What is a Migraine?

A migraine is a type of headache that's often severe. Although any head pain can be miserable, migraines are often disabling. In about 15 percent of cases, these painful headaches are preceded by a sensory warning sign (aura), such as flashes of light, blind spots or tingling in your arm or leg. Migraines are also often accompanied by other symptoms, such as nausea, vomiting and extreme sensitivity to light and sound. Migraine pain can be excruciating and may incapacitate you for hours or even days. Fortunately, migraine pain management has improved dramatically in the last decade. If you've seen a doctor in the past and had no success, it's time to make another appointment. Although there's still no cure, medications can help reduce the frequency of migraines and stop the pain once it has started. The right medicines combined with self-help remedies and changes in lifestyle may make a tremendous difference for you.

A typical migraine attack produces some or all of these signs and symptoms:

• Moderate to severe pain — 60 percent of migraine sufferers feel pain on only one side of their head, while 40 percent experience pain on both sides
• Head pain with a pulsating or throbbing quality
• Pain that worsens with physical activity
• Pain that hinders your regular daily activities
• Nausea with or without vomiting
• Sensitivity to light and sound

When left untreated, migraines typically last from four to 72 hours, but the frequency with which they occur can vary from person to person. You may have migraine headaches several times a month or just once or twice a year.

Not all migraines are the same. Eighty-five percent of people suffer from migraines without auras, which were previously called common migraines. About 15 percent of adults have migraine headaches with auras, which were previously called classic migraines. If you're in the second group, you'll likely have auras about 15 to 30 minutes before your headache begins. They may continue after your headache starts or even occur after your headache begins. These may include:

• Sparkling flashes of light
• Dazzling zigzag lines in your field of vision
• Slowly spreading blind spots in your vision
• Tingling, pins-and-needles sensations in one arm or leg
• Rarely, weakness or language and speech problems

What are the causes of Migraines?

Although much about headaches still isn't understood, some researchers think migraines may be caused by functional changes in the trigeminal nerve system, a major pain pathway in your brain, and by imbalances in brain chemicals, including serotonin, which regulates pain messages going through this pathway.

During a headache, serotonin levels drop. Researchers believe this causes the trigeminal nerve to release substances called neuropeptides, which travel to your brain's outer covering. There they cause blood vessels to become dilated and inflamed. The result is headache pain.

Because levels of magnesium, a mineral involved in nerve cell function, also drop right before or during migraines, it's possible that low amounts of magnesium may cause nerve cells in the brain to misfire.

• Hormonal changes. Although the exact relationship between hormones and headaches isn't clear, fluctuations in oestrogen and progesterone seem to trigger headaches in many women with migraines. About 60 percent of women with a history of migraines report headaches immediately before or during their periods. Others report more migraines during pregnancy or menopause. Hormonal medications such as contraceptives and hormone replacement therapy also may worsen migraine headaches.

• Foods. Certain foods appear to trigger headaches in some people. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; fermented, pickled or marinated foods; aspartame; caffeine; monosodium glutamate — a key ingredient in some Asian foods; certain seasonings; and many canned and processed foods. Skipping meals or fasting also can trigger migraines.

• Stress. A period of hard work followed by relaxation may lead to a weekend migraine. Stress at work or home also can instigate migraine headaches.

• Sensory stimulus. Bright lights and sun glare can produce head pain. So can unusual smells — including pleasant scents, such as perfume and flowers, and unpleasant odors, such as paint thinner and secondhand smoke.

• Physical factors. Intense physical exertion, including sexual activity, may provoke migraines. Changes in sleep patterns — including too much or too little sleep — also can be a problem.

• Changes in the environment. A change of weather, season, altitude level, barometric pressure or time zone can prompt a migraine.

• Medications. Certain medications can aggravate migraine headaches.

Treatment.

At one time, aspirin was almost the only available treatment for headaches. Now there are drugs specifically designed to treat migraines. Several drugs commonly used to treat other conditions also may help relieve migraines in some people. All of these medications fall into two classes — those that reduce or prevent migraines (preventive medications), and those that stop pain once it has started (pain-relieving medications).

Choosing a preventive strategy or a pain-relieving strategy depends on the frequency and severity of your headaches, the degree of disability your headaches cause and other medical conditions you may have. You may be a candidate for preventive therapy if you have two or more debilitating attacks a month, if you use pain-relieving medications more than twice a week, if pain-relieving medications aren't helping or if you have uncommon migraines.

Some medications aren't recommended if you're pregnant or breast-feeding. Some aren't used for children. Your doctor can help find the right medication for you.

Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience migraine signs or symptoms. It may help if you rest or sleep in a dark room after taking them:

• Nonsteroidal antiinflammatory drugs (NSAIDs). These medications, such as ibuprofen or aspirin, may help relieve mild migraines. Drugs marketed specifically for migraine, such as the combination of aspirin and caffeine also may ease moderate migraines, but aren't effective alone for severe migraines. If over-the-counter medications don't help, your doctor may suggest a stronger, prescription-only version of the same drug. If taken too often or for long periods of time, NSAIDs can lead to ulcers, gastrointestinal bleeding and rebound headaches.

Non traditional therapies may be helpful if you suffer from chronic headache pain:

• Acupuncture. In 1998, the National Institutes of Health (NIH) issued a long-awaited statement on acupuncture. Among other benefits, NIH researchers found that acupuncture may be helpful for headache pain. This treatment uses very thin, disposable needles that generally cause little or no pain or discomfort.
   
• Magnetic therapy. The application of static high strength magnets at the point of pain. Wearing a magnetic necklace or sleeping on a magnetic pillow will reduce migraine headaches.   

• Biofeedback. Biofeedback appears to be especially effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses, such as muscle tension.

• Massage. Although massage is a wonderful way to reduce stress and relieve tension, its value in treating headaches hasn't been fully determined. For people who have tight, tender muscles in the back of the head, neck and shoulders, massage may help relieve headache pain.

• Cervical manipulation. There are no scientifically valid studies that prove that chiropractic or other spine manipulation treatments are effective in the treatment of migraine.

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