSG (momosodium glutanate or nitrates)
Additionally, migraines have been linked to a serotonin chemical in the brain. When the levels of serotonin fluctuate, normal brain function is disturbed, and thus can either cause or relieve migraines.
What causes migraine headaches?
There are several theories about the causes of migraine headaches.
The blood flow theory says that the pain of migraine is caused by the blood vessel activity in the brain. Blood vessels either narrow or expand. When they are narrowing, the blood flow in the body is constricted, which results in vision problems or dizziness. When the blood vessels expand, they press up against nearby nerves, causing pain.
Another theory focuses on chemical changes in the brain. Brain cells trigger a nerve, called the trigeminal nerve, to release chemicals. These chemicals cause swelling of blood vessels on the surface of the brain. These swollen, irritated blood vessels send pain signals to the brainstem, where the brain processes these signals. When chemicals that send messages between the cells are interrupted, migraines can also occur.
Genetics has also been theorized to have a role in the development of migraines. People who suffer from migraines may have inherited abnormal genes that control the function of certain cells in the brain.
The actual triggers that cause migraines to arise vary from person to person.
What are the different types of migraines?
Migraine headaches can be classified into three different groups
1. Migraine with aura: Occurs after a person experiences visual symptoms, also known as aura. The aura will occur 10 to 30 minutes before the onset of migraine symptoms. The visual symptoms include seeing flashing lights, zigzag lines, blind spots, or losing vision entirely for a short time.
The aura that precedes a migraine may also make the person hear strange things as well as disrupt the senses of smell, taste, or touch. Men experience these migraines more often than women.
2. Migraine without aura: With this kind of migraine, there are no preceding symptoms, or aura. The migraine occurs suddenly, but any of the usual migraine symptoms may be present.
3. Migraine variants: Migraine headaches associated with other symptoms such as prolonged muscle weakness, prolonged sensory and visual disturbance. These migraine variants occur rarely compared with migraine with and without aura. Prolonged symptoms such as muscle weakness may last for the entire headache, for several days or weeks, or can sometimes cause permanent disability. These migraines are given particular names such as hemiplegic migraine, basilar migraine and migrainous infarction, depending on other associated symptoms. Migrainous infraction is a migraine associated with stroke-like symptoms and can lead to serious disability.
Migraine and Common Comorbidities
For many patients, migraines associated with other illnesses, are known as migraine comorbidities. A comorbidity is an illness occurring with another illness more commonly than by coincidence. This suggests that, at some level, the two illnesses are interrelated, however, research is currently underway to learn more about how and why these illnesses are concurrent.
Common migraine comorbidities include
When a comorbid condition is diagnosed along with migraine, treatment becomes more complex because there are two separate conditions to manage, and both conditions may be interrelated. For example, if someone is struggling with a bout of depression, they may find their migraine attacks become worse. If depression improves, they may find that their migraine also improves. For this reason, migraine and potential comorbid conditions need to be accurately diagnosed and treatment should be considered with the benefit of both conditions in mind. More about this will be discussed in the section on treatment below.
Migraines and women: the statistics
- More than 29.5 million Americans suffer from migraine headaches.
- Three out of four migraine sufferers are women.
- Most people who suffer from migraine headaches are between the ages of 15 and 55.
- The most common ages for women to experience migraine headaches is between 35 and 45.
- Seventy to 80% of migraine sufferers have a history of migraine in their family.
- Less than half of migraine sufferers have received a diagnosis of migraine from their healthcare providers.
- About one fifth of migraine sufferers experience the aura.
- Over half of women with migraine headaches report experiencing migraines right before, during, or after their periods.
How do migraine headaches affect women differently?
Women are more likely than men to be affected by migraine headache. Among children with migraine, both genders are evenly affected. However, in girls, once menstruation begins and hormones levels change, they become much more susceptible to this condition.
Menstruation
Many female migraine sufferers experience their migraines associated with their menstrual periods. Some women experience migraine headaches exclusively around the time of their period (called menstrual migraines) and others experience it around this time as well as at other times during the month (called menstrually associated migraine).
Though this connection with the menstrual cycle is not completely clear, it is thought that the sharp decline in estrogen and progesterone levels at the time of menstruation may trigger migraine symptoms.
Birth control
For some women, birth control pills or oral contraceptive pills may be a migraine trigger. Their migraine will usually occur during the last week of the cycle, when the pills do not contain estrogen, but are sugar pills to remind women to take pills daily. However, without the daily hormones, there can be a fall in estrogen levels in the body. Switching to pills that allow you to take active pills every day, and which do not include sugar pills, may help prevent migraines in this case.
You should not take the combined contraceptive pill (estrogen and progestin containing pill) if you have a history of migraines with aura or if you develop migraines with aura while you are on the Pill, because it may increase your risk of developing a stroke. If you have migraines without aura, you should avoid taking the oral contraceptive pill if you have any risk factors for developing stroke, such as being over the age of 35 years, diabetes, smoking, high blood pressure, or having high cholesterol levels.
Pregnancy
A correlation between migraines and hormones suggests that pregnancy will affect your migraine patterns. You may find that your symptoms lessen or worsen during pregnancy. There is no danger to the fetus from your experiencing migraine headaches, however, if your headaches are accompanied by a fever, if you are experiencing blurred vision, if the headaches last longer than a few hours, or if the headache returns frequently, you should contact your healthcare professional immediately.
It is important to talk with your healthcare professional about treatment options because many medicines commonly used to treat migraines may cause birth defects and other problems. Aspirin, for example, may increase the risk of bleeding for both you and your baby.
Motherhood
If you are breastfeeding, talk to your healthcare professional about what medications are safe to use for migraine treatment. Some medications can be passed through breast milk and be harmful to your baby who may experience his or her first migraine headache in childhood. The frequency of these headaches increases as your child approaches and goes through adolescence. Do not give aspirin to children under the age of 20, as it can cause Reye's syndrome, a rare problem that causes severe vomiting and fever.
Menopause
If migraines seem to be linked to your menstrual cycle, they may become less severe after menopause. However, for some women, symptoms may worsen, or menopause itself may exacerbate migraines. This may be caused by hormone therapy used by many postmenopausal women.
Ask Your Healthcare Provider
Diagnosis and talking with your healthcare provider
If you are suffering from headaches, which you think may be migraines, you should make an appointment to see your healthcare professional. Frequent headaches should be assessed carefully by a clinician for the following reasons:
- The true cause of your headache needs to be determined.
There are actually many causes of headache and some of these can be serious medical conditions such as infections, internal bleeding, and tumors. In rare cases migraine can be associated with prolonged muscle and/or sensory deficit similar to a stroke. Your clinician will have the expertise to differentiate headaches and will be able to guide you towards the correct diagnosis and subsequently the correct treatment. Some features you may have that may indicate a serious cause for your headaches include- Headache onset after age 40 to 50 years
- History of seizures or epilepsy
- Headache occurring after trauma to the head e.g. a fall, or any severe knock to the head
- Fever or altered level of consciousness
- Headaches progressing in frequency and severity
- Headache that's wakes you up from sleep
- If your headaches are provoked by factors such as cough
- Having muscle and joint aches and pains
- Persistent and progressive vomiting
- Nervous system abnormalities such as visual disturbance, arm or leg weakness, clumsiness, or loss of balance
- Headaches made worse by bright lights
- People with migraine often have other comorbidities (see previous section on migraine comorbidities) and you should be screened for these when you present to your healthcare professional.
