Migraine (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, MD

Overview
Migraine is a recurrent headache disorder with intense pain. Many patients can identify triggers that cause or aggravate the headache. Usual triggers include certain food, anxiety and stress, changes in the weather, l ack of sleep or too much sleep and sensory stimuli. Hormonal changes may induce pain for some female patients. Headache caused by migraine is ususally described as moderate to severe, intense, throbbing or pounding pain which may be confined to one side or may affect both sides of the head. Other symptoms include nausea with or without vomiting, sensitivity to light and sound. Typical trigger and symptoms with a family history of migraines may help the doctor diagnose migraine. For atypical patients, the doctor may order head images to rule out other possible causes of headache. Pain relievers including NSAIDS and acetaminophen may help relieve pain and reduce frenquency. Many patients with migraine can relieve pain and reduce frenquency with treatments.

What are the symptoms of Migraine?
Patients may experience the following symptoms after the trigger.
 * Headache: Headache caused by migraine is ususally described as moderate to severe, intense, throbbing or pounding pain which may be confined to one side or may affect both sides of the head. Headache of migraine usually is aggravated by regular activities.
 * Nausea with or without vomiting
 * Sensitivity to light and sound
 * Cold hands and cold feet

Who is at highest risk?
The cause of migraine remains unknown. It seems that both genetics and environmental contribute to the cause. The following factors make you more prone to having migraines.
 * A family history of migraines
 * Younger than 40.
 * Female.
 * Hormonal changes: For female patients with migraines, the trigger is associated with menstruation cycle. They may also change during pregnancy or menopause.

Many individuals with migraine can identify triggers that cause or aggravate the headache. Avoiding triggers may be helpful to decrease the frequency or severity of migraine. Some triggers include:
 * Anxiety
 * Stress
 * Food: Some migraines can be triggered by certain foods, including beer and red wine, aged cheeses, chocolate, aspartame, caffeine, monosodium glutamate, salty foods, and processed foods.
 * Changes in the weather
 * Lack of sleep or too much sleep
 * Sensory stimuli, including bright lights, sun glare, loud sounds, unusual smells such as perfume, paint thinner and secondhand smoke, can also trigger migraines.
 * Hormonal changes in women, during menstruation cycle, pregnancy or menopause.

When to seek urgent medical care?
Call 911 if:


 * You are experiencing "the worst headache of your life"
 * You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a migraine before
 * Your headaches are more severe when lying down
 * The headache starts very suddenly

Also, call your doctor if:


 * Your headache patterns or pain change
 * Treatments that once worked are no longer helpful
 * You have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst
 * You are pregnant or could become pregnant -- some medications should not be taken when pregnant

Diagnosis

 * Medical history and physical examination: Typical trigger and symptoms, a family history of migraines may help the doctor diagnose migraine.
 * Head images such CT and MRI are needed to rule out other possible causes of headache.
 * Lumbar puncture: When your headache is suspected meningitis, the doctor may order this test. During this procedure, the patient lies on the side, with knees pulled up toward the chest, and chin tucked downward. After injecting the anesthetic into the lower spine, the doctor insert a spinal needle into the lower back area to measure CSF pressure and collect a sample. The patient is often asked to lie down for a while after the process.

Treatment options
Treatment of migraine is to relieve pain.
 * Meidcations of pain relievers
 * Nonsteroidal anti-inflammatory drugs (NSAIDS): NSAIDs relieve pain by reducing the inflammation that causes the pain. Usual drugs include aspirin, ibuprofen and naproxen.
 * Acetaminophen: Acetaminophen reduces pain and fever by acting on pain centers in the brain.


 * Acupuncture, biofeedback and massage: These methods may help relieve the headache and reduce the frequency of migraines.

Diseases with similar symptoms

 * Brain tumor
 * Brain infections such as meningitis, encephalitis
 * Brain aneurysm abrupt
 * Hemorrhagic stroke
 * Hysteria

Where to find medical care for Migraine?
Directions to Hospitals Treating Migraine

Prevention of Migraines

 * Avoid triggers: Avoid to contact with certain foods and sensory stimuli.
 * Try to relax, control stress.
 * Keep a regular sleeping habit
 * Exercise regularly: This may reduce tension and can help prevent migraines.
 * Reduce the effects of estrogen: For female patient with migraine that trigger is associated with menstruation cycle or hormone drugs, avoid or reduce the amount of medications such as birth control pills. Talk with your doctor about the best alternatives or dosages for your  hormone replacement therapy.

What to expect (Outlook/Prognosis)?
Many patients with migraine can relieve pain and reduce frenquency with treatments.

Possible complications
Migraine headache is a risk factor for stroke in both men and women.

Migraine headaches generally represent no significant threat to your overall health. However, they can be a long-term (chronic) problem and may interfere with your day-to-day life.