A lot of people get migraines -- about 11 out of 100. The headaches tend to start between the ages of 10 and 46 and may run in families. Migraines occur more often in women than men. Pregnancy may reduce the number of migraines attacks. At least 60 percent of women with a history of migraines have fewer such headaches during the last two trimesters of pregnancy.

Until the 1980s, scientists believed that migraines were due to changes in blood vessels within the brain. Today, most believe the attack actually begins in the brain itself, and involves various nerve pathways and chemicals in the brain. A migraine attack can be triggered by stress, food, environmental changes, or some other factor. However, the exact chain of events remains unclear.

Migraine attacks may be triggered by:

* Allergic reactions
* Bright lights, loud noises, and certain odours or perfumes
* Physical or emotional stress
* Changes in sleep patterns
* Smoking or exposure to smoke
* Skipping meals
* Alcohol or caffeine
* Menstrual cycle fluctuations, birth control pills
* Tension headaches
* Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
* Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods

Symptoms

Migraine headache may be diagnosed by your doctor based on your symptoms, history of migraines in the family, and your response to treatment. Your doctor will take a detailed history to make sure that your headaches are not due to tension, sinus inflammation, or a more serious underlying brain disorder. During the physical exam, your doctor will probably not find anything wrong with you.

Sometimes an MRI or CT scan is obtained to rule out other causes of headache like sinus inflammation or a brain mass. In the case of a complicated migraine, an EEG may be needed to exclude seizures. Rarely, a lumbar puncture (spinal tap) might be performed.

Treatments

There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or altering triggers. When you do get migraine symptoms, try to treat them right away. The headache may be less severe.

When migraine symptoms begin:

* Rest in a quiet, darkened room * Try placing a cool cloth on your head

Over-the-counter pain medications like acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. (Be aware, however, that chronic usage of such pain medications may result in rebound headaches.) If these don't help, ask your doctor about prescription medications.

Your doctor will select from several different types of medications, including:

* Ergots like dihydroergotamine or ergotamine with caffeine (Cafergot)
* Triptans like sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), frovatriptan (Frova), and zolmitriptan (Zomig); these are available as a tablet, nasal spray, or self-administered injection
* Isometheptene (Midrin)
* Stronger pain relievers (narcotics)

Many of the prescription medications for migraines narrow your blood vessels. Therefore, these drugs should not be used if you have heart disease, unless specifically instructed by your doctor.

Prevention

* Avoid smoking, caffeine, and alcohol
* Exercise regularly
* Get enough sleep each night
* Learn to relax and reduce stress -- try progressive muscle relaxation (contracting and releasing muscles throughout your body), meditation, biofeedback, or joining a support group

If you get at least three headaches per month, your doctor may prescribe medication for you to prevent recurrent migraines.

Such prescription drugs include:

* Beta-blockers such as propranolol (Inderal)
* Anti-depressants, including tricyclics like amitriptyline (Elavil) or selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac, Sarafem), paroxetine (Paxil), or sertraline (Zoloft)
* Anti-convulsants such as valproic acid (Depacon, Depakene), divalproex sodium (Depakote), or topiramate (Topamax)
* Calcium channel blockers such as verapamil

Links:

Migraines.Org

Family Doctor.Org

Neurology Channel


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