Migraine

What is a migraine headache?

A migraine is a distinctive type of headache that can last from hours to days. It can cause intense pain along with other symptoms, such as nausea or changes in your vision.

How does it occur?

For many years it was thought that migraine headaches occurred when the blood vessels in the head constricted and then swelled, producing pain. More recent research shows that certain substances or events trigger an imbalance of brain chemicals (neurotransmitters). Common migraine triggers include:
stress
fatigue
changes in the weather
certain foods
MSG and food preservatives, such as nitrates
red wine
bright lights
Migraines tend to run in families. They affect women three times more often than men, and often occur during, or just before, a woman’s period.

What are the symptoms?

Before a migraine begins, there is often a warning period during which you feel generally unwell. 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, are called a migraine aura. The visual changes of the aura usually fade as the headache begins.

The symptoms of a migraine may include:
a throbbing headache
extreme sensitivity of the eyes to light
blurred vision
nausea and vomiting
numbness or tingling of the face or one arm

The pain is usually more intense on one side of the head, but it can affect the whole head.

How is the diagnosis made?

Your doctor will ask about your symptoms and medical history, and will examine you. There are no laboratory tests or X-rays that diagnose migraine.
A careful history of your headaches is therefore very valuable.

Your doctor may ask you to keep a headache diary, recording the following:
the date and time of each attack
how long the headache lasts
the type of pain (for example, dull, sharp, throbbing or a feeling of pressure)
where the pain is located
any symptoms before the headache starts
the foods and drinks you had before the headache started (including checking the ingredient lists of any packaged foods you have eaten)
any cigarettes, caffeine, alcohol or fizzy drinks you had before the headache began
the time you went to bed and the time you got up before the headache started
if you are a woman, your menstrual periods and any use of birth control pills or other female hormones

Depending on your symptoms, your doctor may recommend tests to rule out other, more serious causes. For example, you may have an MRI scan of the brain.

How is it treated?

Prevention is an important part of treatment. For instance:
You may need to switch to a healthier diet.
Relaxation exercises can help you manage stress.
Your headache diary may point to particular foods or activities to avoid.
You may need to take medication regularly to prevent severe and frequent headaches. Medicines your doctor may prescribe include propranolol, verapamil, and antidepressants, as well as preparations such as ergotamine, ergonovine or methysergide. You may need to try a medicine for several weeks to see whether it works.

Your doctor may also prescribe medication to stop a migraine from becoming severe once it starts. It is best to take this medicine as soon as possible after the headache begins.

How long will the symptoms last?

Symptoms last from a few hours to a few days. You may have migraines for the rest of your life, but attacks usually become less frequent as you get older.

How can I take care of myself?

When a migraine begins:
As soon as possible after the symptoms start, take a painkiller such as aspirin, acetaminophen or ibuprofen, or the medicine your doctor has prescribed.
Rest in a quiet, dark room until the symptoms improve. Placing a cool, moist cloth on your forehead can help.
Call your doctor immediately if you have unusual symptoms such as:
fever
a stiff neck
neurological symptoms such as difficulty speaking, weakness in the arms or legs, or paralysis

You can do the following to help prevent migraines:
Eat regular meals.
Avoid the foods listed below if eating them seems to bring on your headaches:
Wine and beer
Aged and processed cheeses
Aged, canned, cured and processed meat
Breads made with yeast, and yeast extracts
Foods containing cheese, chocolate or nuts
Ask your doctor about avoiding medicines that can cause headaches
If you take birth control pills or other female hormones, ask your doctor whether you should stop
Ask your doctor about medicines you can take daily to help prevent migraines
Avoid smoking
Get regular rest
Try to balance work, relaxation, recreation and rest in your life
Try to recognise and avoid stress
Do not drive during a migraine

If your symptoms worsen, or do not improve with medication, make another appointment with your doctor. It may take several visits to find the best way of controlling your headaches.