If you are diagnosed with any of these comorbidities your doctor can advise you on how to treat them. Often treatment for migraines will also depend on existing comorbidities, if any.
- Migraine pain can be severe and quite distressing.
Instead of resorting to frequent use of overÐthe-counter painkillers your healthcare professional will be able to recommend the most effective yet safest for you. Overuse of painkillers can lead to medication overuse headache, or rebound headache.
You can prepare for your appointment with your healthcare professional by keeping a record of the following:- Frequency of headaches
- Location of pain
- Duration of headaches
- When the headaches occur, especially in relation to your menstrual cycle
- Symptoms in addition to pain, such as nausea, vomiting, or vision problems
- Family history of migraine
Treatment
Symptoms of migraine differ from person to person in terms of pain severity, frequency, whether auras are present and, whether migraine comorbidities exist.
Even though your migraine symptoms may be different from the next person's, the feelings of disability and anxiety that come from suffering with this condition will be common to all migraine sufferers. The pain and associated symptoms of migraine can be debilitating, and when pain is severe it's common for migraine sufferers to have to resort to finding a dark and quiet place to lie down. Such measures greatly impact quality of life, disturbing your daily routine and impact your job. There is no cure for migraines but it's important to learn how to manage so that you can maintain your optimal lifestyle and minimize the distress the condition may cause. Managing your migraines is also important help reduce the risk of developing troublesome migraine comorbidities.
Living with the pain of migraines can be a challenging but your attitude to towards your condition will influence how it affects you. It helps to believe that you are in control of the pain and that it doesn't control you. With this attitude or belief system, you are more likely to be open to healthy lifestyles choices that are part of the recommended treatment for migraines. If you are feeling anxious or depressed about your condition, talk to your healthcare professional and to your loved ones and friends. You may benefit from joining a support group where you can talk to other people who may suffer with a similar condition.
Medications can help abort an acute migraine attack (stop the pain of a sudden migraine attack) as well as reduce the frequency and duration of your attacks. In other words there is treatment available to take with the onset of a sudden attack. There is also treatment you can take as a daily preventative regimen so you get fewer migraines if they occur often and disrupt your life significantly. The right medications combined with self-help remedies and changes in lifestyle may make a tremendous difference for you.
There are many medications available for the treatment of migraine and your healthcare professional will be able to advise you on the best option for you.
Migraines treatment that will be recommended to you will depend on the following factors:
- The type of migraine you have e.g. migraine with or without aura, migraine with or without nausea, migraine associated with menstruation or menstrual migraines
- The severity of your symptoms and their frequency
- Your expectations of migraine treatment: the main symptoms of this condition is pain, which is generally a subjective experience, everyone will feel and respond to it differently and your healthcare professional will have to take this into consideration when prescribing your treatment
- Your other medical problems, and if you have any migraine co morbidities
- Your tolerance to medication and how you may have reacted to them in the past
- Your personal preferences and lifestyle
Your health professional will probably have explained to you that there are many theories on what causes migraine and some of these were discussed in an earlier section in this module. At this time, it is not known how to completely prevent developing this condition. It is possible that it may not be completely preventable since it is accepted thinking that migraines are often genetically determined and cure linked to the presence of abnormal genes. Research is underway to learn more about this.
Preventing the development of migraine
At this time, there is no definitive advice that will to prevent you from developing the condition of migraines. Experts simply do not know enough about this condition yet. However, risk factors for developing migraine are useful to keep in mind to minimize your risk for developing the condition.
Know risk factors for developing migraine include a greater likelihood:
- Of developing migraine with aura if one of your first degree relatives suffers it.
- Of having migraine one or both of your parents have.
- If you are young and female. In fact, women are three times as likely to have migraines as men are, particularly after the onset of puberty and menstruation.
- If you use the oral contraceptive pill, even if you have never had migraine before.
- With cyclical hormone changes, which can trigger menstrual migraines.
Accepted Treatment
Here we will discuss the two types of accepted migraine treatments: abortive and preventative.
Abortive treatment
Abortive treatment (also called acute or symptomatic treatment) refers to the use of medications to end or lessen the severity of a headache. This treatment will be prescribed to you if you are having infrequent headaches (for example, fewer than 4 headaches per month).
Nonmedication-based abortive treatment
Medication is a proven way to treat and prevent migraines. However, medication is only one part of migraine treatment. It's also important to take care of yourself and practice lifestyle habits that can reduce the frequency and severity of your migraines. In fact, combining lifestyle measures with medication is often the most effective way to handle migraines.
At the first sign of a migraine, whether it be an aura (a visual disturbances that appears as flashing lights, zig-zag lines, or a temporary loss of vision) or in others it be the onset of pain
- Retreat from your usual activities, and if possible, rest
- Turn off the lights and relax in a dark, quiet room. Sleep if you can. Migraines are often made worse with sensitivity to light and sound.
- Apply hot or cold compresses to your head or neck. Ice packs have a numbing effect, which may dull the sensation of pain. Hot packs and heating pads can relax tense muscles. Warm showers or baths may have a similar effect.
- Apply gentle pressure to painful areas and reduce muscle tension with a shoulder or neck massage.
- Drink a caffeinated beverage. In small amounts, caffeine can enhance the pain-reducing effects of acetaminophen and aspirin. However, sudden cessation from caffeine can lead to withdrawal headaches.
Medication-based abortive treatment
To relieve symptoms during a migraine attack, your healthcare professional may recommend over-the-counter drugs like aspirin, acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. If these drugs fail to appease your symptoms, you may be given a prescription for one of the following:
- Ergotamines: work by narrowing the blood vessels, which helps to alleviate the throbbing pain of migraines.
- Triptans: new drugs that both narrow the blood vessels and balance chemicals in the brain.
- Hormonal treatments: may help women whose migraines are linked to their menstrual cycles.
Abortive treatment is most effective when the migraine medication is taken at the first sign of an attack (for example, the onset of aura, or the onset of pain). In some people migraine attacks are preceded by an aura, which can serve as a reliable warning that a headache is imminent. It is at this time that you should take your abortive migraine medication.
It is essential to use antimigraine medications according to the prescription and a clinician's instructions. Overuse of these medications, including over-the-counter drugs such as acetaminophen or NSAIDs, can lead to medication-overuse headaches (also called rebound headaches) and to a pattern of daily headaches that require increasing quantities of medications for relief. A vicious cycle occurs when frequent headaches lead to frequent and sustained medication use, which in turn cause rebound headaches as the medication wears off, leading to chronic medication use.
Speak with a healthcare professional if a treatment is not adequately relieving your migraines, or if it is causing unpleasant side effects. Switching to another drug or switching from abortive treatment to preventive treatment may be helpful.
General pain medications
Here are the main types of general pain medications used for migraines:
- Acetaminophen (Acephen, Tylenol Extra Strength, Tylenol)
- Aspirin (Ascriptin , Aspercin , Aspergum , Aspirtab)
- Acetaminophen, aspirin, and caffeine (Excedrin)
- NSAID (Ibuprofen, for example, Motrin, Advil; Indomethacin, for example, Indocin IV, Indocin; Naproxen, for example, Naprosyn, Aleve; Diclofenac. for example, Cataflam, Solaraze, Voltaren-XR, Voltaren)
These medications can be used to treat pain caused by many different conditions not just migraine. They are called general pain medications because they are available over-the-counter and without a prescription. Pain medications are also available in combination with caffeine, which enhances their antimigraine effect.
