Headaches and Migraines

 

What is a migraine?

Although many people use the term "migraine" to describe any severe headache, a migraine headacheis the result of specific physiologic changes that occur within the brain and lead to the characteristic pain and associated symptoms of a migraine.

Migraine headaches are usually associated with sensitivity to light, sound, and smells. In addition, many patients experience nausea or vomiting. The headache of a migraine often involves only one side of the head but in some cases, patients may experience pain bilaterally or on both sides. The pain of a migraine is often described as throbbing or pounding and it may be made worse with physical exertion.

In some cases, patients with migraines experience specific warning symptoms, or an aura, prior to the onset of their headache. These warning symptoms can range from flashing lights or a blind spot in one eye to numbness or weakness involving one side of the body. The aura may last for several minutes, and then resolves as the head pain begins or may last until the headache resolves. For patients who have never experienced an aura, the symptoms can be frightening and can mimic the symptoms of a stroke.

Not all headaches represent migraines, and migraine is not the only condition that can cause severe and debilitating headaches. For example, cluster headaches are very severe headaches that affect one side of the head in a recurrent manner (occurring in a "cluster" over time). The pain is sometimes described as "drilling," and can be worse than migraine pain in some cases. Cluster headaches are less common than migraine.

What Are the Symptoms and Phases of a Migraine?

Migraine symptoms may begin one to two days before the headache itself. This is known as the migraine’s prodrome stage. Symptoms include:

• food cravings
• depression
• fatigue or low energy
• frequent yawning
• hyperactivity
• irritability
• neck stiffness

Some — but not all — people may also experience an aura after the prodrome stage. An aura causes visual, motor, and/or speech disturbances, such as:

• difficulty speaking clearly
• feeling a prickling or tingling sensation in the arms and legs
• flashes of light
• seeing shapes, light flashes or bright spots 
• transient vision loss

The next phase is known as the attack phase. This is the most acute or severe of the phases when the actual migraine occurs. Attack phase symptoms can last anywhere from four hours to three days. Symptoms of a migraine can vary from person to person. Some symptoms may include:

• feeling dizzy or faint
• increased sensitivity to light and sound
• nausea
• pain on one side of the head
• pulsing and/or throbbing pain
• vomiting

What Causes a Migraine?

Researchers haven’t identified a definitive cause for migraines. However, they have found some contributing factors that can trigger the condition. This includes changes in brain chemicals, such as a decrease in serotonin levels.

Factors that may trigger a migraine include:

• bright lights
• severe heat, or other extremes in weather
• changes in barometric pressure
• hormonal changes, such as estrogen fluctuations during menstruation, pregnancy, or menopause for women
• drinking alcohol or caffeinated drinks
• foods such as aged cheese, salty, or processed foods
• consuming food additives, such as aspartame (an artificial sugar) or monosodium glutamate (MSG)
• eating foods that have the additive tyramine, which is found in soy products, fava beans, hard sausages, smoked fish, aged cheeses, and Chianti wine
• excess stress
• loud sounds  
• physical activity
• skipping meals
• loss of sleep
• taking certain medicines, such as oral contraceptives or nitroglycerin
• unusual smells

If you experience a migraine, your doctor may ask you to keep a headache journal. Writing down what you were doing, what foods you ate, and what medications you were taking before your migraine began can help identify your triggers.

What Are the Risks Associated with Migraines?

Migraine headaches can cause risks and complications, both from the headaches themselves and from the medications you take to help with your symptoms.

Sometimes migraine headaches can be long-lasting, occurring anywhere from 3 to 15 days or more in a month. Because the headache affects your ability to think clearly, you may have difficulty at school or at work.

Taking nonsteroidal anti-inflammatory drugs (NSAIDS) in high doses or for a long period of time can lead to stomach pain or bleeding ulcers. Taking medicines for more than 10 days a month for longer than three months can lead to more headaches. This can cause medication-overuse headaches.

If you take prescription medications for your migraines, you’re at risk for experiencing a condition known as serotonin syndrome. Many prescription medicines boost the amount of serotonin in the brain to reduce migraines. Examples include:

• duloxetine (Cymbalta)
• fluoxetine (Sarafem, Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)
• sumatriptan (Imitrex)
• venlafaxine (Effexor XR)
• zolmitriptan (Zomig)