migraine

A migraine headache can cause intense throbbing or pulsing in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down.
Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots or tingling in your arm or leg.
Medications can help reduce the frequency and severity of migraines. If treatment hasn't worked for you in the past, talk to your doctor about trying a different migraine headache medication. The right medicines, combined with self-help remedies and lifestyle changes, may make a tremendous difference.


causes migraines
Some people who suffer from migraines can clearly identify triggers or factors that cause the headaches, but many cannot. Potential migraine triggers include:

• Allergies and allergic reactions
  
• Bright lights, loud noises, and certain odors or perfumes
  
• Physical or emotional stress
  
• Changes in sleep patterns or irregular sleep
  
• Smoking or exposure to smoke
  
• Skipping meals or fasting
  
• Alcohol
  
• Menstrual cycle fluctuations, birth control pills, hormone fluctuations during menopause onset
  
• Tension headaches
  
• Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
  
• Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods.

Triggers do not always cause migraines, and avoiding triggers does not always prevent migraines.


symptoms of migraine

• nausea - you may feel queasy and sick; this may be followed by vomiting
• increased sensitivity - you may have photophobia (sensitivity to light), phonophobia (sensitivity to sound) and/or osmophobia (sensitivity to smells), which is why many people with a migraine want to rest in a quiet, dark room

Other symptoms can also occur during a migraine. These include:

• poor concentration
• sweating
• feeling very hot or very cold
• abdominal pain (which can sometimes cause diarrhoea)
• a frequent need to urinate

Not everyone experiences these symptoms when they have a migraine, and they do not usually all occur at once.
The symptoms accompanying migraine can last anywhere between four hours and three days. They will usually disappear when the headache goes.
You may feel very tired for up to seven days after a migraine attack.

Symptoms of aura

About one third of people with migraines have warning symptoms, known as aura, before the migraine. These include:

• visual problems - you may see flashing lights, zigzag patterns or blind spots
• stiffness or a tingling sensation like pins and needles in your neck, shoulders or limbs
• problems with co-ordination - you may feel disoriented or off balance
• difficulty speaking
• loss of consciousness - this only happens in very rare cases

Aura symptoms typically start between 15 minutes and one hour before the headache begins. Some people
may experience aura with only a mild headache


Tests and diagnosis

 you have typical migraines or a family history of migraine headaches, your doctor will likely diagnose the condition on the basis of your medical history and a physical exam. But if your headaches are unusual, severe or sudden, your doctor may recommend a variety of tests to rule out other possible causes for your pain.

• Computerized tomography (CT). This imaging procedure uses a series of computer-directed X-rays that provides a cross-sectional view of your brain. This helps doctors diagnose tumors, infections and other possible medical problems that may be causing your headaches.
• Magnetic resonance imaging (MRI). MRIs use radio waves and a powerful magnet to produce very detailed cross-sectional views of your brain. MRI scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.
• Spinal tap (lumbar puncture). If your doctor suspects an underlying condition, such as meningitis — an inflammation of the membranes (meninges) and cerebrospinal fluid surrounding your brain and spinal cord — he or she may recommend a spinal tap (lumbar puncture). In this procedure, a thin needle is inserted between two vertebrae in your lower back to extract a sample of cerebrospinal fluid (CSF) for laboratory analysis.

Medical Treatment

Drug treatment for migraine headaches can relieve the pain and symptoms of a migraine attack and prevent further migraine attacks.

Migraines can be treated with two approaches: abortive and preventive.

Abortive: The goal of abortive therapy is to stop it once it starts. The prescribed medications stop a migraine when you one coming or once it has begun and may be taken as needed. Abortive medications can be administered by self-injection, by mouth, or by nasal spray. These forms of medication are especially useful for people who have nausea or vomiting related to their migraine, and they work quickly.
Abortive treatments include the triptans, which specifically target serotonin. They are all very similar in their action and chemical structure. The triptans are used only to treat headache and do not relieve pain from back problems, arthritis, menstruation, or other conditions. People with certain medical conditions should not take these medications.

• Almotriptan (Axert)

• Eletriptan (Relpax)
• Frovatriptan (Frova)
• Naratriptan (Amerge, Naramig)
• Rizatriptan (Maxalt)
• Sumatriptan (Alsuma, Dosepro, Imitrex, Sumavel, Treximet)
• Zolmitriptan (Zomig)

The following drugs are also used for treatment.

• Acetaminophen -isometheptene-dichloralphenazone (Midrin)
• Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
• Ergotamine tartrate (Cafergot)  
• Over- the-counter medications such as Advil Migraine (containing ibuprofen), Excedrin Migraine (containing aspirin, acetaminophen, caffeine), and Motrin Migraine Pain (containing ibuprofen)

The following drugs are mainly used for nausea related to migraine headaches in addition to migraine treatment: 

• Metoclopramide (Reglan)
• Prochlorperazine (Compazine)
  Promethazine (Phenergan)

Some drugs are used for headache pain but are not specific for migraines. These include analgesics, narcotics, and barbiturates. Since they can be habit forming, they are less desirable than specific headache drugs listed above. These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work.

Preventive: This type of treatment is considered if migraines occur frequently, typically more than one migraine per week, or if migraine symptoms are severe. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily. Preventive treatment medications include the following:

• Medications used to treat high blood pressure: beta-blockers (propranolol (Inderal), timolol), calcium channel blockers (verapamil (Covera))
• Antidepressants : amitriptyline (Elavil), nortriptyline (Pamelor)
• Antiseizure medications: gabapentin (Neurontin), topiramate (Topamax), valproic acid (Depakote)
• Botox

Some nontraditional supplement treatments for migraine prevention include butterbur, coenzyme Q10, and feverfew. Evidence has been inconclusive and studies have produced mixed findings.