These pain medications are often recommended first for mild-to-moderate migraine attacks. Generally, they should not be used more than once or twice a week, because overuse can lead to side effects and medication-overuse headaches. If you experience side effects such as nausea, abdominal discomfort, vomiting or heart burn while taking these medications, then you should see your healthcare professional. If you are finding that your headaches are getting worse despite using these medications, your healthcare professional will suggest preventative treatment regimen which will be discussed in the section below.
People with gastritis (inflammation of the stomach), stomach ulcers, kidney disease, and bleeding conditions should not take products containing aspirin or NSAIDs.
When migraine headaches are accompanied by nausea and vomiting, several medications can be given by nonoral routes including injection, rectal suppositories, or intravenous administration. Alternately, some medications for migraine may be given in combination with those that alleviate gastrointestinal symptoms of migraine, called antiemetics. Antiemetics are not usually used alone to treat acute migraine.
If a general pain medication does not effectively control migraines, your healthcare professional will likely recommend a migraine-specific treatment such as triptans or the older type of medication called ergots.
Medication overuse, e.g. certain pain relievers including acetaminophen and aspirin, is common amongst people who suffer severe migraines, and it can lead to rebound headache. Therefore, pain medications for treating acute migraines should be limited to no more than 8 to 10 days per month, and preventive therapies should be used as the mainstay if you have frequent headaches.
Triptans
Triptans relieve migraine pain by blocking the release of certain active chemicals in the brain that are involved in constriction of blood vessels and promotion of pain.
- Sumatriptan (Imitrex) oral, nasal spray and injection
- Zolmitriptan (Zomig) oral and nasal spray
- Naratriptan (Amerge) oral
- Rizatriptan (Maxalt) oral
- Almotriptan (Axert) oral
- Eletriptan (Relpax) oral
- Frovatriptan (Frova) oral
Older adults and people with hypertension, vascular disease (including coronary artery disease), and kidney or liver disease should not take triptans.
Common side effects of the injection include redness around the injection site, chest pressure, flushing, weakness, or drowsiness. These reactions usually occur soon after the injection and resolve within 30 minutes.
The most common side effect of sumatriptan (Imitrex) nasal spray is an unpleasant after taste.
Ergots
Ergotamine (Cafergot, Wigraine)
Dihydroergotamine (Migrainol) nasal spray and injection
They are usually recommended for people with headaches that last a long time more than 48 hours, or that recur frequently. However, ergots are generally prescribed less commonly than other medications for migraine. People with artery disease should not take ergots because they cause coronary artery constriction, reducing blood flow to the heart, which can put you at risk of a heart attack. They also should not be used in people who have migraine with prolonged aura because they may reduce blood flow to the brain.
Side effects of ergots include worsening of migraine-associated nausea, and vomiting, and rebound headaches if this medication is overused.
Similar to the triptans, dihydroergotamine should not be used by people with hypertension or ischemic heart disease and in the elderly.
Antiemetic medications
- Metoclopramide (Reglan) oral and injection
- Chlorpromazine (Thorazine®) oral and injection
- Prochlorperazine (Compazine®) oral and injection
Antiemetics are medications traditionally used to treat nausea and vomiting. The injectable forms can be used in hospital settings to treat migraine whereas the oral forms can be used as an addition treatment to general pain medications for migraines with associated nausea and/or vomiting. For example, NSAIDs can be combined with metoclopramide to decrease nausea and vomiting.
Preventive treatment
Preventive treatment (also called prophylactic treatment) refers to the regular (usually daily) use of medication to reduce the frequency and severity of migraine headaches. Preventive treatment is usually recommended if the headaches are frequent, long lasting, or interfere with your ability to function. You may be a candidate for preventive therapy if you have two or more debilitating migraine attacks a month, if you use pain-relieving medications more than twice a week, if pain-relieving medications aren't helping, or if your migraine signs and symptoms include a prolonged aura or numbness and impaired movement on one side of your body.
Nonmedication-based preventative treatment
- Addressing migraine triggers
One of the most effective ways to prevent your migraine headaches is to learn what triggers them. Triggers increase your risk of having a migraine attack. They do not "cause" migraine, but are thought to activate migraines in people who are sensitive to certain triggers.
Headache triggers will be different for each individual and keeping a migraine diary can help you to determine what triggers your headaches. For instance, when your migraines start, what you were doing at the time, how long they last and what, if anything, provides relief. Eventually you may be able to prevent migraines by changing patterns in your daily life.
A list of some common migraine triggers follows. If you find that any of these trigger your migraines, you can discuss with your healthcare professional strategies to avoid or reduce exposure to them.- Hormonal changes: Fluctuations in the hormone estrogen, particularly dropping estrogen levels in the body seems to trigger migraines in many women. This corresponds to the time immediately before or during their menstrual periods. Some women have a tendency to develop migraines during pregnancy or menopause. Hormonal medications, such as contraceptives and hormone therapy, may also trigger migraines.
- Foods, beverages: Certain foods and beverages can trigger migraines in some people. Those to avoid include alcohol, especially beer and red wine; aged cheeses; chocolate; fermented, pickled, or marinated foods; aspartame; excess use of caffeine; monosodium glutamate and certain seasonings; and many canned and processed foods. Skipping meals or fasting also can trigger migraines.
- Stress: Stress at work or at home and periods of relaxation following intense stress can trigger migraines. At certain times everyone experiences stress in their life, so it's worthwhile discussing stress management strategies with your healthcare professional. Techniques can include relaxation, regular exercise, acupuncture, and counseling. Remember that if you exercise too intensely, especially if you are not used to it, this in itself can trigger migraines.
- Sensory stimuli: Bright lights, sun glare, and strong smells (such as perfumes, paint thinner, and smoke) can trigger migraines.
- Altered sleep pattern: Either being deprived of sleep or getting too much sleep may serve as a trigger for migraine attacks in some people. It is best to establish regular sleep hours and if you are having trouble falling asleep get up and do some activity, then try to sleep again once you feel drowsy.
- Physical factors: Intense physical exertion, including intense exercise, sports, and even sexual activity, may provoke migraines.
- Environmental factors: A change of weather (extreme heat or cold), season, altitude level, barometric pressure, or time zone can trigger migraines.
- Medications: Certain medications such as nitroglycerine and contraceptive pills can trigger migraines.
- Nontraditional therapies
Nontraditional therapies may also be helpful for migraines and are often used in addition to medications.- Acupuncture: With this treatment many thin, disposable needles are inserted into several areas of your skin. Limited research has found acupuncture may be helpful for headache pain, therefore experts do not routinely recommend this treatment.
- Biofeedback: This technique raises the patient's awareness and conscious control of certain physical responses, such as muscle tension.
- Massage: If you have tight muscles in the back of the head, neck, and shoulders, massage may help relieve headache pain.
- Herbs and vitamins: Some evidence indicates that the herbs feverfew and butterbur may prevent or reduce the severity of migraines. Riboflavin (vitamin B-2) and coenzyme Q10 supplements also may prevent migraines.
Medication-based preventative treatment
Medications are recommended to prevent frequent migraine headaches that occur more than four times per month and that significantly interfere with your life. You may also choose to start preventative therapy if abortive treatments cause significant side effects or fail to provide relief.
Preventative treatment may also be prescribed if you have had serious attacks such as hemiplegic migraine; basilar migraine; migraine with prolonged aura; and migrainous infarction, associated with nervous system complications (see section on "What are the different types of migraines?")
