Migraine headaches affect 26 million Americans. Seventy percent of those
suffering from migraines in America are women, roughly 21 million people (Mayo
Clinic, 2003). One in four American households has someone who is affected by
migraine headaches. Although many employers do not consider migraines to be a
legitimate medical problem, migraines can be a source of considerable disability. It is
estimated that migraines cost the American taxpayers $13 billion a year in missed work
or loss of productivity (National Institute of Neurological Disorders and Stroke, 2003).
Although any head pain can be miserable, migraines are in a class by themselves in terms
of the pain and suffering they cause. Migraine pain can be excruciating for those who
suffer from them. Migraines can incapacitate the sufferer for hours and affect his/her
daily activities for days after.
By definition, a migraine is a very bad headache that tends to recur. Nausea and
vomit might accompany the headache. The pain is usually on one side of the head. The
affected person may become sensitive to lights and noises. Moving around can make the
headache feel worse. There are many forms of migraine headaches. The two major
varieties are classic and common. (McKinley Health Center, 2003). The difference
between the two is the occurrence of the “aura.” The aura is the occurrence of
neurological symptoms 10-30 minutes before the classic migraine may attack.
Symptoms of a Migraine
The pain of a classic migraine is described as intense throbbing. This throbbing
or pounding can be felt in the forehead/temple, ear/jaw or around the eyes. This type of
migraine, the classic, starts on one side of the head but may eventually spread to the other
side of the head. An attack can last for one or two painful days. Other symptoms of the
classic migraine can include speech difficulty, confusion, weakness of an arm or leg and
even tingling in the face or hands. The common migraine, on the other hand, is the other
type of migraine.
Unlike the classic type, common migraines are not preceded by an aura. There
are a variety of symptoms people do experience before common migraines. These
include mental fuzziness, mood changes and fatigue. During the headache phase of the
common migraine, abdominal pain can occur. Other symptoms can include diarrhea,
increased urination, vomiting and nausea. Both the classic and common forms of the
migraine headache can strike as often as several times a week or as rarely as once every
couple years (McKinley Health Center, 2003).
Causes of the Migraine
Although much about headaches still is not understood, some researchers think
that migraines may be caused by functional changes in the trigeminal nerve system,
which is a major pathway in the brain (Clinical Journal of Pain, 2003). It is believed
there are imbalances in the chemistry of the brain. A connection has been made between
serotonin and migraines. Serotonin is a chemical that is responsible for regulating pain
messages in trigeminal pathway of the brain. During a headache serotonin levels drop. It
is believed then that this drop triggers a release of substances called neuropeptides, which
travel to the brain’s outer covering. There they cause the blood vessels of the brain to
become dilated and inflamed. The result is a severe headache with intense pain (Mayo
There have been other studies, however, that use brain scans to try and understand
the cause of migraine headaches. Brain scans have shown that the volume of blood
reaching the brain drops during an attack. This has led some experts to believe that
migraines occur when blood drains from the blood vessels in the center of the brain to the
vessels that are on the outer region of the brain.
And yet another possible cause of migraine headaches has to do with a mineral
called magnesium. Magnesium is involved in proper nerve cell function. Research has
shown that magnesium also drops when a person experiences a migraine headache. It is
possible that low amounts of magnesium may cause nerves in the brain to misfire, thus
resulting in a migraine (Mayo Clinic, 2003).
According to the National Institute of Health, there are other possible causes of
migraine headaches. For many years, scientists believed that migraines were caused by
dilation of the blood vessels in the brain. Some now believe that the migraine is actually
caused by an inherited abnormality in certain cells in the brain (NINDS, 2003). With the
help of new imaging technology, scientists can see changes in the brain while a person is
having a migraine attack. These scientists believe that there is a migraine pain center
located in the brainstem. The brainstem is the region at the base of the brain. As neurons
are fired, the blood vessels that surround them dilate and become inflamed. This is
thought then to be the cause of the migraine headache.
Though the cause or causes of the migraine headache are not precisely known, it
is clear that this disorder is a genetic disorder. Specific abnormal genes have been
identified for some forms of migraines (NINDS, 2003). Sadly then, people with migraine
headaches have a lasting predisposition to the attacks.
Triggers of Migraine Headaches
Whatever the cause of migraines, they do not just occur on their own. Something
has to trigger them. Some things can trigger a migraine or make it worse. Triggers can
be almost anything. They can range from allergies and stress to the sun and changes in
temperature. These factors that can trigger or promote migraines in people should be
identified in order to not provoke a migraine. Not all migraines have the same provoking
factors and neither do all these factors necessarily provoke an attack.
Diet: certain foods appear to trigger headaches in some people. Common food triggers
include alcohol (especially beer and red wine), aged cheeses, fermented or pickled food,
chocolate, aspartame, and caffeine. Another food related trigger is monosodium
glutamate (MSG). MSG is a key ingredient in some Asian foods, certain seasoning, and
canned foods that have been processed.
Sleep: In some migraine sufferers, too much sleep or too little sleep can trigger an attack.
It is important for someone whose migraines are trigger by too much or too little sleep to
be consistent in their sleep patterns (American Medical Association, 1998).
Hormone changes: Many women who suffer from migraines have attacks that are linked
to their menstrual cycles. Changes in estrogen levels, especially a decline in the hormone
level, are thought to play a role. Menstrual migraines are more difficult to treat and last
longer than other migraines, typically. Research shows that these migraines
characteristically decline in frequency as the age of the women increases. Also, there is
evidence that oral contraceptives or estrogen replacement therapy can provoke or worsen
the migraine headache in some women (American Medical Association, 1998).
Stress and Anxiety: Another common migraine trigger is stress. Anxiety and fatigue
also can provoke a migraine.
Environmental Factors: There exist also environmental triggers of migraine headaches.
These include such factors as changes in weather, season, altitude level or time zone.
Other environmental triggers consist of bright lights, computer screens, and strong odors.
And finally other common factors that can be involved in triggering a migraine are
certain medications, low-blood sugar, changes in mealtimes, skipped meals or fasting,
intense physical exertion, and tobacco (Mayo Clinic, 2003).
Screening and Diagnosis
If an individual has typical migraine headaches or a family history of migraines,
then the doctor will likely to able to diagnose this medical condition on the basis of the
person’s medical history. However, if the headaches are unusual and very severe and no
family history of migraines exists, then the doctor may recommend certain tests to rule
out other possible causes of the pain.
A diagnostic procedure of x-raying the individual’s skull and sinuses is also
helpful in determining the diagnosis. A magnetic resonance imagining test (MRI) can be
used to x-ray the brain. This test results in imagery that produces clear images of the
brain. Detector measurements are taken of the brain from thousands of angles. Then this
information is processed by a computer to produce a three-dimensional representation of
the individual’s head.
If a doctor suspects that a person’s headaches are caused by an underlying
medical condition, the doctor may recommend a spinal tap. In this procedure, a hollow
needle is inserted in between two vertebrae in the lower back of the patient. Once in
place, the pressure of the cerebrospinal fluid is measured. A sample of the fluid is taken
for testing. This procedure takes about 30 minutes. It is used to measure out any other
already existing medical condition that could be causing the severe headaches that the
patient is experiencing.
Treatment of Migraine Headaches
Significant advances have occurred and are occurring in the treatment of migraine
headaches. Today, most migraine sufferers can better control this disorder and relieve
some of its impact. To manage a migraine effectively, an individualized treatment plan
can be created with a doctor. The three main components of a treatment plan include:
identifying and controlling factors that may be triggers of the migraine headache;
describing medications that prevent and treat the attacks; and finally, encouraging healthy
behavior and lifestyle changes in the migraine sufferer (American Medical Association,
A vital component of migraine management is to provide therapy that consistently
relieves migraine symptoms. Treatment can either stop an attack before it occurs or treat
the symptoms when an attack does occur. For those individuals who experience frequent,
disabling attacks, a preventive treatment is needed to that the migraines will strike less
often and then last for a shorter time. While almost everyone who suffers from migraine
headaches will need treatment to treat the symptoms, only one in five people with
migraines need preventative treatment (American Medical Association, 1998).
There are also many migraine drugs available. Migraine medications are also
used as treatments for other medical conditions. For example, beta-blockers, which are
used to treat hypertension and depression, are also used to treat migraine victims.
However, the dosages of these drugs are different when used for migraine than when
used to treat these other conditions.
Migraine medications that are used to treat the symptoms of migraine attacks
work best when taken as soon as the individual feels a migraine coming on. Drugs that
are pain relievers such as aspirin, ibuprofen, and acetaminophen are often recommended
by doctors for initial treatment of migraines. However, if these over the counter
medications do not relieve the pain of the migraine, the doctor might then prescribe a
drug or a combination of drugs. Prescription analgesics (pain relievers) including
narcotics, are often combined with sedatives to relieve the pain of the migraine. There
are also many different anti-inflammatory drugs that are effective in treating migraine
headaches. And finally, there are specific drugs used to stop migraine attacks. One of
these is derived from ergot alkaloids. The drug names are ergotamine and
dihydroergotamine. Another drug used to stop the attack of migraines is triptans.
