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  • International Headache Society Definition:  Unilateral severe headache pain with a pounding quality that often occurs with nausea and/or sensitivity to head movement, sound and light.  The headache must recur in order for a diagnosis to be confirmed.
  • Migraines may have an associated "aura":  this is an accompanying cluster of visual and sensory symptoms, altered sensation ("paresthesias"), or numbness; migraine without aura is more common. 
  • Migraine headaches are nearly three times more common in women as in men.
  • Migraines affect 17% of all adult women and 6% of adult men.
  • Migraines occur most often between ages 30-50.
  • In women, migraines generally resolve after menopause.
  • Migraines have several triggers that vary from patient to patient.  They include:  hormonal changes (e.g. "menstrual migraine", early pregnancy), hormonal medications (e.g. birth control pills, hormone replacement therapy), certain odors (e.g. perfume), red wine, MSG, nitrates, sulfites, flickering lights, chocolate, aged cheese, stress, changes in the weather, sleep deprivation or skipped meals.

Migraine Diagnosis:

  • Migraine occurs with different levels of pain and associated symptoms:
    • Level I:  moderate to intermittent headache that responds well to over-the-counter (OTC) medicines; patients generally self-medicate and don't consult their doctors.
    • Level II:  more intense headache that is unresponsive to OTC medicines; patients are more likely to consult their doctors.
    • Level III:  The headache is present more days than not, and often accompanied by nausea and vomiting; patients require medicine for prevention and treatment.
    • Level IV:  Daily headache, often with nausea, vomiting and other associated symptoms that can last up to two full days.

  • "Menstrual migraine" occurs in 60% of women with migraine.
  • Menstrual migraine most commonly occurs within 6 days preceding a menstrual period.
  • Migraine and birth control pills:  If new migraines are associated with starting a new birth control pill, it usually occurs soon after starting the Pill, during the placebo phase.  Newer Pill formulations such as those that have an even distribution of estrogen and lower dose Pills may be less likely to trigger migraines.  Progestin only pills may also be helpful.
  • Prevention:  identify triggers and avoid them.  Practice healthy lifestyle habits such as getting adequate sleep and balanced nutrition.  Keep a headache diary.

Migraine Treatment:

  • OTC medications:  Excedrin, non-steroidal anti-inflammatory medicines, Tylenol.
  • Prescription medications:  triptans (sumatriptan, naratriptan, rizatriptan, zolmitriptan), dihydroergotamine.

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Created: 5/8/2001  -  Donnica Moore, M.D.

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