Preventive treatment effectively controls migraines in most people, although the benefits of this treatment may not be evident for 3 to 4 weeks. In some cases, both abortive treatment and preventive treatment are necessary to adequately control migraines. The choice of medication should be tailored to each individual, and it is often based upon how well you tolerate the medication as well as whether you have a history of other medical conditions which may include migraine co morbidities such as anxiety, epilepsy, or stroke.
Not all of the following listed medications are FDA approved for migraine, however, we have listed those that are commonly prescribed based on established therapeutic benefits attained in clinical trials.
Beta blockers
Beta blockers are used for treating hypertension and cardiovascular disease, therefore, if you have these conditions as well as migraines, your healthcare professional may wish to prescribe them. Here are some commonly used beta blockers for migraine treatment. Not all of these are FDA approved for migraine prevention, but some health professionals may prescribe there.
- Propranolol (Inderal LA, Inderal, InnoPran XL™) (FDA approved for migraine treatment)
- Timolol (Betimol, Blocadren, Istalol™, Timoptic-XE, Timoptic in OcuDose, Timoptic) (FDA approved for migraine treatment)
- Atenolol (Tenormin) (not FDA approved for migraine treatment)
- Nadolol (Corgard) (not FDA approved for migraine treatment)
- Metoprolol Lopressor, Toprol-XL (not FDA approved for migraine treatment)
Some of the side effects of beta blockers are depression, insomnia, or impotence. More on these medications can be found in the module on cardiovascular disease.
Tricyclic antidepressants
Tricyclic antidepressants are also prescribed for the treatment of depression. Therefore, if you suffer from depression as well as migraines your healthcare professional may recommend this medication for you.
- Amitriptyline (Elavil)
- Nortriptyline (Aventyl, Pamelor)
- Doxepin (Sinequan)
- Protriptyline (Vivactil)
Side effects may include drowsiness, dry mouth, constipation, weight gain, and cardiac arrhythmias.
Antiepileptics
Antiepileptic medications are used to treat epilepsy or seizures. Not all of these medications are FDA approved for migraine treatment, but they may still be prescribed by your healthcare professional.
- Valproate (Depacon, Depakene, Depakote, Depakote ER, Depakote Sprinkle)
Side effects include nausea, weight gain, tremor, hair loss, and hirsutism.
- Topiramate (Topamax)
Side effects of topiramate may include paresthesias (abnormal sensations in the skin such as numbness and tingling), nausea, weight loss, altered sense of taste, memory loss, word-finding difficulty, and dizziness.
- Gabapentin (Neurontin)
Side effects that may occur include dizziness, poor balance, fatigue, diarrhea, nausea and vomiting.
Calcium channel blockers
Calcium channel blockers are widely used for migraine prevention as well as for treating hypertension and cardiovascular disease. Such medications include
- Verapamil (Calan SR; Calan; Covera-HS; Isoptin SR; Verelan PM; Verelan)
- Nifedipine (AdalatCC, Afeditab CR , NifediacCC , Nifedical XL, Procardia XL, Procardia)
- Nimodipine (Nimotop)
Side effects may include nausea, constipation, fluid retention, and low blood pressure.
Angiotensin converting enzyme inhibitors
- Lisinopril (Zestril)
Angiotensin II receptor blockers
- Candesartan (Atacand)
Prevention of menstrual migraines
Menstrual migraine is defined as migraine headache that occurs exclusively around the time that the menstrual period begins. Abortive treatment for menstrual migraine is the same as for any other type of migraine (see section above on abortive treatment).
If abortive therapy is not working well enough to relieve the migraines, preventive strategies for menstrual migraines may be recommended to you. Prevention includes lifestyle modifications and/or medications. Preventive therapies for menstrual migraine can be either nonspecific (those that do not address the hormonal trigger) or specific (hormonal strategies).
Nonspecific preventative treatment usually consists of medication started 1 or 2 days before you expect the onset of your headache and is continued for the entire duration of the headache. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) for example ibuprofen or naproxen and tripans (eg, sumatriptan) can be used in this way.
Specific preventative treatment for menstrual migraine consists of using hormonal treatments such as the oral contraceptive pill to counteract the fall in estrogen that often triggers menstrual migraine. Your healthcare professional can discuss this treatment with you further and explain how to take the hormones. If you suffer migraine with aura you may not be able to take oral contraceptive pills because of the potential increased risk of migrainous infarction.
Emerging therapy
Research into new migraine therapies is underway. Here are some therapies that are currently being researched.
- Botulinum toxin (Botox®)
- Ramelteon (Rozerem™)
- Olanzapine (Zyprexa®)
- Tonabersat (SB-220453)
- Olcegepant (A calcitonin gene-related peptide [CGRP] antagonist known as BIBN 4096BS)
- MK-0974
Frequently asked questions
How does a migraine headache differ from a tension headache?
Although migraine headaches affect millions of people, they are still less common than tension headaches. Tension headaches cause a more steady pain over the entire head rather than throbbing pain in one spot. Tension headaches often feel like a "tight band" sensation around the head. Migraine attacks typically happen once in awhile, but tension headaches can occur as often as every day. While fatigue and stress can bring on both tension and migraine headaches, migraines can be triggered by certain foods, changes in the body's hormone levels, and even changes in the weather.
There are also differences in how these two types of headaches respond to treatment with medicines. While some over-the-counter drugs used to treat tension headaches sometimes help migraine headaches, the drugs specifically used to treat migraine attacks do not usually work for tension headaches.
When should I seek help for my headaches?
Nearly half of the people in the US who have migraine do not get diagnosed and treated. The National Headache Foundation suggests you talk to your healthcare professional about your headaches if you have several headaches per month that last for several hours or days; you have nausea, vomiting, vision, or other sensory problems; or your headaches disrupt your home, work, or school life.
What tests are used to find out if I have migraine?
If you think you get migraine headaches, talk with your doctor. Before your appointment, write down:
- how often you have headaches and where the pain is located
- how long the headaches last
- when the headaches occur, for example, during your menstrual cycle
- other symptoms, such as nausea or blind spots
- any family history of migraine
Are women more prone to migraine headaches?
Yes, migraine headaches are more common in women. In fact, about three out of four migraines sufferers are women. They are most common in women between the ages of 35 and 45; this is often a time that women have more job, family, and social commitments. Women also tend to report higher levels of pain, longer headache time, and more symptoms, such as nausea and vomiting.
Hormones may also trigger migraine. Over half of women with migraines report having them right before, during, or after their period. Others get migraines for the first time when taking birth control pills. And some women start getting migraines when they enter menopause.
How is a woman's menstrual cycle related to migraine?
More than half of women with migraine have more headaches around or during their menstrual cycle. How the menstrual cycle and migraine are linked is still unclear. We know that just before the cycle begins, levels of the female hormones, estrogen and progesterone, go down sharply. This drop in hormones may trigger a migraine because estrogen controls chemicals in the brain that affect a woman's pain sensation.
Can using birth control pills make my migraines worse?
Yes. For these women, migraine headaches seem to occur during the last week of the pill pack when they take sugar pills, or the pills that don't have the active hormones. The last seven pills (if included) in the monthly pack help remind you to take them daily. But these pills do not contain hormones and the fall in hormone levels may trigger migraine in some women.
