Migraine Headache

GENERAL INFORMATION:

What is a migraine? A migraine is a headache that causes severe pain and other symptoms. Migraines can affect your ability to do everyday activities. Migraines may last anywhere from a few hours to several days. Some people only have migraines once or twice a year. Others may have them as often as one or more times a week. Some people have warning signs before their migraines start. Migraines that have warning signs before they start are called classic migraines. Migraines that start without warning signs are called common migraines.

Why do migraines happen? Migraines are thought to be a type of vascular (VAS-ku-lar) headache. Vascular headaches are caused by problems with the blood vessels in the head. Migraines may start when blood vessels in your head widen or swell. This can happen for many reasons. For example, women are more likely to have migraines than men because of the female hormone called estrogen. Migraines can also run in families.

What are some things that can trigger (start) migraines? Things that trigger migraines are different from person to person. Over time, you may learn that you get migraines after certain foods or experiences. Keeping a daily diary or calendar of your migraines may help you learn what triggers them. Some things that may trigger migraines include:

• Bright or flashing lights, loud noises, or strong smells (such as chemical fumes).
  
  
• Certain foods or drinks like chocolate, hard cheese, red wine, or other alcoholic drinks. Things in foods like nitrates or gluten may also cause migraines. Nitrates are found in many processed meats, such as bacon, hot dogs, and deli meats. Gluten is a protein found in wheat and other grains. Things added to foods, such as MSG or artificial sweeteners, may cause a migraine to start. Caffeine, which is often used to treat migraines, can also trigger them.
  
  
• Changes in the weather may trigger migraines. For example, hot and humid days or bright sunlight may trigger them. Sudden changes in air pressure may also cause a migraine to start.
  
  
• Eye strain.
  
  
• Hormone changes in women, such as changes that happen during a monthly period.
  
  
• Medicines, such as birth control pills.
  
  
• Oversleeping, or not getting enough sleep.
  
  
• Skipping meals or going too long without eating.
  
  
• Smoking or being around smoke.
  
  
• Stress.

What are the warning signs that a migraine is about to start? Classic migraines have warning signs before the headache starts. These signs usually start 15 to 60 minutes before the headache does. However, some people notice changes in their body up to three days before the start of a migraine. There are a wide variety of warning signs, and they are different from person to person. The more common migraine warning signs include:

• Unusual tiredness or frequent yawning.
  
  
• Visual changes, often called auras , that happen before a migraine starts. Auras may include:
  
  
  • Blind spots that last for a short time.
    
    
  • Seeing bright spots, lines, or other things that are not there (hallucinations).
    
    
  • Your vision may blur, or things may look different.
  
  
• Tingling in an arm or leg.

What are the signs and symptoms of a migraine headache? A migraine headache usually begins as a dull ache. It may begin around the eye or temple (on the side of the forehead near the hairline). The pain may increase to the point where you cannot do everyday activities. The pain may be on one or both sides of your head. Migraine pain may be throbbing, pulsing, or pounding. It is common to have nausea (feeling sick to your stomach) and vomiting before and during a migraine headache. You may be more bothered by light, noise, or smells.

How are migraines diagnosed? Your caregiver will examine you and ask you questions. A neurologic (nu-roh-LAH-jik) exam to check your brain and nerves may be done also. You may need tests to make sure your headaches are not a symptom of a more serious problem. These tests may include an MRI or a CT ("cat") scan to check the tissue and blood vessels of your head.

How are migraines prevented and treated? There is no cure for migraine headaches, but with treatment they can be controlled. Ask your caregiver for the most up-to-date treatments that are available for migraines. Some things that may help migraines include:

• Avoid smoke and alcohol: It is never too late to quit smoking. Besides triggering migraines, smoking increases your chance of having a heart attack, lung disease, and cancer. Alcohol can react badly with many of the medicines used to treat migraines. Alcohol may also trigger migraines.
  
  
• Exercise: Exercise may help prevent migraines. Begin a regular exercise program. Talk to your caregiver before you start exercising. Together, you and your caregiver can plan the best exercise program for you. It is best to start slowly and do more as you get stronger. Exercising also makes the heart stronger, lowers blood pressure, and keeps you healthy.
  
  
• Find and avoid triggers: Use a diary or calendar to keep track of your migraines. Write down when your headaches start and stop, what you were doing when they started, and your symptoms. Record anything you ate or drank during the 24 hours before the headaches. Describe how the pain feels, where it is, and how bad it is. Keep track of the things you did to help your headaches and when you did them. Make a note about whether these things helped your symptoms or not. This record will help you learn what may trigger your headaches and what helps them the most. Bring this diary with you every time you see your caregiver.
  
  
• Heat and cold: Some people find that heat or cold applied to the headache area can ease migraine pain. If heat helps you, use a heating pad (turned on low), a hot water bottle, or warm shower. Do not sleep on the heating pad or hot water bottle. This can cause a bad burn. You can also try cold packs to decrease your migraine pain. Put ice in a plastic bag and cover it with a towel. Place this over the painful area for 20 minutes out of every hour, for as long as you need it. Do not put the ice pack directly on the skin because you can get frostbite.
  
  
• Medicines:
  
  
  • Medicines may be taken to prevent migraines, or to stop them once they start. Some over-the-counter medicines, such as aspirin, acetaminophen (a-seet-a-MIN-oh-fen) or ibuprofen (eye-bu-PROH-fen), may help your pain. Some medicines can also help your other migraine symptoms, such as anti-nausea medicines.
    
    
  • Some medicines that were made to treat other illnesses have been found to help migraines. Examples include certain kinds of blood pressure medicines, anti-seizure medicines, and medicines used to treat depression. Learn the warning signs of your migraines so you can take medicine as early as possible. If you use some medicines too often, you may get a "rebound" migraine. Talk to your caregiver about ways to avoid rebound migraines.
  
  
• Special medical care: If you are having trouble controlling your migraines, you may need to see a special caregiver. Some caregivers, such as neurologists (nu-ROL-oh-jists) or those at pain clinics, specialize in treating migraines.
  
  
• Stress and rest: Avoid or control stress as much as you can. Learn new ways to relax, such as deep breathing, meditation (med-i-TAY-shun), relaxing your muscles, music, or biofeedback. Ask your caregiver for more information about any of these. Talk to someone about things that upset you. Get plenty of rest. Try to go to bed and wake up at the same time each day. During a migraine, rest in a dark, quiet room.

Can migraines cause other serious health problems? Migraines are usually not the cause of other serious health problems. Because of the discomfort of migraine symptoms, they can interfere with the quality of your life. People who have migraines often have problems with anxiety or depression also. You may have side effects from certain medications used to treat your migraines. Rarely, severe migraines may cause a stroke.

For support or more information: Some people find it helpful to talk with others who are also living with migraine headaches. Support groups and national organizations can help you learn more about migraines. Ask your caregiver for a support group in your area, or contact the following organizations:

• National Headache Foundation
  820 N. Orleans, Suite 217
  Chicago, IL 60610
  Phone: 1-888-NHF-5552
  Web Address: http://www.headaches.org
  

• National Institute of Neurological Disorders and Stroke
  P.O. Box 5801
  Bethesda, MD 20824
  Phone: 1-800-352-9424
  Web Address: http://www.ninds.nih.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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