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Vascular Headaches - Migraine

Overview, Causes, & Risk Factors

A migraine is a moderate to severe headache affecting one or both sides of the head.

What is going on in the body?

Migraines are believed to be caused by changes in the blood flow in the vessels of the head. Changes in blood flow to different areas of the brain can produce a variety of symptoms.

What are the causes and risks of the condition?

The tendency for migraine headaches is probably inherited. Other factors that put a person at risk for migraines include:

  • bright lights
  • certain foods and drinks, such as caffeine, chocolate, or alcohol
  • head injury or neck injury
  • hormonal changes in women, especially during menstruation
  • stress
  • poor sleep habits
  • weather changes

    • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Signs and symptoms of migraine can include:

  • confusion
  • depression
  • difficulty swallowing
  • drowsiness
  • headache that can last for hours or days on one or both sides of the head
  • irritability
  • loss of coordination
  • nausea
  • numbness or tingling in hands and feet
  • paralysis anywhere in the body
  • ringing in the ear
  • sensitivity to sound, light, or smell
  • sensory loss, such as loss of smell or taste
  • trouble remembering things
  • vomiting
  • weakness

    • Diagnosis & Tests

    How is the condition diagnosed?

    According to the International Headache Society, migraine is diagnosed when a person has the following:

  • at least five headache episodes, each lasting 4 to 72 hours
  • nausea or sensitivity to light and sounds
  • at least two of the following: one-sided pain, pulsing pain, moderate or severe pain, or pain aggravated by physical activity

    • There are no blood tests for migraine.

    Usually a migraine headache can be diagnosed with a complete physical examination and a medical history that includes information about the person's headache experiences. Doctors seldom use tests to diagnose a migraine. They may order tests to rule out other possible causes of the headache. These tests may include:

  • biopsy of the arteries in the head. In this test, a doctor collects a small sample of the artery and examines it under a microscope.
  • a cranial CT scan, which is an examination of the head using a special three-dimensional X-ray
  • a cranial MRI, which is a special three-dimensional image made using a magnetic field
  • an electroencephalogram, also called an EEG, which is a recording of brain waves
  • an electromyogram, also called an EMG. This test is a recording of the electrical activity of selected muscle groups.
  • skull X-rays
  • a spinal tap, where a small amount of cerebrospinal fluid is removed from the spine using a thin needle
  • testing of levels of certain drugs or toxins in the blood

    • Prevention & Expectations

    What can be done to prevent the condition?

    A person can help prevent migraine headaches by:

  • avoiding his or her personal triggers
  • exercising regularly
  • limiting stress

    • A trigger is different from a symptom. A symptom is a condition that accompanies or results from a migraine headache. A trigger is actually something inside or outside the body that can cause or aggravate headache pain. It can be related to something the person does or eats. Other triggers include changes in the weather, fatigue, light, noise, and many other factors.

    Triggers can include:

  • any type of medicine, including prescription medicines, over-the-counter medicines, and herbal remedies
  • bright or flickering lights
  • changes in the seasons
  • changes in the weather
  • excessive or repetitive noises
  • high altitudes
  • jet lag
  • specific smells

    • Sometimes a headache is triggered by a combination of food and drink. The National Headache Foundation Listing of Trigger Foods includes:

  • alcoholic beverages
  • any pickled, fermented, or marinated food
  • bananas
  • broad beans, lima beans, fava beans, and snow peas
  • caffeinated beverages, such as tea, coffee, and colas
  • chicken liver or pate
  • chocolate
  • citrus foods and drinks
  • figs, raisins, papayas, avocados, and red plums
  • foods or beverages that contain aspartame and phenylalanine
  • freshly baked yeast products
  • meats that may contain nitrates, such as bacon, sausage, bologna, salami, pepperoni, summer sausage, or hot dogs
  • monosodium glutamate, also known as MSG, which is found in meat tenderizers, seasoned salt, and soy sauces
  • nuts or nut butters
  • onions
  • pickled or dried herring
  • ripened or aged cheeses, including cheddar, Emmenthaler (Swiss), Stilton, Brie, and Camembert
  • sour cream
  • sourdough bread

    • Medicines used to prevent a migraine headache include:

  • anticonvulsants such as valproic acid and gabapentin
  • beta-blockers such as propranolol and nadolol
  • calcium channel blockers such as verapamil
  • cyproheptadine
  • lithium
  • methysergide maleate
  • tricyclic antidepressants such as amitriptyline and nortriptyline

    • What are the long-term effects of the condition?

    Severe and frequent migraine headaches can greatly affect a person's ability to function. A migraine may rarely be linked with a stroke caused by blockage of blood flow in blood vessels.

    What are the risks to others?

    Although migraines are not catching, 70% of migraine sufferers do have a family history of migraine.

    Treatment & Monitoring

    What are the treatments for the condition?

    Treatment for acute migraine attacks includes:

  • butalbital/APAP/caffeine
  • dihydroergotamine
  • isometheptene/dichloralphenazone/APAP
  • nonsteroidal anti-inflammatory drugs called NSAIDs, such as ibuprofen and naproxen
  • other analgesics, such as hydrocodone/APAP
  • triptans, such as sumatriptan or zolmitriptan

    • Nonmedicine treatments include:

  • acupuncture
  • aromatherapy
  • avoiding migraine triggers
  • biofeedback
  • chiropractic
  • electromagnetic therapy
  • exercising regularly
  • herbal remedies
  • hypnosis
  • massage therapy
  • physical therapy
  • stress management

    • Other than avoiding one's triggers, the non-medicine treatments listed above may or may not be effective. A person should always talk with the doctor first before trying any of these treatments for migraine headache.

    What are the side effects of the treatments?

    Side effects of medicines used to treat migraines include stomach upset, drowsiness, and allergic reactions. Nonmedicine treatments generally have few or no side effects.

    What happens after treatment for the condition?

    After an effective treatment for migraine is in place, the person will usually feel like resuming normal activities. Rarely, complicated migraines can cause a stroke.

    How is the condition monitored?

    A person with migraines may be asked to keep a headache diary. Any new or worsening symptoms should be reported to the doctor.

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