Talk with your healthcare provider if you think birth control pills cause your migraines or make them worse. Switching to another pill or dose or taking a type of pill that contains all “active” pills in the monthly pack, instead of skipping a week, may help. Lifestyle changes, such as getting regular sleep and eating a healthful diet, can help too. Remember, as well as the oral contraceptive pill, there are other methods of contraception that may not cause you to have migraines, and you should talk to your healthcare professional about this.
Can stress really cause migraines?
Yes, stress is the most common trigger of headache. Events like getting married, moving to a new home, or having a baby are all sources of stress. But studies have found that it is the day-to-day stresses, not these major life changes, that are most linked to headaches. Juggling our many roles, such as being a mother and wife, having a career, and financial pressures, can be daily stressors for women.
Learning to make time for yourself and finding healthy ways to deal with stress are important. Some things you can do to help prevent or reduce stress include:
- eating a healthful diet
- being active (at least 30 minutes most days of the week is best)
- relaxation exercises, eg, meditation
- getting enough sleep
Also, it may be helpful to pinpoint which factors cause stress in your life. You may find that you can even avoid some of these stressors. And for other stressors that you can't control, try to think of things you can do ahead of ti me to help you cope with them.
How long do migraines usually last?
Migraines may last from 4 to 72 hours. They may happen only once or twice a year, or as often as daily. Women are more likely than men to have migraines.
What factors may trigger a migraine?
Certain factors that can trigger migraines in some people include the following:
- Strong or unusual odors, bright lights, or loud noises
- Changes in weather or altitude
- Being tired, stressed, depressed, or letdown after a stressful event
- Changes in sleeping patterns or sleeping time
- Certain foods (see the list below), especially those that contain tyramine, sodium nitrate, or phenylalanin
- Missing meals or fasting
- Menstrual periods, birth control pills, or hormones
- Intense physical activity, including sexual activity
Can nonprescription medicines help relieve the pain?
Yes. Nonprescription medicines can sometimes help migraine pain. They include aspirin, acetaminophen (one brand name: Tylenol), aspirin and caffeine combination (one brand name: Excedrin Migraine), ibuprofen (one brand name: Motrin), naproxen (brand name: Aleve), and ketoprofen (brand name: Orudis KT).
What about prescription medicines?
People with more severe pain may need prescription medicine. Ergotamine (brand name: Ergostat) can be effective alone or combined with other medicines. Dihydroergotamine (brand names: Migranal, DHE 45) is related to ergotamine and can be helpful.
Other prescription medicines for migraines include sumatriptan (brand name: Imitrex), zolmitriptan (brand name: Zomig), naratriptan (brand name: Amerge), rizatriptan (brand name: Maxalt), almotriptan (one brand name: Axert), eletriptan (brand name: Relpax), and frovatriptan (brand name: Frova).
If the pain persists, stronger medicine may be needed, such as a narcotic (brand name: Stadol nasal spray) or medicines that contain a barbiturate. These medicines can be habit-forming and should be used cautiously.
Can medicine help prevent migraines?
Yes. Medicine to prevent migraines may be helpful if your headaches occur more than twice a month or if your headaches make it hard for you to work and function. Examples of medicines presribed to prevent migraines include propranolol (brand name: Inderal), amitriptyline (brand name: Elaveil), divalproex (brand name: Depakote), and topiramate (brand name: Topamax).
What else can I do to prevent migraines?
Try to avoid foods or situations that seem to cause migraines for you. Get plenty of sleep. Try to relax and reduce the stress in your life.
Tips on reducing the pain:
- Lie down in a dark, quiet room.
- Put a cold compress or rag over your forehead.
- Massage your scalp using a lot of pressure.
- Put pressure on your temples.
Empower Yourself
Dealing with migraines
Migraine headaches can be debilitating and disruptive to your life, causing you to miss work and social engagements. They can cause you to hole yourself up in your room and miss out on the things you love. It's important to learn how to manage your migraines so that you can maintain your healthiest lifestyle.
By creating a home treatment plan, you can better cope with your headaches. If you feel a migraine coming on, it may help to lie down in a dark room with a cold pack across your forehead. You can also limit pain by employing stress management techniques like relaxation, meditation, and massage. Keep over-the-counter painkillers at home in case you need them. It will also help to keep a headache diary, which will help you see what treatments work best, as well as what triggers set your headaches off.
If your migraines are gettng worse or more disruptive despite these measures and techniques, talk to your healthcare professional about preventative treatments.
Glossary of migraine headache terms
Abdominal Migraine: A type of migraine that mainly occurs in childhood, characterized by abdominal pain, nausea, vomiting, and sometimes diarrhea, but with little or no headache. Later in life, children with abdominal migraine may develop more typical migraine attacks.
Abortive Treatment: Treatment performed or taken to "abort" or stop a headache after it already begins.
Acetaminophen: An aspirin substitute. Like aspirin, acetaminophen works as a painkiller and fever reducer, but it does not have anti-inflammatory properties and does not produce the side effects associated with aspirin, such as stomach irritation.
ACHE: American Council for Headache Education, an organization affiliated with AHS, and made up of both headache patients and professionals who treat headaches. The purpose of the organization is to educate patients and the public about headache and to advocate up-to-date treatment for headache sufferers.
Acupressure: Derived from traditional Chinese medicine, this is a form of treatment for pain that involves pressure on particular points in the body know as “acupressure points”.
Acupuncture: Derived from traditional Chinese medicine, this is a form of treatment for pain that involves insertion of fine needles into particular points in the body known as “acupuncture points.”
AHS: American Headache Society, a professional organization of physicians, dentists, physician's assistants, nurses, and other health professionals and scientists interested in the study of headache and it’s treatment.
Amitriptyline: An antidepressant medication useful in treating migraine and tension type headaches.
Analgesic: Medication for the relief of pain. An analgesic works to increase the patient's pain threshold, thereby decreasing the sensation of pain. Analgesics range from aspirin and acetaminophen to narcotics.
Aneurysm: A congenital weak point in the wall of an artery that may bulge outwards, and may occasionally rupture and bleed, causing what is called a “subarachnoid hemorrhage,” which produces a severe headache and stiff neck and sometimes can be fatal.
Anticonvulsant: A class of drugs used to treat convulsive seizures, or epilepsy. Some of these medications, such as valproic acid or Depakote, are also used in prevention of headache, even when headaches are not associated with seizures.
Antidepressant: A class of drugs used primarily to treat depression. Some of these drugs have also been found to be useful in the prevention of headache, even when headaches are not associated with depression.
Antiemetics: A class of drugs used to treat nausea and/or vomiting.
Anti-inflammatory: A class of drugs that reduces inflammation in the body and that are often used to treat arthritis. These drugs can also be useful in reducing the inflammation associated with certain types of headaches but may cause gastrointestinal upset.
Anxiety: Anxiety is a psychological state where people experience feelings such as fear, apprehension, or worry.
Aspartame: Artificial sweetener known to act as a migraine trigger in some vulnerable people.
Aura: The warning symptoms, usually visual, that may sometimes occur shortly before a migraine headache begins. An aura can consist of flashing lights before the eyes or even numbness of the skin in the arms or legs, or both. The word aura comes from the Greek word for wind, and just as a strong wind may precede a storm, an aura may precede the storm of migraine. Auras may occur without head pain.
Barbiturate: A class of drugs that causes sedation and relaxation. Barbiturates may be found in combination abortive medications used to treat the symptoms of headache. If used too frequently (more than a couple of days per week), they may be habit-forming.
