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Migraines are extremely painful, recurring headaches that are sometimes accompanied by other symptoms such as visual disturbances -- seeing an aura -- or nausea. There are two types of migraine -- migraine with aura, formerly called common migraines, and migraine without aura, formerly called classic migraines.
If you have a migraine with aura, you may see things such as stars or zigzag lines or have a temporary blind spot about 30 minutes before the headache starts. Even if you don't experience an aura, you may have other warning signs in the period before the headaches starts, such as a craving for sweets, thirst, sleepiness, or depression.
Although there is no cure for migraines, you can manage the condition by reducing the frequency of attacks and reducing pain once an attack starts.
Signs and Symptoms
The headache from a migraine, with or without aura, has the following characteristics:
These symptoms may happen at the same time or before the headache:
Symptoms that may linger even after the headache is gone:
Researchers aren't sure what causes a migraine, although they know it involves changes in the blood flow in the brain. At first, blood vessels narrow or constrict, reducing blood flow and leading to visual disturbances, difficulty speaking, weakness, numbness, or tingling sensation in one area of the body, or other similar symptoms. Later, the blood vessels dilate or enlarge, leading to increased blood flow and a severe headache.
There also seems to be a genetic link to migraine headaches. More than half of migraine patients have an affected family member. Migraine triggers can include the following:
Your doctor will take a detailed medical history so he or she can tell whether you have a migraine or another kind of headache, such as a tension or sinus headache. Your doctor will ask questions about when your headaches occur, how long they last, how often they come on, the location of the pain, and any symptoms that accompany or precede the headaches. Sometimes it helps to keep a diary about your headaches before seeing the doctor, so you'll have an accurate recording of how often they happen. (See Lifestyle section for what information to include in a diary.)
Tests your doctor may order, depending on your symptoms and exam, include:
Call 911 or go to the emergency room if you have the following symptoms:
Treatment for migraines is aimed at preventing them from happening and reducing pain once an attack starts.
You can control your migraines with a combination of medications, lifestyle changes, and complementary therapies. Biofeedback (see also: Mind-body medicine) may help you control the initial contraction of blood vessels. Relaxation techniques may reduce both the frequency and intensity of attacks.
Keeping a migraine diary, particularly when you first begin to have migraines, can help identify the triggers for your headaches so you can avoid them. When a migraine happens, write down the date and time it started. Note what you ate for the preceding 24 hours, how long you slept the night before, what you were doing just before the headache, any unusual stress in your life, how long the headache lasted, and what you did to make it stop.
Other lifestyle measures that may reduce the number of migraines include:
Medications for migraines can be classified in two major categories: those designed to prevent attacks, and those designed to relieve pain.
Drugs for Prevention
Your doctor may prescribe medications to prevent migraines if you have two or more migraines per month, use pain relievers more than twice a week, or if your symptoms are especially debilitating. Depending on your condition and medication, your doctor may recommend taking the medication daily or when a known trigger is about to happen.
Drugs for Treatment
To work, these medications should be taken as soon as you feel a migraine coming on.
Other medications used to treat the headache pain or associated symptoms:
Nutrition and Dietary Supplements
The following foods may trigger migraine headaches:
If you think that any of these foods cause your migraines, try eliminating all the items on this list from your diet and then reintroducing them one at a time. Pay close attention to when the number of headaches increases after eating certain foods. Then you know which trigger foods to avoid. You may also want to consider food allergy testing to determine your specific sensitivities or triggers.
Preliminary research indicates that these supplements may also help prevent migraines, although more research is needed to say for sure:
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.
Although there are no scientific studies showing that these herbs work, they are sometimes suggested to treat migraines and other types of headaches. People who take blood-thinning medications or who have bleeding disorders should not take these herbs:
Acupuncture has been studied as a treatment for migraine headache for more than 20 years. While not all studies have shown that it helps, researchers agree that acupuncture appears safe and that it may work for some people. A study published in 2003 suggest that getting an acupuncture treatment when migraine symptoms first start works as well as taking the drug Imitrex. As symptoms continue, however, the medication works better than acupuncture.
In addition to needling treatment, acupuncturists may recommend lifestyle changes, such as suggestions for specific breathing techniques, qi gong exercise, and changes to your diet.
Several clinical trials indicate that spinal manipulation therapy may help treat migraine headaches. In one study of people with migraines, 22% of those who received chiropractic manipulation reported more than a 90% reduction of attacks. Also, 49% reported a significant reduction of the intensity of each migraine.
In another study, people with migraine headaches were randomly assigned to receive spinal manipulation, a daily medication (Elavil), or a combination of both. Spinal manipulation worked as well as Elavil in reducing migraines and had fewer side effects. Combining the two therapies didn't work any better.
In addition, researchers reviewed 9 studies that tested chiropractic for tension or migraine headaches and found that it worked as well as medications in preventing these headaches.
However, not all of these studies were good quality, and they varied in the techniques used. More research is needed to say for sure whether chiropractic can prevent migraines.
Massage and Physical Therapy
Reflexology is a technique that places pressure on specific "reflex points" on the hands and feet that are believed to correspond to areas throughout the body. Some early studies suggest it may relieve pain and allow people with migraines to take less pain medication. However, more research is needed. Practitioners believe reflexology helps you become more aware of your own body signals, which might help you sense the signals that a migraine is about to occur -- before pain starts. They also believe reflexology helps improve general well-being and energy level.
One of the most common reasons people seek homeopathic care is to treat chronic headaches. However, only 1 out of 4 studies included in a scientific review found that individually prescribed homeopathic remedies significantly reduced the frequency, severity, and duration of migraines. Some of these effective remedies are listed below. Professional homeopaths may also recommend various treatments based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account the individual's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
The following are some of the remedies found to be effective:
Homeopaths may also prescribe the following remedies based on their knowledge and clinical experience:
Reducing and learning to cope with stress may help reduce the number and intensity of your headaches. Techniques that can help include:
Many of the medications, herbs, and supplements used to prevent or treat migraines should not be used if you are pregnant. Talk to your doctor before using any medication, over-the-counter or prescription, or any complementary therapy before or during your pregnancy. Some doctors may recommend treating mild to moderate attacks during pregnancy with acetaminophen (Tylenol).
Warnings and Precautions
Use medications only as directed. Using some medications on a regular basis can cause rebound headaches.
Call your doctor if you experience a new headache, a change in quality of a previous headache or headache pattern, or if a medication that usually takes away the pain no longer works.
Prognosis and Complications
Migraine headaches generally don't pose a threat to your overall health, although they can be chronic, recurrent, frustrating, and interfere with your day to day life. Stroke is an extremely rare complication from severe migraines. Other studies show that migraine headaches are associated with heart disease. People who have migraines are up to 4 times more likely to suffer from depression. Migraine patients also have an increased rate of anxiety and panic disorders.
Many people find that migraines go into remission -- meaning that they stop for a long time and happen only very infrequently -- or even disappear altogether, especially as you get older. For women, this may be related to lower levels of estrogen after menopause.
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Review Date: 10/14/2011
Reviewed By: Reviewed by Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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