Causes and Risks: Migraines may occur when blood vessels of the head and neck spasm or constrict, which decreases blood flow, causing symptoms other than headache. Classic migraine is preceded by an aura, a group of symptoms that indicates a pending migraine headache. Common migraine is not.

Migraine headaches affect about 6 out of 100 people. They are a common type of chronic headache. Migraines most commonly occur in women and usually begin between the ages of 10 and 46. They appear to run in families in some cases. Classic migraine accounts for about one-sixth of all migraines. Common migraine and other (rare) forms account for the rest.

Triggers may include lack of sleep, MSG (monosodium glutamate), alcohol and stress.

Prevention: In people who tend to have migraines, preventive medications may reduce the number of incidences of headache. Avoid factors that have triggered a migraine in the past. See the Treatment section.

Symptoms:

• headache
  • throbbing, pulsating
  • usually worst on the sides of the head
  • may be on only one side of the head
  • may be severe or dull
  • commonly lasts 6 to 48 hours
  • may be associated with nausea, vomiting, sensitivity to light and sound
• An aura may precede the headache (any of various symptoms that indicate an impending migraine). This may include visual phenomena like zig zag patterns in a visual field. There may also be numbness or weakness on one side of the body that marches up the arm, leg or face over the course of minutes.
• Various neurologic symptoms may be present during the headache and disappear after the headache is relieved (dizziness, tingling, or other symptoms).

Signs and Tests: Migraine headache may be diagnosed by the health care provider based on the pattern of symptoms, history of migraines in the family, and the response to treatment. A physical examination shows no detectable abnormalities. Sometimes an MRI is obtained to rule out other causes of headache upon initial investigation.

Treatment: Resting in a quiet, darkened room often reduces the severity of symptoms. Drinking a lot of fluids is important to maintain hydration especially if there is vomiting.

Several medications may be advised to relieve symptoms. The response of migraine to medications is highly variable. If a medication has been effective in relieving a previous migraine, it may be tried before others. Over-the-counter analgesics may reduce pain if they are taken early in the development of the headache. If over-the-counter analgesics are ineffective, vasoconstricting or other medications may be helpful. Ergotamine tartrate preparations constrict the arteries of the head and may be used alone or in combination with other drugs such as caffeine (Cafergot) or fioricet. Ergonovine maleate may relieve symptoms. Propoxyphene or other medications that relieve pain and/or inflammation may provide relief for some people. Nausea should be treated early with Reglan, Compazine, or other antiemetics. Imitrex is a newly released medication that has been found very effective in the treatment of a migraine. It is self-administered as an injection under the skin or can be taken as a pill, but needs to be given at the onset of a migraine.

Any factors that have triggered a migraine in the past should be avoided.

Preventive medications include propranolol, amitriptyline, ergonovine, cyproheptadine, clonidine, methysergide, calcium channel antagonists, valproic acid, and carbamazepine. Several medications may need to be tried before a medication that is effective in preventing migraine is found.

Prognosis: The migraine will relieve with time. Treatment may reduce discomfort when the migraine is present, and may prevent future migraines.

Complications: Rarely, people with severe migraines may have a stroke.

Call for an appointment with your health care provider if this is the first time that you have had symptoms of migraine.

Call for an appointment if migraine symptoms are severe, persistent, recurrent, or accompanied by other symptoms.

Also call if previously effective treatments are no longer helpful, or if symptoms indicating side effects of medications occur, including irregular heartbeat, changes in skin color (pale or blue), extreme sleepiness or sedation, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain or cramps, dry mouth, extreme thirst, or others (see specific medication).

Call for an appointment with your health care provider if taking an ergotamine-containing medication and you are likely to become pregnant (these medications should not be taken when pregnant).