Basilar migraine: A type of migraine that mainly affects children and adolescents. Associated with the headache are a number of symptoms related to the part of the brain supplied by the basilar artery, including vertigo (spinning sensations), loss of balance and sometimes, loss of consciousness as well as prominent nausea and vomiting.
Benzodiazepines: A category of potentially addictive tranquilizers that may increase depression at the same time that they reduce anxiety.
Beta blockers: A class of drugs used to treat heart disease and high blood pressure. These drugs lower blood pressure and slow the heart rate. They were discovered accidentally but may also be useful for preventing migraine headaches.
Biofeedback: A form of treatment for headache that uses electronic feedback of hand temperature and/or muscle tension to teach patients how to relax. Acquiring and regularly practicing these skills has been shown to often reduce the frequency and severity of both migraine and tension-type headaches.
Caffeine: A stimulating drug found in coffee, tea, and cola beverages. Caffeine may be helpful in aborting headaches, so it is widely used in combination drugs prescribed for headache relief. Paradoxically, using caffeine in excess or a too rapid withdrawal from caffeine may cause headaches in some individuals.
Caffeine-withdrawal headache: A headache caused by dilation of the blood vessels once the constrictive effects of caffeine are no longer present.
Calcium channel blocker: A type of medication that may prevent migraine headaches by acting on the blood vessels, the brain, or both.
Cardiac arrhythmias: Cardiac arrhythmia is any heart condition in which the electrical activity which controls the heart beat is irregular or is faster or slower than normal.
CAT scan: “Computerized Axial Tomographic” scan, a type of X-ray scan utilized for diagnostic purposes which can be useful in identifying causes of headache that may masquerade as migraine.
Chiropractic: A philosophic system of mechanical therapeutics that associates many diseases on poor alignment of the vertebrae. Chiropractors treat disease with manipulation of the vertebrae in order to relieve pressure on the nerves, “so that nerve force may flow freely from the brain to the rest of the body.”
Chlorpromazine: A powerful major tranquilizer that relieves the pain and nausea of migraine.
Chronic headache: Headache that occurs frequently over a period of time, generally at least every other day or 15 days per month for a period of at least 6 months.
Chronic paroxysmal hemicrania (CPH). A rare headache syndrome that can resemble a cluster headache because it presents itself as multiple, short, severe headaches that occur on a daily basis. They can also be associated with tearing, nasal stuffiness, etc. CPH differs from cluster headache in that the patients are mostly female, the headache attacks are shorter (1 to 2 minutes) and frequent, with attacks occurring an average of 14 times per day. This condition responds very well to treatment with indomethacin.
Cluster headache: A particular type of headache that mainly affects men by a 6 to 1 ratio. It is characterized by intense but brief (30 minutes to 2 hours) pain in and around one eye occurring daily or several times per day in "clusters" that typically last for a couple of months. The patient then may have no headaches at all for many months. Along with the headache, there are usually other phenomena, such as tearing and redness of the affected eye or a stuffy nose.
Cognitive behavioral therapy: An approach to psychotherapy that helps patients take control of their illness, and their lives, through insight, self knowledge, and planning.
Daily headache: Headache that occurs either daily or almost daily, at least 20 days per month.
Depression: Not just temporary or situational sadness, but a persistent and pervasive feeling of sadness or hopelessness that is often associated with weight loss (or gain), sleep disturbances, constipation, disturbances of sexual function, and feelings of guilt or self-blame.
Dexamethasone: A steroid drug used to treat inflammation.
DHE: Abbreviation for dihydroergotamine, a drug used, usually by injection or nasal spray, to treat migraine, rebound, and cluster headaches.
Diagnosis: The process of taking a history and performing an examination in order to decide what is causing a particular symptom, such as headache, so that a correct treatment can be chosen.
DO: Abbreviation for a doctor of osteopathy, a degree indicating medical training approximately the same as that for a doctor of medicine or MD Practitioners of osteopathy, or osteopaths, use the diagnostic and therapeutic measures of ordinary medicine in addition to having training in manipulative measures.
Dopamine: One of several chemicals called “neurotransmitters” that transmit or send messages from one nerve cell to another in the nervous system.
Dysrhythmia: A disturbance in the normal pattern of brain waves as recorded in encephalography (EEG). Dysrhythmias of different kinds may show up during migraine, sleep, overexcitement, etc.
EEG: Electroencephalography is a test used to detect and record the electrical activity generated by the brain.
EMG: Electromyography is a test used to discover diseases of the muscles, spinal cord, and peripheral nerves.
Endorphins: Hormone-like substances produced in the brain that have analgesic properties.
Epilepsy: Epilepsy is a common chronic neurological disorder that is characterized by recurrent seizures.
Episodic: Describing occurrences that come and go, with or without a regular pattern.
Ergotamine: A drug originally derived from the ergot fungus that constricts blood vessels and has been used since the 1920s to treat migraine headaches.
Exercise: Many headache specialists believe that regular physical exercise can reduce the frequency and severity of headaches, although few research studies have been conducted to prove or disprove this widespread belief. If true, exercise may help by reducing stress.
Feverfew: An herb (plant of the chrysanthemum family) used for the prevention of migraine headaches. It is more widely used in England than in the US. Potency varies from one preparation to another since this herb is not regulated by the Federal Food and Drug Administration. There are anecdotal reports in the medical literature that it is helpful, but no carefully controlled scientific studies have been conducted.
Glaucoma: An eye disease that can eventually cause blindness and is sometimes the cause of headache pain.
Hangover headache: A headache linked to the consumption of alcohol, which dilates and irritates the brain’s blood vessels.
Head trauma: Injury to the head, which may in some cases lead to what are called “posttraumatic headaches.”
Headache: Generally refers to a persistent or lasting pain in the head region, as contrasted with a “head pain,” such as trigeminal neuralgia, which is brief.
Heartburn: Heartburn is a painful or burning sensation in the esophagus, caused by regurgitation of gastric acid. It is usually felt in the middle of the chest.
Hemiplegic migraine: Hemiplegic migraine is a type of migraine that involves includes hemiparesis (weakness of half the body) during the aura phase.
Hirsutism: Excessive and hair growth in women in places where hair is normally minimal or absent such as on the face, chest, and back.
Homeopathy: The practice of the use of active ingredients in minute dosages along with naturally occurring substances in order to provide a healthier balance of internal chemistry. These minute dosages would be viewed in traditional medicine as ineffective.
Hormone therapy: The therapeutic use of synthetic hormones, usually estrogen and progesterone, after menopause or following a hysterectomy.
Hormones: Powerful substances secreted by the endocrine glands and are carried through the bloodstream effecting other distant parts of the body.
Hydrocephalus: An uncharacteristic swelling in the amount of cerebrospinal fluid within the skull, causing dangerous expansion of the cerebral ventricles.
Hypertension headache: A headache that strikes people who have very high blood pressure. Its “hatband”-type pain can be most severe in the morning.
Hypnosis: A sleep-like state usually induced by another person in which the subject retains awareness of the presence of the hypnotist and where the subject is susceptible to heightened suggestibility. After training by a hypnotist, some migraine patients can be taught to hypnotize themselves in order to reduce stress and related symptoms.
Ice cream headache: A brief sharp pain produced by eating ice cream too quickly, more common in migraine suffers.
Idiopathic: Occurring spontaneously, not traceable to a direct cause.
Imitrex: Brand name for Sumatriptan, a fairly new migraine abortive medication available as a self-administered injection or a tablet.
Indomethacin: A nonsteroidal anti-inflammatory medication that can be effective for the relief of migraine and other types of headaches.
