Migraine Headaches (Vascular Headaches)
A migraine is a severe, throbbing headache that lasts anywhere from a few hours to several days. There are two general types: classic and common. A classic migraine is heralded by a warning aura, or prodrome, of dizziness, mood changes, loss of appetite, and visual distortions such as flashing lights and blind spots. This prodrome stage is lacking in a common migraine, which develops suddenly when the blood vessels open up, or dilate, thus resulting in expanded flow of blood and producing the throbbing pain that is typical of this headache.
In both types, the pain generally begins in the temple area, and may quickly engulf one side of the head. In some cases, the pain will spread to the other side, or alternate from one side to the other. It is often accompanied by loss of appetite, nausea and vomiting, and increased sensitivity to light.
Migraines occur at any age, but are most common between ages 25 and 55. Women migraine sufferers outnumber men by about three to one, and there is a family history of the headaches in up to 60 percent of cases. Fluctuating levels of serotonin, a hormone-like body chemical that acts on blood vessels, sets a migraine in motion, but exactly how is unknown. Migraine triggers, which vary from person to person, include hormonal changes related to a woman's menstrual cycle, the weather, bright lights, stress, odors, alcohol, and chocolate and certain other foods.
Diagnostic Studies and Procedures
A doctor can usually diagnose migraines by questioning the patient about the nature of the headaches and what brings them on. However, he may order blood and urine studies and a CT scan or MRI to rule out a brain tumor and other possible causes.
Medical Treatments
There are three approaches to the medical treatment of migraines: Prophylactic drugs are taken daily to prevent the headaches. These include low doses of beta blockers, usually propranolol (Inderal); calcium-channel blockers such as verapamil (Calan) or diliiazem (Cardizem); tricyclic antidepressants such as amitriptyline (Elavil) or doxepin (Sinequan); anticonvulsants such as valproic acid (Depakene); and methysergide (Sansert). Abortive medications are taken at the first warning signs to ward off a fullblown headache. These include sumatriptan (Imitrex), a newer injectable drug that works specifically on the receptors in the brain. Older abonive drugs include ergot alkaloids, such as Cafergot and Wigraine, which also contain caffeine, and Ergo mar and Ergostat, which can be taken by placing a pill under the tongue. For some people, naproxen (Naprosyn), a nonsteroidal anti-inflammatory drug, also works. Fiorinal, a combination of butalbital, aspirin, and caffeine, is another alternative, but many doctors do not prescribe it because of its habit-forming barbiturate component. Drugs that relieve symptoms are used for severe, prolonged headaches. Commonly given by injection, they include Imitrex, dihydroergotamine (D.H.E. 45), prochlorperazine (Compazine), and a narcotic painkiller such as meperidine (Demerol). Many people try a combination of treatments before finding a regimen that works.
Alternative Therapies
Biofeedback. Patients are taught to redirect some blood flow from the head by learning to raise the temperature of their hands. Biofeedback also promotes relaxation, thereby reducing the stress that is related to headaches.
Herbal Medicine. Feverfew capsules, taken daily, have been shown to reduce the frequency of migraines in some people. Peppermint tea may help to relieve the nausea that often accompanies a migraine headache.
Nutrition Therapy. Keeping a food diary may help to identify foods that trigger migraines. Although caffeine is highly effective in aborting a migraine, it is also a common trigger and should be eliminated from the diet. Headache specialists also advise avoiding wine, anchovies, strong cheeses, processed meats and other foods that contain nitrites, fermented foods such as soy sauce, and anything prepared with MSG. A few studies have found that high-dose vitamins, especially vitamin A, can trigger a migraine. In contrast, taking 100 milligrams of niacin (nicotinic acid) during the prodrome stage may abort one by causing a brief dilation of constricted blood vessels.
Yoga and Meditation. Some people have learned to abort a migraine by practicing these relaxation techniques during the prodrome period.
Self-Treatment
The best approach is to identify and then avoid as much as possible factors 9 that trigger migraines. Often, adopting a lifestyle that provides adequate rest, regular exercise, and a meal schedule that prevents getting overly hungry goes a long way toward averting them. A strategy that can abort a migraine during the prodrome period is to take aspirin or ibuprofen with caffeine -- a cola or cup of strong coffee -- then lie down in a quiet, darkened room.
Other Causes of Headaches
Cluster headaches are similar to migraines, but lend to be more severe and shorter in duration and occur one 3 after another. Other types of headaches are caused by tension and sinusitis. A number of diseases, ranging from the common cold to brain tumors, also produce headaches.