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Migraine headache

What is it?

A migraine is a headache that causes severe pain and other symptoms. Migraines can affect your ability to do everyday activities. Migraines may last anywhere from a few hours to several days. Some people only have migraines once or twice a year. Others may have them as often as one or more times a week. Some people have warning signs before their migraines start. Migraines that have warning signs before they start are called classic migraines. Migraines that start without warning signs are called common migraines.

Why do migraines happen? Migraines are thought to be a type of vascular (VAS-ku-lar) headache. Vascular headaches are caused by problems with the blood vessels in the head. Migraines may start when blood vessels in your head widen or swell. This can happen for many reasons. For example, women are more likely to have migraines than men because of the female hormone called estrogen. Migraines can also run in families.

What are some things that can trigger (start) migraines? Things that trigger migraines are different from person to person. Over time, you may learn that you get migraines after certain foods or experiences. Keeping a daily diary or calendar of your migraines may help you learn what triggers them. Some things that may trigger migraines include:

  • Bright or flashing lights, loud noises, or strong smells (such as chemical fumes).
  • Certain foods or drinks like chocolate, hard cheese, red wine, or other alcoholic drinks. Things in foods like nitrates or gluten may also cause migraines. Nitrates are found in many processed meats, such as bacon, hot dogs, and deli meats. Gluten is a protein found in wheat and other grains. Things added to foods, such as MSG or artificial sweeteners, may cause a migraine to start. Caffeine, which is often used to treat migraines, can also trigger them.
  • Changes in the weather may trigger migraines. For example, hot and humid days or bright sunlight may trigger them. Sudden changes in air pressure may also cause a migraine to start.
  • Eye strain.
  • Hormone changes in women, such as changes that happen during a monthly period.
  • Medicines, such as birth control pills.
  • Oversleeping or not getting enough sleep.
  • Skipping meals or going too long without eating.
  • Stress.
  • Smoking or being around smoke.

What are the warning signs that a migraine is about to start? Classic migraines have warning signs before the headache starts. These signs usually start 15 to 60 minutes before the headache does. However, some people notice changes in their body up to three days before the start of a migraine. There are a wide variety of warning signs which are different from person to person. The more common migraine warning signs include:

  • Unusual tiredness or frequent yawning.
  • Visual changes, often called auras, that happen before a migraine starts. Auras may include:
  • Blind spots that last for a short time.
  • Seeing bright spots, lines, or other things that are not there (hallucinations).
  • Your vision may blur or things may look different.
  • Tingling in an arm or leg.

Signs and Symptoms:

A migraine headache usually begins as a dull ache. It may begin around the eye or temple (on the side of the forehead near the hairline). The pain may increase to the point where you cannot do everyday activities. The pain may be on one or both sides of your head. Migraine pain may be throbbing, pulsing, or pounding. It is common to have nausea (feeling sick to your stomach) and vomiting before and during a migraine headache. You may be more bothered by light, noise, or smells.

Wellness Recommendations:

You may need to make lifestyle changes when you find out what causes your headaches. Learn how to control your stress.

Medical Care:

If your headaches are new or you have had them but they have changed, tests may be done to be sure you do not have a serious health problem. Caregivers may give you tips on preventing headaches. You may also need medicine to prevent or treat the headaches. Pain medicine will work better if you take it when the headache starts.

HOW TO TREAT YOUR SYMPTOMS:

The following may be helpful and may decrease your need for pain medicine:

Dietary Measures:

  • Keep a record of what you ate before each headache. Avoid foods and drinks that seem to cause an attack. Chocolate, cheese, nuts, cured meat (like bacon), and red wine are common causes. Eating more sugar than normal may also cause a migraine headache.
  • If the migraines are caused by hormonal changes, increased soy in your diet may be helpful. Soy is a good source of phytoestrogens that are estrogen-like compounds in plants. Research has not yet proven how phytoestrogens may prevent migraine headaches.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

  • Butterbur (Petasites officinalis) may prevent migraine attacks from happening when Butterbur is taken everyday.
  • Feverfew (Tanacetum parthenium) may be helpful for migraine headaches and has been studied in people.
  • Ginger (Zingiber officinale) has been used for many years, but has not been studied in people who have migraine headaches.

Supplements:

  • Calcium with vitamin D may decrease migraine attacks in post enopausal women or women with premenstrual syndrome (PMS).
  • Fish oil (EPA) has been used, but has not been studied in people who have migraine headaches.
  • Magnesium may help you from getting migraine headaches and has been studied in humans.
  • Vitamin B2 (Riboflavin) prevents migraine headaches and has been studied in humans.
  • Vitamin D with calcium may decrease migraine attacks in post menopausal women or women with premenstrual syndrome (PMS).

Complementary Therapies:

  • Acupuncture can help migraine headaches.
  • Chiropractic can be helpful if the headache is triggered by a muscle or bone problem.
  • Relaxation therapies, such as biofeedback or guided imagery, can decrease migraine headache pain.

Other ways of treating your symptoms:

Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

  • You would like medicine to treat migraine headaches.
  • Your symptoms have not gone away or improved by these self-help measures.
  • You have questions about what you have read in this document.

SEEK CARE IMMEDIATELY IF:

  • You have a headache that seems different or much worse than your "normal" migraine headache.
  • You have a headache that gets worse or lasts more than 24 hours even though you are taking medicine or using other treatments for the headache.
  • You faint, develop weakness on one side of your body, have numbness, double vision, talking problems, or neck pain or stiffness.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss the treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.

References:

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15. Thys-Jacobs S: Vitamin D and calcium in menstrual migraine. Headache 1994a; 34(9):544-546.

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Last Updated: 4/4/2014

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