The excruciating throb of a migraine, often accompanied by nausea or sensitivity to light and sound, can be brutally painful.

1. Migraine
The excruciating throb of a migraine, often accompanied by nausea or sensitivity
to light and sound, can be brutally painful. As anyone who’s suffered a migraine
can tell you, these headaches, when left untreated or treated ineffectively, can
disrupt every aspect of a person’s life, from the ability to work to day-to-day
activities and relationships. They can eventually lead to a loss of self-confidence,
sense of control and self-esteem.
In the United States, about 12 to 16 percent of the population suffers from
migraine headaches, and 40 percent could benefit from preventative therapies,
according to the American Migraine Prevalence and Prevention (AMPP) Study.
Women experience migraines three times more frequently than men.
Researchers have found that migraines have a greater overall impact on the lives
of female sufferers, affecting their self-esteem, professional development and
family and social life.
What are Migraines?
Migraine is a biologically based disorder. Its symptoms aretheresult of changes in
the brain, not a weakness in character or an inappropriate reaction to stress. For
many years, scientists believed migraines were linked to the dilation and
constriction of blood vessels in the head. They now believe migraine is caused by
inherited abnormalities in certain cells in the brain. People with migraine have an
enduring predisposition to attacks triggered by a range of factors. Specific,
abnormal genes have been identified for some forms of migraine.
People who get migraine headaches appear to have special sensitivities to various
triggers, such as bright lights, odors, stress, the menstrual cycle, weather changes
or certain foods and beverages.
If you get a migraine, you may experience an aura five to 20 minutes before the
attack. An aura may lead to seeing flashing lights, visuals resembling TV static or
zigzag lines, or you may temporarily lose vision. Other classic symptoms of a
migraine aura include speech difficulty, weakness in an arm or leg, tingling of the

2. face or hands and confusion. An estimated 20 percent of migraine victims
experience an aura prior to an attack. Even if you don’t have an aura, you may
experience a variety of vague symptoms before a migraine, including mental
fuzziness, mood changes, fatigue and unusual retention of fluids.
The pain of a migraine is usually described as one-sided and is intense, throbbing
or pounding and is felt in the forehead, temple, ear and/or jaw, around the eye or
over the entire head. It may include nausea and vomiting and can last a few
hours, a day or even up to three days.
People who suffer from migraines may also experience cutaneous allodynia, a
condition in which you feel pain on your scalp from a source that should not
cause pain, such as a single strand of hair.
Migraines can strike as often as nearly every day or as rarely as once every few
years. Some women experience migraines at predictable times such as when
menstruation begins or every Saturday morning after a stressful work week.
In addition to the classic migraine described above, migraine headaches can take
several other forms:
Hemiplegic migraine:Patients with hemiplegic migraine have temporary paralysis
on one side of the body, a condition known as hemiplegia. Some people with this
form may experience vision problems and vertigo (a feeling that the world is
spinning). These symptoms begin 10 to 90 minutes before the onset of headache
pain. Complete recovery may take weeks.
Ophthalmoplegic migraine: In ophthalmoplegic migraine, the pain is around the
eye and is associated with a droopy eyelid, double vision and other sight
problems.
Basilar artery migraine: Basilar artery migraine involves a disturbance of a major
brain artery. Preheadache symptoms include vertigo, double vision and poor
muscular coordination. This type of migraine occurs primarily in adolescent and
young adult women and is often associated with the menstrual cycle.

3. Status migrainosus: This is a rare and severe type of migraine that can last 72
hours or longer. The pain and nausea are so intense that sufferers are often
hospitalized. The useof certain drugs can trigger status migrainosus. Neurologists
reportthat many of their status migrainosus patients weredepressed and anxious
before they experienced headache attacks.
Headache-freemigraine: This type is characterized by such migraine symptoms as
visual problems, nausea, vomiting, constipation or diarrhea, chest or neck pain.
However, there is no head pain. Headache specialists have suggested that
unexplained pain in a particular partof the body, fever and dizziness could also be
possible types of headache-free migraine.
Chronic migraine: Chronic migraine, which affects approximately 2 percent of the
population, is defined as headaches that occur at least 15 days a month for at
least three months. In addition, to be diagnosed with chronic migraine, an
individual must also have two or more of the following symptoms on eight or
more days a month for at least three months: moderate to severe headaches;
headaches on one side of the head; pulsating head pain; headaches aggravated by
routine physical activity; headaches that cause nausea, vomiting or both; or
headaches coupled with sensitivity to light and sound.
Abdominal migraine: The pain of this type of migraine is felt in the middle of the
abdomen rather than the head. Abdominal migraines usually last a few hours and
occur mainly in children as a forerunner of migraine. Symptoms may also include
nausea, vomiting and diarrhea.
Retinal migraine: A rare form of migraine, retinal migraine starts with a
temporary, partial or complete loss of vision in one eye followed by a dull ache
behind the eye. Pain may spread to the rest of the head.
Diagnosis
Because migraine headaches are believed to have a genetic component, it’s
important that your health care practitioner review your family history. Even if
you are not aware that a relative suffered from migraines, consider information
you may know about, such as past illnesses and lifestyles. Keep in mind that the

