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MigraineMigraine Headache Overview Migraine headaches are one of the most common problems seen in emergency departments and doctors’ offices. Migraines are due to changes in the brain and surrounding blood vessels. Migraine headaches typically last from 4-72 hours and vary in frequency from daily to fewer than 1 per year. Migraine affects about 15% of the population. Three times as many women as men have migraines. More than 80% of people with migraines have other members in the family who have them too. Different types of migraine headaches Common migraine accounts for 80% of migraines. There is no "aura" before a common migraine. People with classic migraines experience an aura before their headaches. Most often, an aura is a visual disturbance (outlines of lights or jagged light images). Classic migraines are usually much more severe than common migraines. Status migrainosus is a migraine that does not go away by itself. Migraine Headache Causes The exact cause of migraine headaches is not clearly understood, though experts believe they are due to a combination of the expansion of blood vessels and the release of certain chemicals, which causes inflammation and pain. The chemicals dopamine and serotonin are among those involved in migraine. These chemicals are found normally in the brain and can cause blood vessels to act abnormally if they are present in abnormal amounts or if the blood vessels are unusually sensitive to them. Various triggers are thought to bring about migraine in certain people prone to developing migraine. Different people may have different triggers: Certain foods, especially chocolate, cheese, nuts, alcohol, and MSG, bring on headaches in some people. (MSG is a food enhancer used in many foods including Chinese food.) Missing a meal may bring on a headache. Stress and tension are also risk factors. People often have migraines during times of increased emotional or physical stress. Birth control pills are a common trigger. Women may have migraines at the end of the pill cycle as the oestrogen component of the pill is stopped. This is called an oestrogen-withdrawal headache. Smoking may cause migraines or interfere with treatment. Migraine Headache Symptoms Symptoms vary from person to person and from migraine to migraine. Five phases can often be identified: Prodrome: A variety of warnings can come before a migraine. These may consist of a change in mood (for example, feeling “high,” irritable, or depressed) or a subtle change of sensation (for example, a funny taste or smell). Fatigue and muscle tension are also common Aura: This is commonly a visual disturbance that precedes the headache phase. Some migraineurs develop blind spots (called scotomas); see geometric patterns or flashing, colourful lights; or lose vision on one side (hemianopsia). Headache: Although migraine pain usually appears on one side of the head, 30-40% of migraines occur on both sides. Throbbing pain may be present. More than 80% of migraineurs feel nauseated, and some vomit. About 70% become sensitive to light (photophobia) and sound (phonophobia). This phase may last 4-72 hours. Headache termination: Even if untreated, the pain usually goes away with sleep. Postdrome: Other signs of the migraine (for example, inability to eat, problems with concentration, or fatigue) may linger after the pain has disappeared. When to Seek Medical Care Call a doctor if any of the following occur: A change in frequency, severity, or features of the migraine commonly experienced A new, progressive headache that lasts for days A headache brought on by coughing, sneezing, bearing down, straining while on the toilet, and so on Large, unintentional loss of body weight Weakness or paralysis that lasts after the headache Go to a hospital emergency department if any of the following occur: Having the worst headache ever, especially if the headache came on very quickly Headache associated with trauma to the head Trauma to the head with loss of consciousness Fever or stiff neck associated with headache Decreased level of consciousness or confusion Paralysis of one side of the body Seizure Self-Care at Home Most migraineurs can manage mild-to-moderate attacks at home with the following strategies: Using a cold compress to the area of pain Resting with pillows comfortably supporting the head or neck Resting in a room with little or no sensory stimulation (light, sound, odors) Withdrawing from stressful surroundings Sleeping Drinking a moderate amount of caffeine Trying certain over-the-counter headache medications Nonsteroidal anti-inflammatory drugs (NSAIDS): These include medications like aspirin, ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), and ketoprofen (Orudis). Stomach ulcers and bleeding are serious potential side effects. This type of medication should not be taken by anyone with a history of stomach bleeding. A doctor or pharmacist should be asked about possible medicine interactions if the migraineur is taking other drugs. Acetaminophen (Tylenol): Acetaminophen may be safely taken with NSAIDs for an additive effect. Taking acetaminophen by itself is usually safe, even with a history of stomach ulcers or bleeding. Acetaminophen should not be taken if the migraineur has liver problems or has 3 or more alcohol drinks a day. Combination medications: Some over-the-counter pain relievers have been approved for use with migraine. These include Excedrin Migraine, which contains acetaminophen and aspirin combined with caffeine. A similar effect can be achieved by taking 2 aspirin or acetaminophen tablets with a cup of black coffee. Aromatherapy is often better as a preventative measure and are best used as soon as the sufferer feels that the attack is about to commence. Cold compresses of Lavender and Peppermint oils should be placed across the forehead and temples and changed frequently as soon as the compress begins to get warmer. Hot or warm compresses of Marjoram on the back of the neck will increase the flow of blood to the head. If the migraine is due to stress and tension then regular massages across the neck and shoulders can help to relieve the tensed up muscles. |
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