Migraine headaches vary from person to person, but they are usually characterized by severe pain on one or both sides of the head and are often accompanied by a multitude of other symptoms. The associated symptoms may include nausea and vomiting, light sensitivity and distorted vision, dizziness, fever and chills.

The two most prevalent types of migraine headache are classic and common. The difference between these two is the appearance of a group of symptoms called an aura, which occur about 10 to 30 minutes before the onset of a classic migraine headache. An aura often includes temporary changes in vision such as the appearance of flashing lights, zigzag lines, or loss of vision. Other symptoms seen in classic migraine include speech difficulty, weakness of the arm or leg, tingling in the face and hands, and confusion.

Common migraine, the more common of the two types, is not preceded by an aura but may be associated with vague symptoms like mood changes and fatigue beforehand.

Both types of migraine can occur as often as a few times a week, or as infrequently as once every few years. The headache pain can last from a few hours to as many as four days.

What causes a migraine?

The precise mechanisms involved in the initiation of a migraine headache are not completely understood. There appears to be general agreement however that a key element is changes in the blood flow within the brain that become oversensitive to a variety of triggers.

The early warning signs of a migraine are thought to be due to a narrowing of the blood vessels within the brain, while the pain experienced in the head itself is due to the subsequent expanding or dilating of the blood vessels. The dilation of the blood vessels results in the release of pain-producing substances called prostaglandins. Other chemicals that cause inflammation and swelling, along with some that increase sensitivity to pain are also released. The circulation of these various chemicals, along with the dilation of the scalp vessels stimulates the pain receptors, resulting in a headache.

Who are most affected by migraines?

Although both men and women suffer from migraines, the condition is more common in adult women by a ratio of about 4:1. Migraine headaches can also affect children.

Although many persons who suffer with migraine headaches have a family history of migraine, the exact hereditary mechanism of this disorder is not known. People who get migraines are thought to have an inherited abnormality in the regulation of blood vessels.

How is a migraine diagnosed?

There is no specific test for diagnosing migraine headaches. The determination that a headache is of the migraine classification comes after a detailed physical examination and history taking between the patient and physician. Patients will be asked a series of questions about their symptoms. For example, how often are the headaches occurring, where is the pain located, how long does it last, what other symptoms come before, during, or after the headache? A diary can be helpful for documenting headache characteristics and relating them to lifestyle, diet, menstruation and medication usage.

Many physicians will order a series of blood tests to screen for thyroid disease, anemia, or infections that could cause headaches. At times different types of brain scans like CT (computed tomographic) scans and or MRI (magnetic resonance imaging) scans may be needed to rule out serious brain disorders. If a brain aneurysm is suspected an angiogram may be ordered.

The diagnosis of migraine is not always easy, especially when patient symptoms do not fall into an easily recognizable pattern.

An electroencephalogram (EEG) may be given to measure brain activity. EEG's can indicate a malfunction in the brain, but they cannot usually pinpoint a problem that might be causing a headacheThermography, an experimental technique for diagnosing headache, promises to become a useful clinical tool. In thermography, an infrared camera converts skin temperature into a color picture or thermogram with different degrees of heat appearing as different colors. Skin temperature is affected primarily by blood flow. Research scientists have found that thermograms of headache patients show strikingly different heat patterns from those of people who never or rarely get headaches

Triggering factors for migraines

Triggering factors play a role in migraine headaches for some individuals. Many triggering factors have been implicated in migraine and include but are not limited to the following:

Hormonal changes (particularly associated with menstruation and oral contraceptive use)
Sudden changes in the weather conditions
Certain foods or food additives, especially preservatives, MSG, caffeine, chocolate, cheese and corn products
Strong odors, glaring lights
Cigarette smoke
Emotional factors
Changes in sleep patterns
How are migraine headaches treated?

Currently no cure exists for migraine, although control of the headaches can be achieved for most patients. Medications for treating migraine headaches can be used either to relieve symptoms after the onset of the headache or to prevent future headaches from occurring.

When prescribing and using headache medications, experts warn against using the "quick fix" approach in which more potent pain medications are given with increasing frequency. This method of treatment has most recently been shown to result in "rebound headaches", a condition in which the headaches persist on a daily basis and become increasingly resistant to treatment.

Symptomatic medications for migraine are given to alleviate or decrease the symptoms of the attack. It is best to consult with your physician before taking any of these medications, since persons with certain medical conditions may be advised against using these drugs.

Simple analgesics. These drugs include aspirin and Tylenol, which serve as the first line of defense against mild to moderate migraine attacks.

Nonsteroidal Anti-Inflammatory Drugs.Examples of these drugs include naproxen sodium, ibuprofen, ketorolac and indomethacin. They are often helpful as first-line drugs in mild to moderate migraine attacks.

Caffeine preparations. Drugs that contain small amounts of caffeine may be useful in the early stages of migraine.

Ergot Derivatives.One of the most common drugs used for the relief of classic and common migraine is ergotamine tartrate, a vasoconstrictor that helps counteract the painful dilation stage of a migraine headache. This drug is usually taken in the early stage of a migraine attack. It may be combined with other medications to treat nausea and vomiting, since it sometimes causes these side effects.

Sumatriptan. This drug represents one of the newer classes of drugs to treat migraine attacks. It is characterized as a selective 5-HT1-receptor agonist and has proven effective in controlling migraine symptoms. The drug can be administered in a variety of ways including by injection, orally, and intranasally.

Phenothiazines. These drugs are sometimes administered intravenously to control migraine attacks.

Corticosteroids. Although their use in treating migraine attacks remains controversial, corticosteroids are sometimes helpful in prolonged migraine attacks that do not respond to other treatments.

Narcotic analgesics. Narcotic analgesics are administered to treat severe migraine attacks. It is recommended that they be used only for short periods when other treatments fail and that they be discontinued when the headache is relieved.

Preventative medications for migraine attacks may be prescribed when the headaches are occurring more than 2 to 3 times per month, last more than 48 hours and are severe and disabling. Examples of these drugs include:

Beta-Blockers
Calcium Channel Blockers
Tricyclic Antidepressants
Anticonvulsants
Serotonin Antagonists
Monoamine Oxidase Inhibitors
Many drugs used to treat migraine attacks can have adverse side effects. It is essential to take these medications only when they are prescribed and supervised by a physician who is familiar with you and your medical history.

Other treatments for migraine attack

Medications for the treatment of migraines are often combined with biofeedback and relaxation training. Through biofeedback some patients are able to gain better control over their bodily functions, thereby reducing the number and severity of migraine attacks.

Diet restrictions have proven helpful for some migraine sufferers when headache-causing foods are identified and then eliminated from the diet. Preventing drops in blood sugar levels can also help in controlling some migraine symptoms.