4. term “migraine” was not used much until the 1950s, and even then many
migraines were not diagnosed or referred to as “migraines.”
When checking family history, ask these questions:
When growing up, do you recall a family member who was sick much of the time?
If so, did he/she exhibit any of the following symptoms: head pain that interfered
with daily activities, nausea or vomiting, sensitivity to light or sound, numbness or
speech difficulty?
To what did he or she attribute symptoms of their headache: menstrual cycle,
overwork, fatigue, stress or something eaten or drunk?
Be prepared to discuss with your health care professional both the symptoms of
relatives’ headaches and their methods for coping.
Diagnosing a headache relies on ruling out other problems, such as tumors or
strokes. Experts agree that a detailed question-and-answer session can often
produce enough information for a diagnosis. Some women have headaches that
fall into an easily recognizable pattern, while others require further testing to
determine if symptoms are due to secondary causes such as dental pain,
hemorrhage or tumor.
You may be asked:
 How often do you have headaches?
 Where is the pain?
 How long do the headaches last?
 When did you first develop headaches?
 Your sleep habits and family and work situations may also be discussed.
Most of the time, a migraine diagnosis is made by focusing on your history and
inquiring about past head trauma or surgery and about the use of medications.
However, health professionals may also order a blood test to screen for thyroid
disease, anemia or infections that might cause a headache.

5. Other tests that may be ordered to rule out other medical problems include:
A magnetic resonanceimaging (MRI) scan. Today, MRI is the preferred tool to rule
out headaches associated with aneurysms (abnormalballooning of a blood vessel)
and brain lesions. MRI scans provide a more detailed view of the cerebral
anatomy and are warranted in cases where migraine is not definitively
ascertained by history alone.
A magnetic resonance angiogram (MRA) is a type of MRI that looks at the blood
vessels inside the body. It is a refined tool to pick up minute lesions of the
vascular system of the brain such as small aneurysms.
A computed tomographic (CT) scan. The CT scan produces images of the brain
that show variations in the density of different types of tissue. The scan enables
the physician to distinguish, for example, between a bleeding blood vessel in the
brain and a brain tumor. The CT scan is an important diagnostic tool in cases of
sudden headache caused by hemorrhage.
An eye exam, to check for weakness in the eye muscle or unequal pupil size. Both
symptoms are evidence of an aneurysm. A physician who suspects that a
headache patient has an aneurysm may also order an angiogram. In this test, a
special fluid that can be seen on an x-ray is injected into the patient and carried in
the bloodstream to the brain to reveal any abnormalities in the blood vessels.
A lumbar puncture (spinal tap), to rule out meningitis, encephalitis or a brain
bleed if the headache is associated with neck pain, fever and/or sudden onset.
The spinal tap takes about 30 minutes and may cause a headache due to the drop
in cerebral spinal fluid pressure. There is also a small risk of infection with this
procedure.
Your health care professional will analyze the results of these diagnostic tests
along with your medical history to make a diagnosis.
Head pain is typically diagnosed as one of the following types of headaches; some
people have more than one type:

6. Migrainous headaches, the group that includes migraine. This type of headache is
recognized as being principally “neurogenic-initiated,” eventually affecting the
cerebrovascular system.
Tension-type headache. These headaches involve the tightening or tensing of
facial and neck muscles.
Cluster headaches. These involve excruciating pain in one part of the head and
are rare. They are more commonly found in men with associated eye tearing and
nasal congestion on the side of the head pain.
Traction and inflammatory headaches. Also rare, these headaches involve
symptoms caused by other disorders, ranging from stroke to sinus infection to
eye disorders to an abnormal growth or mass.
Chronic migraine. To be diagnosed with chronic migraine, an individual must meet
the criteria spelled out by the International Headache Society, which include
headaches that occur 15 or more days a month for at least three months coupled
with two or more of the following symptoms on eight or more days a month for at
least three months:
 Moderate to severe headaches
 Headaches on one side of your head only
 Headache pain that pulsates
 Headaches aggravated by routine physical activity
 Headaches that cause nausea, vomiting or both
 Headaches coupled with sensitivity to light or sound
Treatment
Health care professionals say that many women don’t express the true extent of
the pain they feel with migraine, perhaps because they’re worried about
“complaining” too much. One problem may be that many people with migraines
think there is nothing that can be done. They may have watched their mother or
grandmother suffer from migraines, and think they simply have to suffer, too, or
resort to the often-ineffective treatments their older relatives used to cope with

7. their migraines, despite significant advances in medication and treatment options
available today.
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