Migraine is a chronic neurological disorder which is characterized by recurrent, moderate to severe, one-sided headaches which usually last for about 2 to 72 hours. These headaches are associated with nausea, vomiting, sensitivity to light and sound and are aggravated by physical activity. Most people with migraines also have an aura which is described as visual, sensory, language, or movement disorder occurring just before the onset of a migraine.
Migraines are believed to be due to genetic, hormonal and/or environmental factors. They run in the family and sometimes fluctuating hormones are the cause. That is why more girls during puberty have migraines as compared to boys and why this is seen more in the adolescent age group. Other hormonal factors include onset of menstrual periods, use of oral contraceptives, pregnancy and menopause. Migraines may be associated with psychological conditions such as depression, anxiety and bipolar disorders. Triggers such as certain foods or conditions can cause a headache. Sometimes indoor air quality can also set off migraines.
Usually a migraine has four phases. The Prodrome Phase, which occurs hours or days before the headache; Aura Phase, which occurs immediately before the person has a headache; Pain Phase, which presents with headache; and the Postdrome Phase, which is like having a hangover and may include head pain, thinking difficulties, stomach problems, mood changes and weakness.
Diagnosis of migraine is made after excluding other dangerous reasons for headache. Once a diagnosis is made, the person should be taught about prevention, which includes medications, nutritional supplements, and lifestyle alterations.
The first line medications usually used for prevention of migraines are Topiramate, Divalproex, Sodium Valproate, Propranolol, and Metoprolol. Timolol, which reduces the frequency of migraine attack, and Frovatriptan, for prevention of menstrual migraines may be used as appropriate. Amitriptyline and Venlafaxine may also be used in patients with depression. Botox may also be used. Use of Gabapentin is controversial because of the addictive, mind altering nature, behavior changes, and its current use in addictive behavior. Alternate therapies can also be used such as acupuncture, chiropractic manipulations, and use of certain vitamins.
First line medication treatment for migraine headache include Non-steroidal Anti-Inflammatory Drugs (NSAIDS such as Ibuprofen), and Acetaminophen with Acetylsalicylic Acid and caffeine are found to be effective. In an acute attack, Triptans are very effective in treating both the pain as well as the nausea in about 75% of people. Triptans come in different forms - injectable, nasal sprays or oral dissolving tablets. These medications do have some side effects. Another treatment used is a single dose of intravenous Dexamethasone, which is a steroid. It is very important to note that opiates and barbiturates are not recommended in the treatment of migraine, as they give hyperalgesia, rebound and overuse headache, and can lead to chronic or daily headaches.
Treatment of migraines is usually controlled by avoiding triggers and taking care of the acute symptomatic problems, for example, using medications for nausea. For light and sound sensitivity, lay down in a dark, quiet, calm place.
The goal of treatment is to reduce the frequency, painfulness and the duration of a migraine. Much research is being done and the most effective treatment remains NSAIDS and Triptans. Individuals should maintain a diary to help understand his/her migraine and should take steps to prevent medication overuse headaches, as these can become debilitating and lead to a lot of problems.
Editor's note:?Promila Timothy is a family practice and addiction medicine specialist at Baraga County Memorial Hospital Physician Group