Migraines
- 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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