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Migraine is a form of headache, usually very intense and disabling. It is a neurologic disease of vascular origin characterized by attacks of sharp pain involving (usually) one half of the skull and accompanied by nausea, vomiting, photophobia and occasionally visual (or rarely other) disturbances known as aura. The symptoms and their timing vary considerably among migraine suffers, and to a lesser extent from one migraine attack to the next.
In some cases, migraine can cause seizures such as a tonic-clonic seizure. Stroke symptoms (passing or permanent) are seen in very severe subtypes.
The word "migraine" originates from hemicrania (pain affecting one side of the head).
Migraine is often caused by the expansion of the blood vessels of the head and neck. Classical migraine (migraine with aura) is forerun by a group of symptoms called aura, whereas common migraine does not have any indicator for the impending headache. A few (perhaps fortunate) people actually get aura without migraine. Cluster headaches have similar symptoms, but tend to recur in minutes or hours, rather than days, and affect a different area of the face.
Migraine can accompany, in some cases, another type of headache called Tension headache.
Migraine often runs in families and starts in adolescence, although some research indicates that it can start in early childhood or even in utero. Migraine occurs more frequently in women than men, and is most common between ages 15-45, with the frequency of attacks declining with age in most cases.
Because their symptoms vary, an intense headache may be misdiagnosed as a Migraine by a layperson. Where possible, see a doctor to determine if the headaches are a symptom of something else.
Treatment focuses on three areas:
In many patients the incidence of migraine can be reduced through diet changes to avoid certain chemicals present in such foods as cheddar cheese and chocolate, and in most alcoholic beverages. Other triggers may be situational and can be avoided through lifestyle changes.
Many people have found that eliminating most tannins from their diet can substantially reduce their migraines. This can happen even if they have known triggers, such as time-of-the-month for women, certain weather patterns, or going hungry. Some of the foods containing tannins are regular tea, apple juice, orange-coloured cheese, many alcoholic drinks, many herbs and spices.
Until the introduction of sumatriptan (Imitrex®/Imigran®) around 1985, ergot derivatives (see ergoline) were the primary oral drugs available to stop a migraine once it was underway. Analgesics and caffeine were used to provide some relief, though they are not effective for most sufferers. Narcotic pain medications, and antipsychotic drugs such as thorazine and compazine, are effective but have debilitating side effects at the doses required to achieve control.
Ergotamine tablets, usually with caffeine, are sometimes used. Dihydroergotamine (DHE), which must be injected or inhaled, is also effective. These drugs can be used either as preventive or abortive therapy.
Imitrex (sumitriptan) and the related 5-hydroxytryptamine (serotonin) receptor agonists are now available and are the therapy of choice for severe migraine that is relatively infrequent. They are highly effective and have few side effects when used occasionally. Some members of this family of drugs are:
Evidence is accumulating that these drugs are effective because they constrict certain blood vessels in the brain. They do this by acting at serotonin receptors on nerve endings. This action leads to a decrease in the release of a peptide known as CGRP. In a migraine attack, this peptide is released and produces pain by dialating cerebral blood vessels.
These drugs are available by prescription only (U.S.). Many migraine sufferers do not use them only because they have not sought treatment from a physician.
For patients who suffer frequent, intractable and severe symptoms, preventive and prophylactic medications can be used. A large number of medications with varying modes of action can be used. Selection of a suitable medication for any particular patent is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next.
Beta blockers such as propranolol and atenolol are usually tried first. Antidepressants such as amitriptyline may be effective. Antispasmodic drugs are used less frequently. Sansert was effective in many cases, but has been withdrawn from the U.S. market.
Migraine sufferers usually develop their own coping mechanisms for intractable pain. A warm bath, or resting in a dark and silent room may be more helpful than any other medication for many patients.
Some migraine sufferers find relief through acupuncture which is usually used to help prevent headaches from developing. Sometimes acupuncture is used to relieve the pain of an active migraine headache.
Supplementation of Coenzyme Q10 has been found to have a beneficial effect on the condition of some sufferers of migraines.
The plant complementary and alternative medicine to treat migraine and severe headache.
The human side of migraine has been expertly captured in the book of the same name by Oliver Sacks, although the science in the book is not current.
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