Intractable migraine: A migraine headache that “just won’t stop.” By definition, any migraine that persists longer than 72 hours is referred to as “status migrainosus.” Migraines may often become transformed into a chronic daily headache by too frequent use of either painkillers or ergots.
Intravenous: Intravenous means therapy or medication given directly into a vein.
Irritable bowel syndrome: Irritable bowel syndrome (IBS) is a bowel disorder characterized by abdominal pain and changes in bowel habits where there are no associated abnormalities seen on routine medical testing.
Ischemic heart disease: Ischemic heart disease is a condition characterized by reduced blood supply to the heart muscle as a result of blocked coronary arteries. The condition myay be cause by a build up of fatty plaques in the arterial walls called, atherosclerosis.
Letdown migraine: Migraine may often occur after times of stress, such as after an important exam, or on weekends after a hectic week at work. These are referred to as "letdown" attacks.
Light sensitivity: People with migraine may become very sensitive to light, a condition known as “photophobia,” or literally “fear of light.” A similar sensitivity to sound may also occur, and is known as “phonophobia.”
Magnesium: An element found in trace amounts in the body, in certain foods, and believed to possibly play a role in the cause of migraine headaches, according to some recent research.
MAO inhibitors: Monoamine oxidase inhibitors are a class of drugs used for treating depression and also have been found useful in treating migraine. Persons taking MAO inhibitors may not eat certain foods containing tyramine because of the danger of increase in blood pressure and, therefore, must be closely monitored during treatment.
Massage: A method of manipulation of the body by rubbing, pinching, kneading, tapping, etc, which can be helpful in producing relaxation.
Medication-overuse headaches: Medication-overuse headache are usually daily headaches caused by taking painkillers too often to treat headaches or migraine. After stopping the painkillers, you will temporarily have worse and more frequent headaches, but they will eventually disappear and you should return to feeling 'normal.'
Menopause: The natural and permanent stopping of the female monthly menstrual periods.
Menstrual migraine: The terms “pure menstrual migraine” or “true menstrual migraine” refers to migraine attacks that occur only with menses. If attacks occur mainly but not exclusively with menses, this may be referred to as “mainly menstrual migraine."
Migraine: A particular form of recurrent headache that often runs in families. According to the International Headache Society, migraine headache pain must have four of the following characteristics: one-sided, pulsating or throbbing, at least moderate if not severe, and worsened by ordinary daily activities such as climbing stairs or housework. In addition, the pain must be accompanied by either nausea or sensitivity to light and noise. There must be no evidence of other disease and at least four to five attacks before a physician can be confident of the diagnosis.
Migraine equivalents: Symptoms such as unexplained flashing lights or visual disturbances, transient numbness, unexplained bouts of abdominal pain or nausea, etc, all of which are considered to be fragments of a full-blown migraine attack. Migraine equivalents tend to occur most commonly in either children or older persons. Other disorders that might explain these symptoms must be ruled out by appropriate tests.
Migraineur: A designation sometimes used for people with migraine.
Migrainous infarction: A rare complication of migraine in which aura symptoms are not apparently reversible within 7 days of onset, or in which medical tests such as a brain scan can show an area of the brain that has had a stroke due to inadequate blood supply. Infarction means death of tissue. A stroke typically results from tissue dying in the brain due to a lack of blood supply.
Monoamine oxidase: A family of enzymes involved in the breakdown of certain neurotransmitters. MAO inhibitors act to block these enzymes.
MRI: An acronym for “magnetic resonance imaging,” a computerized way of making pictures or images without the use of X-rays, but instead with the help of a powerful magnet.
MSG: Abbreviation for “monosodium glutamate,” often found in seasonings or Chinese food. MSG may sometimes trigger migraine attacks in susceptible individuals.
Naproxen: A nonsteroidal anti-inflammatory medication.
Narcotics: Strong prescription painkillers such as Demerol, Stadol, or Codeine, all of which are habit-forming if taken too often for too long.
Naturopathy: The practice of using natural substances to provide a healthier balance of internal chemistry.
Neuralgia: The pain spasms of a major nerve. The pain can be jabbing, sudden, and repetitive. There are several different types of neuralgias, and each affects a different area. Trigeminal neuralgia, for example, affects the nerves of the face.
Neurologic: Relating to neurology or to the nervous system.
Neurologist: A medical specialist with advanced training in diagnosis and treatment of diseases of the brain, spinal cord, nerves, and muscles, including such common disorders as headache, dizziness, stroke, and back pain.
Neurology: The branch of medical science that specializes in the nervous system.
Neurotransmitters: Naturally occurring chemicals in the brain that transmit messages from one nerve cell to another.
Neurovascular: Pertaining to the relationship between nerves and the blood vessels they supply.
Nitrites: Chemical preservatives used in meats, and various processed foods; because they are known to dilate blood vessels, they can cause headaches in some people.
Nondrug therapy: A treatment that does not involve the use of drugs or medications. In the case of headache, such nondrug therapies might include biofeedback, acupuncture, dietary counseling, stress management training, physical therapy, etc.
Ocular migraine: A type of migraine with aura or “classic” migraine in which visual symptoms are prominent, sometimes with little or no headache component.
Ophthalmoplegic migraine: A very rare type of migraine in which there is weakness of one or more of the muscles that moves the eye, occurring mainly in young people. Other more common causes for painful paralysis of the eye muscles must be excluded by appropriate diagnostic testing.
Oxygen therapy: Breathing of oxygen from a tank which is sometimes helpful for cluster headaches.
Pain rating system: Because pain is an internal and private experience, various scales have been devised for rating pain. One of the most common scales rates pain on a 0 to 10 scale, with 10 being the most severe pain a person has ever experienced. Yet another scale assigns the number 1 to mild pain, 2 to moderate pain, 3 to severe pain, and 4 to pain that causes incapacity.
Personality: In the past, it was thought that there was a typical “migraine personality.” Now, this is no longer felt to be the case, as the primary factor determining whether a person will have migraine is heredity, not personality. Nevertheless, hurrying, worrying, and stress can all aggravate migraine.
Phonophobia: Abnormal sensitivity to sound.
Phosphenes: Tiny, brilliant sparks often seen during the first stage of migraine.
Photophobia: Abnormal sensitivity to light.
Postdrome: The period following a bad migraine headache during which a person feels “hung over,” tired, and “beaten up” is referred to as the headache postdrome.
Posttraumatic headache: Headache that follows an injury or trauma. There does not have to be loss of consciousness for an injury to cause significant headache in some cases.
Premenstrual syndrome (PMS): Combination of symptoms experienced by some women prior to menstruation.
Prodrome: The period of time preceding a migraine headache during which a person may feel irritable, out of sorts, moody, unusually sensitive to light or noise, and may notice some fluid retention. This may go on for 1 or 2 days or just a few hours before the actual headache begins.
Prophylactic medication: Preventative medication taken on a regular schedule to prevent the onset of an ailment such as migraine.
Prophylaxis: Measures taken to prevent the development of headache. These measures may include daily use of medication or nondrug therapies.
Propranolol: Beta-blocker medication widely prescribed for hypertension and other chronic conditions and effective in preventing migraine.
Rebound Headache: A chronic form of headache (lasting usually at least 2 out of 3 days) brought about by taking painkillers to excess and thought to be due to suppression of the body’s own painfighting mechanisms.
Referred pain: Pain perceived as occurring in a part of the body other than its true source.
