MIGRAINES

Types of Migraines

Symptoms that signal the onset of a migraine are used to describe two types of migraine:

• Migraine with aura (known as “classic” migraine)
• Migraine without aura (known as “common” migraine)

What Are the Symptoms of Migraines?

The symptoms of migraine headaches can occur in various combinations and include:

• A pounding or throbbing headache that often begins as a dull ache and develops into throbbing pain. The pain is usually aggravated by physical activity. The pain can shift from one side of the head to the other, or it can affect the front of the head or feel like it’s affecting the whole head.
• Sensitivity to light, noise, and odors
• Nausea and vomiting, stomach upset, abdominal pain
• Loss of appetite
• Sensations of being very warm or cold
• Paleness
• Fatigue
• Dizziness
• Blurred vision
• Diarrhea
• Fever (rare)

Most migraines last about four hours although severe ones can last up to a week. The frequency of migraines varies widely among individuals. It is common for a migraine sufferer to get two to four headaches per month. Some people, however, may get headaches every few days, while others only get a migraine once or twice a year.

DIAGNOSIS

Your doctor will diagnose a migraine by examining you and asking questions about your health and lifestyle. There are no tests that can prove that you have migraines.

Migraines can be hard to diagnose, because their symptoms are like those of other types of headaches. For example, many people have been diagnosed with sinus headaches when they actually have migraines.

It’s likely that you are having migraine headaches if they happen often and interfere with your daily life.

Your doctor will check your symptoms and decide if you need to have tests to find out if your headaches are caused by another health problem. Tests may include:

• MRI or CT scan. These imaging tests may be used to look for tumors or bleeding in the brain. But most headaches aren’t caused by anything serious, so you probably won’t need to have imaging tests.
• Lumbar puncture (also called a spinal tap). This may be done if your doctor thinks that you might have a problem such as meningitis or bleeding in the brain.
• Sedimentation rate (a blood test). This test can find out if another health problem is causing inflammation related to your headaches.

RECOMMENDED MEDICATIONS

Two kinds of medicines are used to treat migraines:

• Medicines to stop a migraine. These are sometimes called abortive medicines. These may be over-the-counter or prescription medicines. If you take the medicine at the first sign you’re getting a migraine, you may stop the headache before it starts.
• Medicines to prevent migraines. These drugs are often called preventive medicines. You get them with a prescription. You take these every day or whenever your doctor tells you to.

Finding the right mix of medicines for you may take some time. So work closely with your doctor to try different medicines and doses.

In most cases, your doctor will first prescribe a drug that causes the fewest side effects. Drugs may be prescribed based on your type of migraine.

Medicines to stop a migraine

If your migraines are mild to moderate, you may need only an over-the-counter drug to stop the pain. Most doctors recommend that you try these drugs first, because they may have fewer side effects than prescription drugs. If over-the-counter drugs don’t stop your headaches, your doctor may prescribe other medicine.

Your doctor may suggest that you take a mix of medicines to stop a headache. For example, you may take acetaminophen or naproxen along with a prescription medicine, such as a triptan.

Drugs used to stop a migraine include:

• Over-the-counter medicines like acetaminophen (Tylenol, for example) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. Brand names for NSAIDs include Advil, Aleve, and Bayer. Some over-the-counter medicines (for example, Excedrin) combine acetaminophen, aspirin, and caffeine.
• Triptans (serotonin receptor agonists), such as sumatriptan (Imitrex) and zolmitriptan (Zomig).
• Ergotamine derivatives, such as Cafergot.

Medicines to prevent a migraine

Drugs used to prevent migraines include:

• Anticonvulsants, such as topiramate.
• AntidepressantsAntidepressants, such as amitriptyline.
• Antihistamine, such as cyproheptadine.
• Beta-blockers, such as propranolol.
• Botulinum toxinBotulinum toxin, such as Botox.
• Calcium channel blockers, such as verapamil.

You may want to try medicine to prevent a headache if:

• You are using medicines to stop headaches more than twice a week.
• Medicines to stop migraines aren’t working well for you.
• You have two or more headaches a month that keep you from doing your daily activities.
• You have uncommon migraine symptoms, such as a long period with aura or numbness during your headache.

Rebound headaches

Taking medicine too often to stop a migraine can cause more headaches. These rebound headaches are different from migraine headaches. They usually start after pain medicine wears off, which leads you to take another dose. After a while, you get a headache whenever you stop taking the drug.

Talk to your doctor if you are taking headache medicine more than 2 days a week. Take your medicine as prescribed by your doctor.