Migraine headaches

2021-08-26 12:55 PM

Some migraines precede or are accompanied by warning sensory symptoms or signs, such as flashing lights, blind spots, or tingling in the arms or legs.

Define

Migraine headaches are chronic headaches that can be significant for hours or even days. Symptoms can be very severe and it may be necessary to find a dark, quiet place to lie down.

Some migraines precede or are accompanied by warning sensory symptoms or signs, such as flashing lights, blind spots, or tingling in the arms or legs. Some migraines are often accompanied by nausea, vomiting, and heightened sensitivity to light and sound.

Although specific treatment is not available, medication can help reduce the frequency and severity of migraines. If your previous treatment hasn't worked, talk to your doctor about trying another migraine medication. Medications combined with self-help measures and lifestyle changes can make a huge difference.

Symptoms

Migraine headaches often begin in children, adolescents, or in early adulthood. A typical migraine attack causes some or all of the following signs and symptoms:

Moderate to severe headache, which may be limited to one side of the head or may affect both sides.

Fluctuating headache.

Pain that gets worse with physical activity.

Pain interferes with regular activities.

Nausea with or without vomiting.

Sensitive to light and sound.

When left untreated, migraines typically last four to 72 hours, but how often headaches occur vary from person to person. You may have migraines several times a month or less often.

Not all migraines are the same. Most people experience migraines without warning signs. Some people have migraines with warning signs, formerly known as classic migraines. The prodromal warning may include vision changes, such as seeing flashing lights or pins and needles feeling in the arms or legs.

There may be one or more prodrome several hours or a day or more before the actual headache, including:

An intense feeling of euphoria.

Craving for sweets.

Thirsty.

Asleep.

Irritability or depression.

Migraine headaches often go undiagnosed and untreated. If you experience signs and symptoms of a migraine, keep a record of the attacks and how to handle them. Then, make an appointment with your doctor to discuss the headache and decide on a treatment plan.

Even if you have a history of headaches, see your doctor if the pattern changes or if headaches suddenly feel different.

See a doctor right away or go to the emergency room if you have any of the following signs and symptoms, which may indicate a more serious medical problem:

Sudden severe headache like a thunderclap.

Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness, or difficulty speaking.

Headaches after a head injury, especially if the headache is more severe.

Chronic headaches that are worse after coughing, exertion, straining, or sudden movements.

New headaches appear at the age of more than 50 years.

Causes

Although many of the causes of migraines are not well understood, both genetic and environmental factors appear to play a role.

Migraines can be caused by changes in the trigeminal nerve. An imbalance in brain chemicals, including serotonin, may also be involved.

Serotonin levels decrease during migraines. This can trigger the trigeminal nervous system to release substances called neuropeptides, which travel to the outer covering of the brain (meninges). The result is a headache.

Whatever the mechanism of headaches, some of the following can trigger them. Common migraine triggers include:

Hormonal changes in women. Fluctuations in estrogen seem to cause headaches in women known as migraines. Women with a history of migraines often get headaches just before or during their periods, when they have high levels of estrogen. Others tend to develop increased migraines during pregnancy or menopause. Hormonal medications, such as birth control pills and hormone replacement therapy, can also worsen migraines, although some women find it beneficial.

Food. Some migraines are triggered by certain foods. Common include wine, beer and wine, cheese, chocolate; aspartame; Overuse of caffeine, MSG - an important ingredient in some Asian foods, salty foods, and processed foods. Skipping meals or fasting can also trigger migraines.

Stress. Stress at work or at home can trigger migraines.

Feeling of stimulation. Bright lights and the sun can trigger migraines, as can loud sounds. Unusual odors - including pleasant scents, such as perfume, and unpleasant odors, such as paint and cigarette smoke, can also trigger migraines.

Change the sleep-wake cycle. Either lack of sleep or too much sleep can be a trigger for migraine attacks in some people.

Physical factors. Physical exertion, including sexual activity, can cause migraines.

Change the environment. Changes in weather or barometric pressure can trigger migraines.

Medicine. Some medications can make migraines worse.

Risk factors

Several factors make you more likely to get migraines:

Family history. Many people with migraines have a family history of migraines. If one or both parents have migraines, chances are they will.

Under 40 years old. Half of the people with migraines start before 20, and migraines are most common in people between the ages of 30 and 39.

Women. Women are about three times more likely to have migraines than men. Headaches tend to affect boys more than girls throughout childhood, but by the timing of puberty, girls are also affected.

Experiencing endocrine changes. If you are a woman with migraines, you may find that the headache begins just before or shortly after the onset of the menstrual cycle. May also change during pregnancy or menopause. Some women with migraines get worse during the first trimester of pregnancy. Although for many people, migraines improve later in pregnancy.