Reye's syndrome: Reye's syndrome is described as sudden brain damage and liver problems of unknown cause. The syndrome has been linked with the use of aspirin to treat chickenpox or the flu in children.
Scintillation: The perception of twinkling light of varying intensity that can occur during the migraine aura.
Scotoma: An area of decreased or lost vision. Scotoma can be a characteristic symptom of migraine auras.
Serotonin: A neurotransmitter thought to be important in the mechanism of migraine headaches.
Sinus headache: A headache caused by a clogged sinus cavity.
Sinusitis: Infection or inflammation of the sinuses. When the sinuses are infected, there is usually a low-grade fever, tenderness to touch over the sinuses, and a thick, colored nasal or postnasal drainage.
Status migrainosus: A severe, unrelenting migraine headache associated with nausea and vomiting that lasts for several days and may not be manageable under outpatient care.
Stress: An emotionally disruptive or upsetting condition occurring in response to adverse external influences and capable of affecting physical health that can be characterized by increased heart rate, a rise in blood pressure, muscular tension, irritability, and depression. Stress does not cause migraine but can be a migraine “trigger.”
Stroke: A condition of rapidly developing loss of brain function due to reduced blood flow in the blood vessels supplying blood to the brain. This can be caused by blood clots or a hemorrhage in the brain.
Sumitriptan: See “Imitrex.”
Synapse: The junction between nerve cells where a nerve impulse is transferred from one neuron to another.
Syncope: A brief loss of consciousness (a blackout or fainting).
Temporal arteritis: A headache caused by inflamed arteries in the head and neck, requiring immediate medical attention.
TENS: Acronym for “transcutaneous electrical nerve stimulation.” A TENS unit is a small battery-powered device with wires that attach to electrodes pasted to the skin. Small electrical stimuli are applied to the skin in order to "tie up" nerve pathways that carry pain messages. This interferes with the transmission of pain messages to the brain and can be helpful in certain chronic pain problems.
Tension headache: As defined by the International Headache Society, a tension type headache is the opposite of migraine; that is, the pain is on both sides of the head, is pressing and steady, rather than pulsating, is usually mild and does not cause incapacity, and is not worsened by ordinary daily activities. There is no associated nausea or sensitivity to light and noise.
TMJ: Acronym for “temporomandibular joint,” the joints where the jaw attaches to the skull just in front of the ears. It is sometimes attributed to headache pain.
Trigger: Anything that can set off a migraine headache in a genetically predisposed individual is referred to as a “trigger.” Common triggers include (but are not limited to) stress, changes in female hormone levels, skipping meals, certain odors such as perfume, sleeping late on weekends, sleep loss, alcohol, and some foods and additives including cheese, chocolate and MSG.
Trigeminal nerve: The fifth cranial nerve, a major nerve of the face and head. It is related to nerve impulses that direct the muscles for jaw movement.
Tumor headache: A headache caused by a tumor, or growth, that presses on the brain. Symptoms can include seizures, loss of consciousness, projectile vomiting, and speech disturbances. Although migraine sufferers can experience severe pain (making them feel as though they may have a tumor), of those persons suffering from migraine, less than .004% actually suffer from a brain tumor.
Tyramine: A substance found in meats, cheese and red wine, that can trigger migraine in a susceptible individual.
Unilateral: Affecting or relating to only one side.
Vascular: Relating to the channels that carry body fluids, usually used in connection with the blood vessels.
Vascular pain: Pain caused by the dilation or constriction of blood vessels. Dilating (enlarging) the blood vessels in the head causes pain when the vessels exert pressure on surrounding nerves. Constructing (narrowing) the blood vessels reduces the supply of blood to the brain. The tissue around the blood vessels may become inflamed, and chemical irritants build up in the area.
Vasoactive: Affecting the dilation or constriction of blood vessels.
Verapamil: A type of calcium channel blocker medication that can be effective in preventing migraine.
Vertigo: The sensation of spinning or whirling.
Migraine resources
Government Agencies
*Accepts Spanish calls
*National Women's Health Information Center, OWH, HHS
8270 Willow Oaks Corporate Drive
Fairfax, VA 22031
Phone: (800) 994-9662
TDD: (888) 220-5446
FAX: (703) 663-6942
http://www.4woman.gov
National Institute of Neurological Disorders and Stroke (NINDS), NIH, HHS
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Phone: (800) 352-9424
http://www.ninds.nih.gov
Office on Women's Health, HHS
200 Independence Avenue, SW, Room 712E
Washington, DC 20201
Phone: (202) 690-7650
FAX: (202) 205-2631
http://www.womenshealth.gov/owh
*National Center for Complementary and Alternative Medicine, NIH, HHS
PO Box 7923
Gaithersburg, MD 20898
Phone: (888) 644-6226
TTY: (866) 464-3615
FAX: (866) 464-3616
http://nccam.nih.gov
*National Institute of Child Health and Human Development, NIH, HHS
Information Resource Center
PO Box 3006
Rockville, MD 20847
Phone: (800) 370-2943
TTY: (888) 320-6942
FAX: (301) 984-1473
http://www.nichd.nih.gov
Office of Research on Women's Health, NIH, HHS
Building 1, Room 201
Bethesda, MD 20892-0161
Phone: (301) 402-1770
FAX: (301) 402-1798
http://orwh.od.nih.gov/index.html
Private Organizations
Migraine Awareness Group: A National Understanding For Migraineurs (MAGNUM)
Washington, DC Office
100 North Union Street
Suite 3
Alexandria, VA 22314
Phone: (703) 349-1929
http://www.migraines.org
American Headache Society Committee for Hadache Educatin (ACHE)
19 Mantua Road
Mt. Royal, NJ 08061
Phone: (856) 423-0258
Fax: (856) 423-0082
http://www.achenet.org
National Headache Foundation
820 N Orleans, Suite 217
Chicago, IL 60610
Phone: (888) 643-5552
http://www.headaches.org
American Chronic Pain Association
PO Box 850
Rocklin, CA 95677
Phone: (800) 533-3231
Fax: (916) 632-3208
www.theacpa.org
Black Women's Health Imperative
1420 K Street N.W., Suite 1000
Washington, DC 20003
Phone: (202) 548-4000
FAX: (202) 543-9743
http://www.blackwomenshealth.org
Boston Women's Health Book Collective (Publications available in Spanish)
34 Plympton Street
Boston, MA 02118
Phone: (617) 451-3666
FAX: (617) 451-3664
www.ourbodiesourselves.org
National Women's Health Network
514 10th Street, NW, Suite 400
Washington, DC 20004
Phone: (202) 628-7814
www.nwhn.org
Newsletters, Magazines, Reports
Healthy Women Today
The National Women's Health Information Center
www.womenshealth.gov/newsletter
National Institute of Neurological Disorders and Stroke
Subscribe to the newsletter to get up-to-date news on research and breakthroughs.
http://www.ninds.nih.gov/funding/nindsnotes/nindsnoteslistserv.htm
Tools
Headache diary
Keep track of your symptoms with this diary.
http://www.headaches.org/consumer/educationindex.html
Women and Migraine Survey
Take this survey form the National Headache Foundation to see how your experience compares to that of other women.
http://www.zoomerang.com/recipient/survey.zgi?p=WEB225D7BJ6NM7
References
1. Silberstein, SD, Rosenberg, J. Multispecialty consensus on diagnosis and treatment of headache. Neurology 2000; 54:1553. Full text of guidelines available at www.neurology.org.
Professional:
