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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Migraine Headache
What is a migraine headache?
A migraine headache is a special kind of headache that can
last for several days and cause intense pain. Migraines may
be accompanied or preceded by other symptoms, such as nausea
and visual disturbances.
Some people start having migraine headaches as children.
Others may not have them until later in life. The headaches
may recur from time to time throughout life. The condition
tends to run in families. It affects women three times more
often than men.
How does it occur?
For years migraine headaches were thought to be caused when
blood vessels in the head contract and then swell, producing
pain. Recent research suggests that certain substances or
events trigger an imbalance of brain chemicals
(neurotransmitters).
Common migraine triggers include:
- stress
- fatigue
- changes in the weather
- certain foods
- bright lights
- loud noises
- strong smells.
What are the symptoms?
Before a migraine starts, there is often a warning period
when you don't feel well. Some people lose part of their
vision or see bright spots or zigzag patterns in front of
their eyes. These symptoms, which may precede and predict a
migraine headache, are called migraine aura. The vision
changes of the aura usually go away as the headache begins.
Migraine symptoms may include:
- throbbing or pounding headache
- extreme sensitivity to light
- blurred vision
- nausea and vomiting
- numbness or tingling of the face or one arm.
The pain is usually more severe on one side of the head but
can affect the whole head.
How is it diagnosed?
Your health care provider will ask about your symptoms and
medical history and give you a physical exam.
A careful history of your headaches is very helpful. Your
doctor may ask you to keep a headache diary in which you
record the following:
- date and time of each attack
- how long the headache lasts
- type of pain (for example, dull, sharp, throbbing, or a
feeling of pressure)
- location of pain
- any symptoms before the headache began
- foods and drinks you had before the headache began
- use of cigarettes, caffeine, alcohol, or carbonated
drinks before the headache began
- time you went to bed and time you got up before the
headache began
- menstrual periods and use of birth control pills or other
female hormones.
Depending on your headache symptoms, your health care
provider may recommend tests to check for other, more
serious causes of your symptoms. For example, you may have
a brain scan or magnetic resonance imaging (MRI).
How is it treated?
Prevention is an important part of treatment. For example:
- You may need to change to a healthier diet.
- Relaxation exercises and biofeedback may help you manage
stress.
- Your headache diary may suggest certain foods or
activities you should avoid.
- You may need to take medication regularly to prevent the
severe and frequent headaches. Drugs your health care
provider might prescribe include propranolol, verapamil,
antidepressants, and ergot preparations such as
ergotamine, ergonovine, or methysergide. You may need to
try a medicine for several weeks to see if it works.
Your health care provider may prescribe other medications
aimed at keeping migraines from becoming severe. It's best
to take the medication as soon as possible after a headache
begins. This means you need to recognize the warning
symptoms. Medications used for this purpose are:
- Midrin, an oral tablet containing isometheptene,
dichloralphenazone, and acetaminophen
- a new group of drugs (the "triptans"), of which Imitrex
(sumatriptan) was the first, which are available as
tablets (including some that may be taken without water),
an injection, and a nasal spray
- D.H.E. (dihydroergotamine), which is an injection
available at your health care provider's office.
How long will the effects last?
Symptoms last from a few hours to a few days. You may have
migraines the rest of your life. However, attacks usually
occur less often as you grow older.
How can I take care of myself?
When a migraine begins:
- As soon as possible after the headache symptoms begin,
take a pain reliever such as aspirin, acetaminophen,
ibuprofen, or a medication prescribed by your health
care provider.
- Rest in a quiet, dark room until the symptoms are gone.
Call your health care provider immediately if you have
unusual symptoms such as:
- fever
- stiff neck
- nervous system symptoms such as difficulty speaking, arm
or leg weakness, or paralysis.
You may do the following to help prevent migraines:
- Eat regular meals.
- Avoid foods from the following list if eating them seems
to cause your headaches:
- wine, ale, and beer
- chocolate milk and buttermilk
- aged and processed cheeses
- aged, canned, cured, and processed meats
- breads made with yeast and yeast extracts
- foods containing cheese, chocolate, or nuts
- Ask your health care provider about avoiding medications
that may trigger headaches.
- Ask your health care provider about discontinuing birth
control or hormone pills if you have been taking them.
- Avoid smoking.
- Avoid drinking a lot of alcohol.
- Maintain your recommended weight.
- Get regular rest.
- Try to balance work, relaxation, recreation, and rest in
your life.
- Try to identify and avoid stress.
Don't drive a car during a migraine.
If your symptoms get worse, or if they don't get better when
you take medication, make another appointment with your
health care provider. It may take several visits to find
the best way to control your headaches.
For more information, call or write:
American Council for Headache Education (ACHE)
19 Mantua
Mt. Royal, NJ 08061
800-255-ACHE (255-2243)
856-423-0258
Web site: http://www.achenet.org
Educational materials, referrals to support groups
National Headache Foundation
428 West St. James Place, 2nd Floor
Chicago, IL 60657
800-843-2256
Web site: http://www.headaches.org
Educational materials, list of headache specialists,
information specialists
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