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- Migraine Headache is a
disease that affects 26 million Americans. It is the
second leading cause of primary headaches, and often
afflicts individuals between the ages of 25-45. It is
a neurological illness with biological changes (see causes)
that often start in childhood. The number and severity
of attacks decline after age 45.
- There are two types of migraines:
migraine with aura (15%) and migraine without aura
(85%). An aura is a warning sign (see symptoms) that
often precedes the headache. In a small number of
patients with this condition, the lower portion of the brain
(brain stem) is involved (i.e., basilar migraine).
- Migraines are often missed as the cause of intense headaches.
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- Prodromal symptoms (24-48 hours
before the headache):
- Mood swings (feeling depressed or unusually happy), weakness, fluid retention, craving certain foods
- Aura or warning signs (1-2 hours
before the headache):
- Flashing lights in one eye.
- Seeing things that are not really
there (visual hallucinations).
- One side of the body or face may
be numb or tingling (pins and needles sensation).
- Illusions of tastes or odors (not
real).
- Double Vision, poor balance, dizziness and Ringing in the Ear.
- Aura symptoms disappear within one
hour.
- There may be variety of other
auras.
- Severe pain over one side of head
(both sides in 1/3 of the patients)
- Sensitivity to light
- Tenderness of the scalp
- Sensitivity to sound and smells
- Nausea or vomiting
- Swelling or pain that overwhelms
the face
- Pain can be disabling, and last anywhere from 4-72 hours
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- Most likely a combination of the
following:
- An abnormality of the blood
vessels and blood flow in the superficial layer of the
brain (cerebral cortex). The blood vessels in the
cortex first shrink (constrict), then swell (dilate),
bringing about the pain.
- Genetic factors -- seems to run in
families (especially in identical twins)
- Platelet disorders -- platelets
are cell fragments that help to stop bleeding after
an injury
- Abnormal levels of brain chemicals (neurotransmitters) such as serotonin, enkephalins (natural painkillers), and chatecholamines. Certain migraines result from changes in female hormones (i.e., estrogen and Progesterone) during
menstruation, menopause, and when birth control pills are
used.
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- Presently, there are no diagnostic
tests available.
- History of medical problems, family,
medications, habits and symptoms are extremely important.
- A medical exam and further
laboratory tests may help rule out other diseases.
- X-Rays and MRI (using magnetic energy to take a picture of the brain) may be done to rule out other diseases.
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- A family history of migraines
- Excessive and prolonged use of
painkillers (analgesic medication or drugs)
- There is a higher risk of developing
migraines for women then there is for men.
- Factors that can trigger an attack:
- Foods -- red wine, beer, iodine,
fermented cheeses, MSG, and aspartame (food additives),
and processed meats. (coffee is not a trigger.)
- A woman's menstrual cycle may
trigger a migraine
- Changes in the climate and the air
- Sunlight
- Florescent light
- Perfumes and other
chemicals
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- Dim lights, quiet environments,
and sleeping may help to ease the pain.
- Avoid triggering factors
- Those that reduce the number of attacks (often taken by mouth daily):
- Propanolol, Depakote, Verapamil, Methysergide, and some of the
newer anti-depressants
- Imitrex, Migranal, Stadol, Zomig, ergotamine tartrate, and Amerge are some
examples of this class. Can be given by
self-injection, by mouth, rectally, or by nasal
spray.
- For severe headaches that are not aborted, hospitalization and medication for nausea and vomiting (Vistaril), and strong painkillers such as Demerol can be
given.
- Prescription painkillers such as Fiorinal with or without codeine, Percodan, and
Ibuprofen are also used. Some of these medications
are addictive and must be used carefully.
- Tylenol and Excedrin Migraine are two
over-the-counter medications that tend to be effective
only in very mild cases.
- Herbal and nutritional treatments such as fever few, butter root, B-2 vitamins (400milligrams/day), and Magnesium (400milligrams/day) may help.
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Talk to
your physician and ask about all your options. If need be, seek a headache specialist. Reliable information can be obtained from the National Headache Foundation at 1-888-NHF-5552.
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