What is Migraine Headaches?
The pain of a migraine headache is often described as an intense pulsing or throbbing pain in one area of the head. It is often accompanied by extreme sensitivity to light and sound, nausea, and vomiting. Migraine is three times more common in women than in men. Some individuals can predict the onset of a migraine because it is preceded by an "aura," visual disturbances that appear as flashing lights, zig-zag lines or a temporary loss of vision. People with migraine tend to have recurring attacks triggered by a lack of food or sleep, exposure to light, or hormonal irregularities (only in women). Anxiety, stress, or relaxation after stress can also be triggers. For many years, scientists believed that migraines were linked to the dilation and constriction of blood vessels in the head. Investigators now believe that migraine is caused by inherited abnormalities in genes that control the activities of certain cell populations in the brain.
Is there any treatment?
There are two ways to approach the treatment of migraine headache with drugs: prevent the attacks, or relieve the symptoms during the attacks. Many people with migraine use both approaches by taking medications originally developed for epilepsy and depression to prevent future attacks, and treating attacks when they happen with drugs called triptans that relieve pain and restore function. Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle. Stress management strategies, such as exercise, relaxation, biofeedback, and other therapies designed to help limit discomfort, may also reduce the occurrence and severity of migraine attacks.
What is the prognosis?
Taking a combination of drugs to prevent and treat migraine attacks when they happen helps most people with migraine to limit the disabling effects of these headaches. Women whose migraine attacks occur in association with their menstrual cycle are likely to have fewer attacks and milder symptoms after menopause.
National Institute of Neurological Disorders and Stroke
What research is being done?
Researchers believe that migraine is the result of fundamental neurological abnormalities caused by genetic mutations at work in the brain. Investigations of the more rare, familial subtypes of migraine are yielding information about specific genes and what they do, or don't do, to cause the pain of migraine headache. Understanding the cascade of biological events that happen in the brain to cause a migraine, and the mechanisms that underlie these events, will give researchers opportunities to develop and test drugs that could prevent or interrupt a migraine attack.
How is Migraine Headache Treated?
During the Stone Age, pieces of a headache sufferer's skull were cut away with flint instruments to relieve pain. Another unpleasant remedy used in the British Isles around the ninth Century involved drinking "the juice of elderseed, cow's brain, and goat's dung dissolved in vinegar." Fortunately, today's headache patients are spared such drastic measures.
Drug therapy, biofeedback training, stress reduction, and elimination of certain foods from the diet are the most common methods of preventing and controlling migraine and other vascular headaches. Joan, the migraine sufferer, was helped by treatment with a combination of an antimigraine drug and diet control.
Regular exercise, such as swimming or vigorous walking, can also reduce the frequency and severity of migraine headaches. Joan found that whirlpool and yoga baths helped her relax.
During a migraine headache, temporary relief can sometimes be obtained by applying cold packs to the head or by pressing on the bulging artery found in front of the ear on the painful side of the head.
There are two ways to approach the treatment of migraine headache with drugs: prevent the attacks, or relieve symptoms after the headache occurs.
For infrequent migraine, drugs can be taken at the first sign of a headache in order to stop it or to at least ease the pain. People who get occasional mild migraine may benefit by taking aspirin or acetaminophen at the start of an attack. Aspirin raises a person's tolerance to pain and also discourages clumping of blood platelets. Small amounts of caffeine may be useful if taken in the early stages of migraine. But for most migraine sufferers who get moderate to severe headaches, and for all cluster headache patients (see section "Besides Migraine, What Are Other Types of Vascular Headaches?"), stronger drugs may be necessary to control the pain.
Several drugs for the prevention of migraine have been developed in recent years, including serotonin agonists which mimic the action of this key brain chemical. One of the most commonly used drugs for the relief of classic and common migraine symptoms is sumatriptan, which binds to serotonin receptors. For optimal benefit, the drug is taken during the early stages of an attack. If a migraine has been in progress for about an hour after the drug is taken, a repeat dose can be given.
Biofeedback and relaxation training
Drug therapy for migraine is often combined with biofeedback and relaxation training. Biofeedback refers to a technique that can give people better control over such body function indicators as blood pressure, heart rate, temperature, muscle tension, and brain waves. Thermal biofeedback allows a patient to consciously raise hand temperature. Some patients who are able to increase hand temperature can reduce the number and intensity of migraines. The mechanisms underlying these self-regulation treatments are being studied by research scientists.
In another type of biofeedback called electromyographic or EMG training, the patient learns to control muscle tension in the face, neck, and shoulders.
Biofeedback can be practiced at home with a portable monitor. But the ultimate goal of treatment is to wean the patient from the machine. The patient can then use biofeedback anywhere at the first sign of a headache.
The antimigraine diet
Scientists estimate that a small percentage of migraine sufferers will benefit from a treatment program focused solely on eliminating headache-provoking foods and beverages.
