1. Migraine
What Is It?
Migraine is a very common, but very particular, type of headache. Most people who have
migraine experience repeated attacks of headaches that occur over many years. The typical
migraine headache is throbbing or pulsating, and often is associated with nausea and changes in
vision. While many migraine headaches are severe, not all severe headaches are migraines, and
some episodes can be quite mild.
Up to 20% of people in the United States will experience migraine headaches at some point in
life. In about half of those, migraine headaches first appear during childhood or adolescence.
Two-thirds of people who get migraines are women, probably because of the influence of
hormones. Migraines also tend to run in families.
Despite years of research, scientists do not know exactly why migraines occur. The pain of
migraines is associated with swelling in blood vessels and irritation of nerves that surround the
brain. The brain chemical serotonin appears to play an important role in this process as it does in
other conditions, including depression and eating disorders.
Symptoms
A migraine usually is a throbbing headache that occurs on one or both sides of the head. The
headache typically is accompanied by nausea, vomiting or loss of appetite. Activity, bright light or
loud noises can make the headache worse, so someone having a migraine often seeks out a
cool, dark, quiet place. Most migraines last from 4 to 12 hours, although they can be shorter or
much longer. One unique feature of migraines is an unusual sensation that a migraine is about to
occur. This sensation is called a prodrome. Prodrome symptoms can include fatigue, hunger and
nervousness. Migraines also have typical aftereffects, such as a feeling of exhaustion that lasts a
day or two after a severe migraine headache has faded. Not all people who get migraines have
prodromes or aftereffects.

2. Another unique feature of migraines is an aura. In a typical aura, a person suddenly will develop
blurry or distorted vision or will see pulsating lights. These changes in vision will come and go
over 15 to 30 minutes and alert someone that a headache is about to begin. Sometimes, auras
affect the sense of hearing, smell or taste. Only some people who get migraines have auras, and
they don't accompany every headache. An aura also can occur without being followed by a
headache. Rarely, migraines can cause unusual neurological symptoms such as dizziness, loss
of vision, passing out, numbness, weakness or tingling.
Migraines can be triggered by certain activities, foods, smells or emotions. Some people are
more likely to experience migraines when they are under stress, while others develop migraines
when stress is relieved (for example, the day after exams or an important meeting). Women who
have migraines often find that their headaches occur or worsen around the time of their
menstrual periods.
Diagnosis
A doctor usually will diagnose migraine based on your history and symptoms. In most cases, a
physical and neurological examination will be entirely normal.
There are no special tests to diagnose migraines. For example, a computed tomography (CT) or
magnetic resonance imaging (MRI) scan of the brain usually will be normal. However, your
doctor may recommend additional testing if your headaches have features that are not typical for
migraines, or you develop other worrisome symptoms. If there is any doubt about your diagnosis,
your doctor also may recommend a consultation with a neurologist, a doctor specializing in
illnesses of the nerves and brain.
Expected Duration
Migraine headaches can last from a few hours to a few days. A typical migraine sufferer will have
several headaches each month. However, some people have only one attack in a lifetime, while
others have more than three attacks per week.
Prevention
Not all migraine headaches can be prevented. However, identifying your headache triggers can
help to reduce the frequency and severity of migraine attacks. Common migraine triggers
include:
• Caffeine (either using too much or cutting back on regular use)
• Certain foods and beverages, including those that contain tyramine (aged cheeses
and meats, fermented beverages); sulfites (preserved foods, wines); and
monosodium glutamate (MSG), a common flavor enhancer
• Stress, or relief from stress
• Hormone levels (menstrual cycles, hormone-containing medication such as birth
control pills or estrogen)
• Lack of sleep or disrupted sleep patterns
• Travel or changes in weather or altitude
• Overuse of pain-relieving medications
Even if you avoid all possible triggers, you are still likely to experience a migraine occasionally.
And many people who get migraines have frequent and severe headaches no matter how well
they avoid triggers.