Triptans are fairly new drugs that where developed specifically to stop migraine
headaches. These drugs have important treatment similarities but they differ in how they
are taken (tablets, shots, nasal sprays) and possible side effects. However, if one drug in
these families of drugs does not work, another drug might be very effective (American
Medical Association, 1998).
Women and Migraines
Both men and women are affected by migraine headaches but the condition is
most common in women. Even though both sexes may develop the disorder in infancy,
most often the disorder begins between the ages of five and thirty five. Since migraines
are more prevalent in women, it is believed that hormonal changes can influence the
occurrence of a migraine, especially related to the female menstrual cycle. These gender
differences in migraine may be the result of differences in the central nervous system of
men and women as well as the effects of estrogen. Hormonal manipulation may reduce
the occurrence of migraines among women (Neurolog, 2003). There is also a researched
connection between oral contraceptive pills (OCP) and migraine headaches. Scientists
report that some women with migraines who take OCP’s do experience more frequent
and severe headache attacks.
Migraines and Children
Children get migraine headaches too! It is estimated that more than eight million
children and adolescents suffer from migraine headaches. This results in more than 1
million lost school days each year. Before the stage of puberty, as many boys as girls can
get these painful headaches. But after the onset of puberty, migraine headaches are more
common in girls. By age 15, about five percent of adolescents have at one time or
another experienced a migraine attack. The migraines may stop as children grow into
adulthood, but the disorder may return in middle age. In seventy percent of the cases of
children with migraines, there is a family history of migraine headaches (American
Medical Association, 1998).
It is believed that the same mechanism that initiates a migraine attack in adults is
the same initiating mechanism in children. However, doctors look for slightly different
symptoms to diagnose the disorder in children. In some cases involving children, certain
recurring or cyclical symptoms occur. These involve vomiting, dizzy spells, and
abdominal pain. These recurrent medical conditions are thought to be forms of juvenile
migraines. Another difference with children is where the pain is located in the head.
Younger children usually feel migraine pain on both sides of the head. Older children
and adults tend to feel the pain only on one side of the head. Fortunately for children
migraine sufferers, the attacks are usually shorter in them than in adults. The most
common related symptoms in children are nausea and vomiting, diarrhea, sweating,
increased urination, thirst, and swelling. Also, visual auras are not as common in
children as in adults.
In order to diagnose a child with migraines, a medical evaluation of the child is
needed. This usually includes a review of the child’s medical history, a physical
examination and sometimes a neurological examination. While reviewing the medical
history, the doctor may direct questions to the parent and the child. The questions may be
specific ones concerning the frequency and severity of the migraine headaches, activities
that seem to trigger or provoke the migraine, as well as the symptoms that occur while
the child is experiencing a migraine headache. After thorough tests and evaluation, the
doctor can prescribe a treatment that is individual to the child. Often migraines in
children improve within a year without specific treatment. The doctor may recommend
maintaining a regular bedtime, a regular meal time, and avoiding an overload of activities
in the child’s life. Just as it is with adults who suffer from migraine headaches, it is also
helpful to identify and avoid any provoking factors or triggers (American Medical
If drug treatment is needed for the child, the doctor can prescribe simple
analgesics (pain relievers). Sometimes combination analgesics that are given to adults
can be given to children, but in lower doses. Depending on the frequency, duration, and
intensity of the migraine headaches, preventive drugs can also be part of the treatment
plan. Many of the drugs used for adults can be prescribed for children. The most
commonly used preventive drugs for children with migraine headaches are
cyproheptadine and propranolol. Propranolol is not prescribed to children who also
suffer from asthma or bradycardia (a heart rate that is below 60 beats per minute). As the
children age, other medications may be used to treat the migraine headache in a child or
young adult (American Medical Association, 1998).
A study was conducted that assessed the quality of life of children and young
adults who suffer from migraines. A clinical sample of children with the disorder was
compared to a group who did not have the disorder. The results of the study indicated
that the impact of quality of life of children with migraines is similar to the impact of
quality of life of children who suffer from diseases such as arthritis and cancer.
Impairments in school and impairments in emotional functioning were the most
prominent factors of the quality of life that were affected (Pediatrics, 2003).
Although migraines affect millions of Americans, new drug treatments and
individualized treatment plans are proving to be very helpful in preventing and
maintaining this disorder. Active participation on the part of the migraine sufferer can
spell the difference between success and failure in overcoming the disorder. The more
that is understood about migraine headaches, the greater the likelihood of success in their
prevention and treatment.