Other migraine patients may be helped by a diet to prevent low blood sugar. Low blood sugar, or hypoglycemia, can cause headache. This condition can occur after a period without food: overnight, for example, or when a meal is skipped. People who wake up in the morning with a headache may be reacting to the low blood sugar caused by the lack of food overnight.
Treatment for headaches caused by low blood sugar consists of scheduling smaller, more frequent meals for the patient. A special diet designed to stabilize the body's sugar-regulating system is sometimes recommended.
There are two ways to approach the treatment of migraine headache with medications: prevent the attacks, or relieve symptoms after the headache occurs.
For infrequent migraine, medications can be taken at the first sign of a headache in order to stop it or to at least ease the pain. People who get occasional mild migraine may benefit by taking aspirin or acetaminophen at the start of an attack. Aspirin raises a person's tolerance to pain and also discourages clumping of blood platelets. Small amounts of caffeine may be useful if taken in the early stages of migraine. But for most migraine sufferers who get moderate to severe headaches, and for all cluster headache patients (see section "Besides Migraine, What Are Other Types of Vascular Headaches?"), stronger medications may be necessary to control the pain.
Several medications for the prevention of migraine have been developed in recent years, including serotonin agonists which mimic the action of this key brain chemical. One of the most commonly used medications for the relief of classic and common migraine symptoms is sumatriptan, which binds to serotonin receptors. For optimal benefit, the drug is taken during the early stages of an attack. If a migraine has been in progress for about an hour after the drug is taken, a repeat dose can be given.
Physicians caution that sumatriptan should not be taken by people who have angina pectoris, basilar migraine, severe hypertension, or vascular, or liver disease.
Another migraine drug is ergotamine tartrate, a vasoconstrictor which helps counteract the painful dilation stage of the headache. Other medications that constrict dilated blood vessels or help reduce blood vessel inflammation also are available.
For headaches that occur three or more times a month, preventive treatment is usually recommended. medications used to prevent classic and common migraine include methysergide maleate, which counteracts blood vessel constriction; propranolol hydrochloride, which stops blood vessel dilation; amitriptyline, an antidepressant; valproic acid, an anticonvulsant; and verapamil, a calcium channel blocker.
Antidepressants called MAO inhibitors also prevent migraine. These medications block an enzyme called monoamine oxidase which normally helps nerve cells absorb the artery-constricting brain chemical, serotonin. MAO inhibitors can have potentially serious side effects - particularly if taken while ingesting foods or beverages that contain tyramine, a substance that constricts arteries.
Many antimigraine medications can have adverse side effects. But like most medicines they are relatively safe when used carefully and under a physician's supervision. To avoid long-term side effects of preventive medications, headache specialists advise patients to reduce the dosage of these medications and then stop taking them as soon as possible.
Riboflavin for Migraine Headache Relief
By Loren Baker
Supplementing with relatively small amounts of riboflavin (vitamin B2) may reduce the severity and frequency of migraines in chronic sufferers, reports a study in Headache (2004;44:885-90). Previous studies showing that riboflavin can prevent migraines used 400 mg per day, which is at least 200 times the amount in a typical diet. In the new study, 25 mg per day appeared to be effective.
Riboflavin was originally considered for migraine prevention because researchers observed that migraine sufferers tend to have impaired energy production in brain cells, which riboflavin has the potential to enhance as it is a component of a key substance involved in the body's energy production. Magnesium, another nutrient important for producing energy, has already been shown to reduce migraine recurrence. In earlier studies with riboflavin, a very high dose was chosen, presumably to give the vitamin the best chance of working. While riboflavin does not appear to cause any significant adverse effects even at high doses, it is possible that taking large amounts of any single nutrient might cause subtle imbalances in body chemistry. For that reason, if lower doses are equally effective, they are preferable to higher amounts.
Fifty-two people suffering from recurrent migraines participated in the three-month study. They were randomly assigned to receive either a daily combination of riboflavin (400 mg), magnesium (300 mg), and the herb feverfew (100 mg), or 25 mg of riboflavin per day. Each of the three components of the combination product has been shown in earlier research to reduce the recurrence rate of migraines. A positive response was defined as a reduction in the frequency of migraines by 50% or more. Forty-two percent of participants responded to combination therapy and forty-four percent responded to low-dose riboflavin. In addition, the average headache severity and the number of days with tension headaches decreased significantly in the low-dose-riboflavin group, but not in the group receiving combination therapy.
Because there was no control group in the new study, one cannot rule out the possibility that the beneficial effects of low-dose riboflavin were due to a placebo effect. However, the researchers considered that possibility unlikely, because the effects of riboflavin were greater than those found with a placebo in previous migraine studies.
In addition to riboflavin, magnesium, and feverfew, coenzyme Q10 has been found in one preliminary trial to reduce the recurrence rate of migraines.
Dietary factors also appear to be important migraine triggers in susceptible people. For some, tyramine-containing foods such as certain wines and aged cheeses are the main offenders. For others, allergic reactions to common foods such as wheat, oranges, egg, coffee, tea, and beef seem to be the main triggers.
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