Complications

Digestive tract problems. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and aspirin, can cause abdominal pain, bleeding, and ulcers - especially if taken in large doses or for a long time.

Rebound headache. In addition, prescription or OTC headache medications, for more than nine days/month or in high doses, can establish a serious complication known as rebound headache. A rebound headache occurs when the pain reliever stops and starts to cause a headache again. Then use more pain relievers, and end up in a vicious cycle.

Serotonin syndrome. This is life-threatening, with the potential for possible drug interactions if migraine triptans, such as sumatriptan (Imitrex) or zolmitriptan (Zomig), are taken along with a selective serotonin reuptake inhibitor antidepressant. filters (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Some popular SSRIs include Zoloft, Prozac, and Paxil. SNRIs include Cymbalta and Effexor. Fortunately, serotonin syndrome is rare.

Testing and diagnosis

If migraines are typical or there is a family history of migraines, your doctor is likely to diagnose the underlying problem based on your medical history and examination. However, if the headache is unusual, severe, or unexpected, your doctor may recommend a series of tests to rule out other possible causes.

Computed tomography (CT). This helps the doctor diagnose tumors, infections, and possibly other medical problems that can cause headaches.

Magnetic resonance imaging (MRI). Using powerful radio waves, an MRI creates a very detailed cross-section of the brain. MRI helps diagnose tumors, strokes, aneurysms, neurological diseases, and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.

Lumbar puncture. If your doctor suspects an underlying problem, such as meningitis and the cerebrospinal fluid that surrounds the brain and spinal cord, a lumbar puncture may be ordered. During this procedure, a fine needle is inserted between two vertebrae in the lower back to extract a sample of cerebrospinal fluid (CSF) for laboratory analysis.

Treatments and drugs

A variety of medications have been specifically indicated for the treatment of migraine headaches. In addition, certain medications commonly used to treat other problems can also help relieve or prevent migraines. Medications used to combat migraines fall into two main categories:

Painkiller type. In acute treatment, medications are indicated during migraine attacks and are indicated to stop symptoms that have already begun.

Prophylactic drugs. These medications are taken regularly, often daily, to reduce the severity or frequency of migraines.

Choosing a strategy for migraine management depends on the frequency and severity of headaches, the extent of the disability causing the headache, and the medical problem.

Some medications should not be taken if you are pregnant or breastfeeding. Some are not intended for use by children. Your doctor can help find the right medication.

Analgesic

For best results, use a pain reliever as soon as you experience signs or symptoms of a migraine.

Non-steroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) or aspirin, can help relieve mild migraines. Medicines marketed specifically for migraines, such as a combination of acetaminophen, aspirin, and caffeine (Excedrin Migraine), may also be helpful for moderate migraines but alone are ineffective for severe migraine. If taken too often or for a long time, NSAIDs can lead to ulcers, gastrointestinal bleeding, and rebound headaches.

Triptans. For many people with severe migraine attacks, triptans are the drug of choice. Effective in reducing pain, nausea, and sensitivity to light and sound associated with migraines. Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova), and eletriptan (Relpax). Side effects of triptans include nausea, dizziness, and muscle weakness. Not recommended for people at risk of stroke and heart attack. A prescription for the combination of sumatriptan and naproxen sodium (Treximet) was available in 2008. More effective at relieving migraine symptoms than either drug alone.

Ergot. Ergotamine (Migergot, Cafergot) is less expensive, but also less effective than triptans. It seems to be most effective for people with pain that lasts more than 48 hours. Dihydroergotamine (Migranal) is a more effective ergot derivative with fewer side effects than ergotamine.

Anti-nausea medication. Because migraine attacks are often accompanied by nausea with or without vomiting, the use of anti-nausea medications is appropriate and is often combined with other medications. Frequently prescribed medications are metoclopramide (oral) or prochlorperazine (oral or suppository).

Butalbital combination. Drugs that combine the sedative butalbital with aspirin or acetaminophen (Butapap, Phrenlin Forte) are sometimes used to treat migraine attacks. Some combinations also include coffee or codeine (Esgic-Plus, Fioricet). However, these drugs carry a high risk of headache symptoms returning when stopped.

Drug. Narcotic drugs, especially codeine, are sometimes used to treat migraines when triptans or ergot cannot be taken. Drugs form a habit and are often used only as a last resort.

Preventive medicine

Nearly half of people with migraines can benefit from the medication, but only about 1 in 10 take it. Prophylactic treatment is possible if there are two or more attacks per month, pain relievers are ineffective if there are signs of migraine, and symptoms include persistent aura or numbness and weakness.

Prophylactic medications can reduce the frequency, severity, and length of migraines and may increase the effectiveness of symptom-relief medications used during migraine attacks. Your doctor may recommend taking a prophylactic pill daily, or only when anticipation is triggered, such as menstruation.