3. Other methods some people have used to decrease their migraine attacks include biofeedback,
yoga, acupuncture, massage and regular exercise.
Treatment
How your migraines are treated will depend on the frequency and severity of attacks. People
who have a headache several times per year often respond well to nonprescription pain
relievers. However, other therapies should be considered when headaches are disabling enough
to interfere with usual activities and pain relievers don't work well.
There are two types of medications to treat migraines — drugs that are taken when a headache
starts (called abortive medications) and drugs that are taken every day to prevent migraines
(called preventive medications). The decision of whether to take a daily preventive medication or
abortive medications is a personal choice. In the past, daily preventive medication was
prescribed when a person had an average of two or more migraines per month. Today, reasons
for prescribing preventive medication include:
• Infrequent attacks that don't respond well to abortive medications
• Attacks that occur too often
• Overuse of abortive medications or common pain relievers
• Adverse reactions to abortive medications
• Cost, including costs related to missing work
• Migraines associated with unusual neurological symptoms (complicated migraines)
Abortive Medications
When possible, an abortive medication should be taken immediately after an aura or migraine
headache starts. This can be a challenge for people with frequent auras or headaches because
overusing abortive medications can lead to chronic daily headache, a headache disorder that
describes headaches that occur day after day without a specific cause or diagnosis. Several
nonprescription drugs and some relatively inexpensive prescription drugs are available. Aspirin,
ibuprofen (Advil, Motrin and other brand names) or naproxen (Aleve) taken at the earliest
warning may be enough to stop a full-blown headache. Drug combinations often work better than
drugs with a single active ingredient. One popular remedy for migraines is the combination of
aspirin, acetaminophen and caffeine (Excedrin) taken once or twice per month when symptoms
occur.
Other medications require a prescription. Examples include isometheptene (Midrin and other
brand names); medications called triptans, such as sumatriptan (Imitrex), naratriptan (Amerge),
zolmitriptan (Zomig) and rizatriptan (Maxalt); and medications called ergotamines, such as
sublingual ergotamine (Ergomar) and dihydroergotamine (Migranal). In addition, people who
experience nausea with or without vomiting also can take an anti-nausea pill or suppository.
If the headache becomes more intense and does not respond to one or two doses of an abortive
medication, pain relievers can be used to lessen the discomfort. The type and amount of pain
reliever you should take varies depending on how you responded to the medication previously
and how much other medications you took when the headache started.
Preventive Medications
Many drugs are listed as potentially useful to prevent recurrent migraine attacks. The following
are prescribed most frequently:

4. • Beta-blockers — Propranolol (Inderal) and nadolol (Corgard) have a good track
record of being safe and effective. Metoprolol (Lopressor) and atenolol (Tenormin)
are reasonable alternatives.
• Calcium channel blockers — Verapamil (Calan, Isoptin) is a popular choice,
especially when a person also has high blood pressure.
• Anticonvulsants — Of the drugs in this class, valproate (Depakote and other brand
names) and topiramate (Topamax) have the best evidence to support using it for
prevention.
• Tricyclic antidepressants — These medications are very effective, but often have
troublesome side effects such as sedation, blurred vision, dry mouth and
constipation. The first choice is often amitriptyline (Elavil). Nortriptyline (Norpramin)
and others also can be tried.
• Serotonin antagonists — Methysergide (Sansert) has been available for many
years and is very effective. However, it has side effects that are potentially very
serious and is used less often now that doctors have many other good choices.
Some people with migraine have very frequent headaches, sometimes every day. This form of
migraine, called chronic migraine, is difficult to treat. The newest treatment is Botox
(onabotulinumtoxinA). The doctor gives multiple injections around the head and neck once every
12 weeks. It is approved for people that experience migraine headaches more than 14 days per
month.
Preventive medications (except for Botox injections) need to be taken every day to be effective.
In choosing which medication to try first, you and your doctor will evaluate the benefits and the
possible side effects. For example, if you have both high blood pressure and migraine, a calcium
channel blocker or beta-blocker might be the best choice to treat both. However, if you have
asthma, your doctor might not prescribe a beta-blocker.
Don't be discouraged if your first choice of preventive medication does not meet your
expectations. You and your doctor may need to try three or four different strategies to find the
best one for you.
When To Call a Professional
If you have a history of migraine, you should contact your doctor if you develop headaches that
differ from your usual headache or other migraine symptoms. Examples include:
• Headaches that get worse over time
• New onset of migraine in a person over age 40
• Severe headaches that start suddenly (often known as thunderclap headaches)
• Headaches that worsen with exercise, sexual intercourse, coughing or sneezing
• Headaches with unusual symptoms such as passing out, loss of vision, or difficulty
walking or speaking
• Headaches that start after a head injury
In addition, you may want to see your health care professional if you have headaches that do not
get better with over-the-counter medications; severe headaches that interrupt work or the
enjoyment of daily activities; or daily headaches.
Prognosis

5. Most people who develop migraines will continue to have intermittent headaches over many
years. However, many people learn to control or to live with their headaches. In addition,
migraines often diminish when people reach their 50s or 60s

6. Most people who develop migraines will continue to have intermittent headaches over many
years. However, many people learn to control or to live with their headaches. In addition,
migraines often diminish when people reach their 50s or 60s