Migraine is a type of headache . See also classic migraine (migraine with an aura); common migraine (migraine without an aura); mixed tension migraine (has features of both migraines and tension headache ).

Alternative Names

Headache - migraine

Causes, incidence, and risk factors

The cause of migraine is not known. Migraine headaches are associated with abnormalities in blood flow through the brain, which is probably responsible for many of the symptoms. However, it is not known with certainty why this happens or how it causes these symptoms. Classic migraine is preceded by an aura, which is a group of warning symptoms that indicates a pending migraine headache. Common migraine does not have an associated aura. Migraine headaches affect about 6 out of 100 people. They are a common type of chronic headache. Migraines most commonly occur in women and usually begin between the ages of 10 and 46. They may run in families in some cases. Classic migraine accounts for about one-sixth of all migraines. Common migraine and other (rare) forms account for the rest. Risk factors include a strong family history of migraine, some medical conditions, and the use of certain medications (such as birth control pills).

Signs and tests

Migraine headache may be diagnosed by the health care provider based on the pattern of symptoms, history of migraines in the family, and the response to treatment. A physical examination shows no detectable abnormalities. Sometimes an MRI is obtained to rule out other causes of headache upon initial investigation. In the case of complicated migraine, an EEG may be needed to exclude seizures.

Treatment

The treatment of migraine varies, depending on the frequency and severity of symptoms. Most patients find that resting in a quiet, darkened room can reduce the severity of symptoms. Drinking a lot of fluids is important, especially if there is vomiting. Nausea can be treated with anti-emetics. Over-the-counter analgesics may reduce pain if they are taken early in the development of the headache. Many patients with mild migraines only need medications like acetaminophen, ibuprofen, or aspirin to treat their headaches. Medications that constrict the arteries inside the head (such as ergotamine tartrate preparations) may be used alone or in combination with other drugs such as caffeine (Cafergot), acetaminophen, and mild sedatives. A class of drugs called triptans are also effective in the treatment of migraine. Various drugs from this class are available as self-administered injections under the skin, pills, tablets that dissolve in the mouth, and nasal sprays. These tend to be more effective if given at the beginning of a migraine. Another strategy for migraine treatment is using medications that reduce the frequency of the headaches. These drugs are not helpful once the headache begins. Most of these medications were designed for use in other medical problems, but they are effective in preventing migraines in some patients. These medications include various beta-blockers, calcium channel blockers, anti-depressants, anti-epilepsy drugs, and various combinations of such drugs. Several medications may need to be tried before a medication that is effective in preventing migraine is found. The use of botulinum toxin has gained more recognition as a migraine prevention treatment. Modifying diet, sleep habits and other personal activities may also reduce the frequency of migraine headaches. Factors that have triggered a migraine in the past should be avoided whenever possible. A "headache diary" that lists diet, sleep pattern, stressful incidents, and other factors can help patients determine what their personal triggers are. Some women may find that birth control pills are a trigger for them and may wish to choose another form of contraception.

Expectations (prognosis)

Each patient responds differently to treatment. Some patients have rare headaches that require little to no treatment, while other patients often require hospitalization or the use of numerous medications. Different environmental factors may cause headaches to improve or worsen with time.

Complications

Rarely, people with severe migraines may have a stroke related to their headaches.

Calling your health care provider

See your health care provider if this is the first time that you have had symptoms of migraine. Call for an appointment if migraine symptoms are severe, persistent, recurrent or accompanied by other symptoms. Also call if there is a change in the nature of your headaches, if previously effective treatments are no longer helpful, or if symptoms indicating side effects of medications occur (e.g., irregular heartbeat , pale or blue skin color, extreme sleepiness or sedation, persistent cough , depression , fatigue , nausea , vomiting , diarrhea , constipation , stomach pain or cramps, dry mouth, extreme thirst , or others). Call your health care provider if you are likely to become pregnant. (Some medications should not be taken when pregnant.)

Prevention

In people who tend to have migraines, preventive medications may reduce the number of headaches. Avoid factors that have triggered a migraine in the past, if possible.