In most cases, headache prevention medications do not completely eliminate them, and some cause serious side effects. If you've had good results from preventive medicine and have been using it for migraines for six months to a year, your doctor may recommend stopping the medication to see if the migraines return.

Other medications your doctor may prescribe

Cardiovascular drugs. Beta-blockers, commonly used to treat high blood pressure and coronary artery disease, can reduce the frequency and severity of migraines. These drugs are considered first-line. Calcium channel blockers, a class of cardiovascular drugs, especially verapamil (Calan, Isoptin), may also be helpful in preventing migraines and relieving prodromal symptoms. In addition, the blood pressure-lowering drugs lisinopril (Prinivil, Zestril) and candesartan (Atacand) are helpful in reducing the length and severity of migraines. Researchers don't understand exactly why all cardiovascular drugs prevent migraines. Side effects may include dizziness, drowsiness, or lightheadedness.

Antidepressants. Some antidepressants help prevent certain types of headaches, including migraines. The most effective are tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor), and protriptyline (Vivactil). These medications are considered first-line and can relieve migraines by affecting levels of serotonin and other brain chemicals. Other types of antidepressants, called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), have not been shown to be effective for prevention. migraine headache. However, preliminary research suggests that the SNRI, venlafaxine (Effexor), may be helpful in preventing migraines.

Antiepileptic drugs. Some antiepileptic drugs, such as Divalproex (Depakote) and topiramate (Topamax), and gabapentin (Neurontin), seem to reduce the frequency of migraines. However, at high doses, antiepileptic drugs can cause side effects such as nausea and vomiting, diarrhea, abdominal pain, hair loss, and dizziness.

Cyproheptadine. This particular anti-allergic drug affects the action of serotonin. Doctors sometimes give it to children as a preventative measure.

Botulinum toxin type A (Botox). Botulinum toxin type A is sometimes used to treat chronic migraines. Studies have had mixed results. However, some headache experts believe it can be helpful for some people. When this is effective, treatment usually needs to be repeated every three months.

Lifestyle and remedy

Self-care measures can help relieve migraine pain.

Try muscle relaxation exercises. Muscle relaxation, relaxation meditation, and yoga do not require any equipment. They can be learned in the classroom or at home using books or tapes. Or spend at least half an hour a day doing something relaxing - gardening, music, taking a hot bath or reading a book.

Get enough sleep but don't oversleep. Middle-aged adults need six to eight hours of sleep a night. It is best to go to bed and wake up at the same time.

Rest and relax. If possible, rest in a quiet room in the dark when you feel a headache coming on. Place an ice pack wrapped in a cloth on the back of the neck and apply gentle pressure to the painful areas of the scalp.

Keep a headache diary. Continue to keep a headache diary even after seeing your doctor. It will help to learn more about what triggers migraines and what treatment is most effective.

Alternative medicine

Non-traditional therapy may be helpful if you have chronic headaches:

Acupuncture. Insert multiple needles into several areas of the skin at specified points. Several clinical trials suggest that acupuncture may be helpful for headache pain.

Biofeedback. Biofeedback seems to be particularly effective at reducing migraines. This technique uses special relaxation equipment to teach how to monitor and control certain responses related to stress, such as muscle tension.

Massage. Massage can help reduce the frequency of migraines. And it can improve sleep quality, which can help prevent migraines.

Herbs, vitamins, and minerals. There is some evidence that herbs can prevent or reduce migraine severity. High doses of riboflavin (vitamin B-2) may also prevent migraines by correcting small deficiencies in brain cells. Coenzyme Q10 supplements may be helpful in some individuals. Taking magnesium sulfate supplements may reduce the frequency of headaches in some people, although research doesn't all agree on this. Intravenous magnesium seems to help some people with acute headaches, especially those with a magnesium deficiency. Ask your doctor for the right treatment. Do not use Feverfew or butterbur if you are pregnant.

Prevention

With or without preventive medication, lifestyle changes can help reduce the number and severity of migraines. One or more of these suggestions may be helpful:

Avoid triggers. If certain foods seem to have caused headaches in the past, avoid those foods. If certain scents are a problem, try to avoid them. Overall, establish a daily routine with regular sleep and regular eating. Also, try to control stress.

Exercise regularly. Regular exercise reduces stress and can help prevent migraines. If your doctor agrees, choose any appropriate exercise, including swimming, walking, and biking. However, warm up slowly, as sudden intense exercise can trigger headaches. Obesity is also thought to be a factor in migraines, and regular exercise can help keep weight down.

Reduces the effects of estrogen. If you're a woman with migraines and estrogen seems to trigger or make them worse, you can avoid or reduce the amount of estrogen-containing medications you take. These include birth control pills and hormone replacement therapy. Talk to your doctor about the best alternatives or dosage.

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