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What is it?

Migraine headaches are the second most common  type of headache. It affects many people, causing periods of pain and sometimes debilitation.

Who gets it?

More than 23 million people in the United States alone suffer from migraine headaches. They usually affect women more than men (about 75% of the people who experience migraines are women).

What causes it?

The mechanism behind migraines isn’t completely understood. There are a few theories:

1. It might be related to blood vessels in the brain – One theory says that they constrict (for unknown reasons) and then dilate too much, with the dilatation causing the pain.
2. There might be a depression of the activity of neurons in certain parts of the brain, leading to inflammation of the area.
3. It might be related to a substance called serotonin, which causes the change in blood vessels mentioned above.

There are other theories, but the bottom line is the same – no one really knows.

How does it feel?

It’s important to distinguish migraine headaches from other types of headache, since other types may be life threatening, while migraine headaches are usually a benign condition.

Migraines. They suck. Photo by annia316

Migraine headaches come in the form of attacks – this means that between attacks you don’t feel anything. These attacks usually occur in the morning, but can happen at anytime. These are the symptoms that usually come with it:

1. Pain – It usually begins gradually and intensifies over the course of minutes to hours. It also resolves gradually. The pain usually lasts a few hours, but it can last up to 3 days. It can be dull and deep, or it can be throbbing or pulsatile (meaning you’ll feel it “knocking” in your head). In most cases it affects only one side of the head There are things that classically make migraine headaches worse:
   a. Exposure to light – People prefer being in a dark, quiet place white experiencing an attack.
   b. Moving the head rapidly, such as in sneezing.
   c. Noise
2. Aura – This is a visual phenomenon that usually comes before the headache begins. It lasts for up to 60 minutes. These are things you “see” before the headache, and include things like flashing lights or bright spots, zigzag lines.
   An aura doesn’t have to be visual – people can have a feeling of “pins-and-needles” in their hands and arms, or alongside the mouth and nose. They can also smell or hear things that aren’t there or have other neurological symptoms.
   Example of a visual aura in a migraine attack.
3. Nausea and vomiting – Are common in migraine attacks.
4. Other things – Other things that might accompany a migraine attack include a runny nose and tears.

1. If the headache start suddenly and is very severe
2. If the headache is persisting beyond 72 hours
3. If the headache first  appears in life after the age of 55
4. If the headache appears after an injury to the head
5. If there is also a stiff neck, fever or a rash
6. Headaches that wake you up at night
7. If the headache involves weakness, dizziness, loss of balance or falling, paralysis, problems speaking, confusion, seizures, inappropriate behavior, double vision

In any of these cases, seek medical care immediately.

Usually no special lab tests are needed. Usually it’s enough for the doctor to hear the description of a headache that contains an aura, comes in attacks, lasts for up to 72 hours and involves vomiting, to know that this is a case of a migraine headache.

If the doctor suspects a different problem, they might run some tests.

How is it treated?

Treatment can be given at the time of the attack or beforehand, to prevent it.

1. Treating the attack itself – This is best if done at the first sign of the attack (when the aura appears or when the pain just starts). The treatment includes a few types of drugs:
   a. Pain medications – Such as aspirin, Advil and others.
   b. Drugs that stop the vomiting
   c. Triptans – This is a special type of drug that was specially created to treat migraine headaches. Examples include Imitrex, Zomig, Amerge, Maxalt, Axert, Relpax or Frova.
2. Treatments to prevent an attack from coming – There are many types of drug here, that usually take 3-4 weeks of taking them to see the benefits. Consult your doctor about these (they are not included here because of a lot of medical mumbo-jumbo that’s needed to explain how they work).

What happens after treatment?

Most people can bring their attacks under control by using the above mentioned drugs and by avoiding triggers (see ahead), although some people with severe migraines don’t respond well to drugs.

There are some things thought to bring about a migraine attack in people susceptible to it. These are called triggers. Avoiding them can help avoid the attack. They include:

1. Chocolate
2. Red wine
3. Cheese
4. Monosodium glutamate (a type of food additive, found frequently in Chinese food)
5. Aspartame (Nutrasweet)
6. Caffeine
7. Nuts
8. Strong odors, flickering lights or a strong light, noise
9. Not eating
10. Poor sleep habits
11. Sometimes the monthly period, or replacement hormones

There are also other triggers. The important point is to find out which trigger causes your migraine, and to avoid it if possible.

Do you suffer from migraines or know someone who does? Share in the comments.

What next?

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