Understanding Migraine Headaches

Patients should understand how to avoid their triggers and treat painful migraine attacks.

What Is a Migraine?

Just about everyone has headaches, but a migraine is not just a bad headache. A migraine headache is a complex condition of the nervous system. It is often described as an intense pulsing or throbbing pain that usually occurs in 1 area of the head. Migraine attacks may cause severe, debilitating pain for hours to days, necessitating the need to retreat to a dark, quiet place.

A migraine headache is often accompanied by additional symptoms, such as nausea, vomiting, and sensitivity to light and sound. About one-third of affected people can predict the start of a migraine because they experience sensory warning symptoms (also called “aura”). These early-warning symptoms may include flashes of light, blind spots, zig-zag lines, temporary loss of vision, or tingling in the arm or leg.

What Causes Migraines?

Scientists still do not know for certain what causes migraines. Migraines could involve disturbances in nerve pathways and brain chemicals that affect blood vessels near the brain’s surface. The blood vessels swell, sending pain to the brain stem (an area that processes pain information). A genetic predisposition to migraine may exist, as it often runs in families.

Recurring migraine attacks are caused by a number of different triggers. Recognizing and recording individual triggers in a headache diary or calendar may be useful in helping to prevent future attacks.

How Can I Treat My Migraine Headache?

There is no cure for migraine. There are 2 ways to approach treating migraines with medicine. You can take medicine during migraine attacks to relieve symptoms (acute treatment) or you can take medicine daily to prevent or reduce attacks and lessen the intensity of the pain (preventive treatment).

Acute treatment consists of over-the-counter pain relievers (or analgesics) such as acetaminophen, aspirin, and ibuprofen. If these products do not work for you, your doctor may prescribe medication that may include a stronger analgesic and/or a drug that acts more specifically on the cause of migraines. These migraine-specific treatments may include drugs from the “triptan” class (such as sumatriptan, almotriptan, or zolmitriptan), or “ergot-type” products such as dihydroergotamine nasal spray. If needed, drugs for nausea and vomiting may also be prescribed. The sooner these treatments are administered, the more effective they are.

If you have frequent migraine attacks, if your attacks do not respond consistently to migraine-specific treatments, or if acute medications are ineffective or cannot be used because of other medical problems, then preventive treatment may be prescribed. Certain drugs originally developed for epilepsy, depression, or high blood pressure have been shown to be effective in preventing migraine attacks. Botulinum toxin A, which is injected into muscles in the head and neck, has also been shown to be effective in prevention of chronic migraine.

What Are Rebound Headaches?

Rebound headaches (or medication-overuse headaches) are caused by frequent use of headache medication. They are also the most common cause of progression from episodic migraine (where attacks occur occasionally or infrequently) to chronic migraine (where attacks occur more frequently or regularly).

If you use acute over-thecounter and prescription drugs too often (more than 2-3 days per week), it can create a headache-worsening pattern that results in more headaches and the need to take more medicine. This pattern is harmful, and while in this cycle, other treatments often don’t work. The only way to break this cycle is to stop the pattern of overuse, which should be done under a doctor’s care.

Also, overuse of certain antiinflammatory drugs, such as ibuprofen or naproxen sodium, may cause stomach irritation and even ulcers. Excessive use of acetaminophen may increase the risk of liver problems in certain people.

Can Migraines Increase the Risk of Stroke?

Although the symptoms of severe migraine attacks can cause fear that you are having a stroke, the likelihood of a migraine causing a stroke is small. It is true, however, that in people younger than 40 years (or in someone with long-term, untreated migraine with aura), the most common associated factor for stroke is migraine.

Migraine sufferers should avoid other risk factors for stroke, such as smoking, high- cholesterol diets, estrogen use, and untreated high blood pressure. Individuals who experience stroke-like symptoms (numbness or slurred speech) should seek immediate medical attention.

Dr. Beyzarov is scientific director for the Pharmacy Times Office of Continuing Professional Education.