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Migraines
General Information
DEFINITION--Migraine refers to a group of symptoms that may occur together. The most noted one is an incapacitating headache, usually on one side of the head, which can last from 2 to 72 hours. Episodes of migraines can occur weekly in some people; others may have less than one a year.
BODY PARTS INVOLVED--Blood vessels, central nervous system, gastrointestinal.
SEX OR AGE MOST AFFECTED
Both sexes, but more common in females.
Adolescents and adults.
SIGNS & SYMPTOMS--
The nature of attacks varies between persons and from time to time in the same person. Symptoms appear as follows:
An aura that precedes the headache. This may affect vision, hearing or smell.
The most common symptom is the inability to see clearly, followed by seeing bright spots and zig-zag patterns. Visual disturbances may last several minutes or hours, then disappear.
Dull, boring pain in the temple that spreads to the side of the head. Pain becomes intense.
Nausea and vomiting. In other types of migraine attack, the above symptoms (vision disturbances, headache or vomiting) may be absent, or other symptoms may be present.
CAUSES--
Exact cause is uncertain. A disturbance in blood circulation in the head accompanies migraine and may be a cause. Attacks may be triggered by:
Tension. Emotional problems are probably the most common reason for migraine attacks, but headaches don't necessarily coincide with emotional upset. They often occur on weekends when stress is decreased.
Menstruation; use of oral contraceptives.
Fatigue; missing meals.
Consumption of alcohol or certain foods.
RISK INCREASES WITH
Stress; family history of migraines; smoking; excess alcohol consumption; use of many prescription and non-prescription drugs.
HOW TO PREVENT
Reduce stress in your life where possible (see How to Cope with Stress in Appendix).
Take a prescription drug to help prevent attacks. Ask your doctor.
Avoid those factors that trigger attacks.
Learn to look for warning signs of a headache and do something different (take a walk,etc.).
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What To Expect
DIAGNOSTIC MEASURES--
Medical history and exam by a doctor.
Laboratory blood studies or CT scan (See Glossary) of the head may be done to rule out other disorders.
APPROPRIATE HEALTH CARE
Self-care after diagnosis; doctor's treatment.
POSSIBLE COMPLICATIONS--None expected.
PROBABLE OUTCOME--Symptoms can be controlled with treatment.
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How To Treat
GENERAL MEASURES--
At the first sign of a migraine attack: Apply a cold cloth or ice pack to your head or splash your face with cold water. Lie down in a quiet, dark room for several hours. Wedge pillows to support head. Relax and sleep if possible. Minimize noise, light and odors (especially cooking odors and tobacco smoke). Don't read.
See Resources for Additional Information.
MEDICATION--A wide variety of drugs can be prescribed for migraine symptoms and prevention. Follow all prescription instructions carefully. Your doctor may prescribe:
Ergotamines (contain caffeine) in oral form, suppository or inhaler.
Aspirin, acetominophen or ibuprofen.
Drugs that combine acetominophen and a narcotic (codeine).
Antihistamines to expand blood vessels.
Antiemetics to decrease nausea and vomiting.
Vasoconstrictors to narrow blood vessels.
Sumatriptan (Imitrex) in self-administered subcutaneous (under the skin) injection or oral tablet.
Beta-adrenergic or calcium channel blockers or tricyclic antidepressants to prevent attacks, if headaches are so frequent that you can't function normally. These medications may have undesir-able side effects and may not help everyone.
ACTIVITY--Rest during attacks; exercise regularly; keep a regular sleep pattern.
DIET--
Don't skip meals. At least snack.
Because some attacks are caused by foods, avoid or limit: cheese, chocolate, spicy foods, mixed spices, monosodium glutamate (MSG), nitrites or nitrates (used in preserved meats such as bacon, hot dogs or deli meats). Keep a record of what you ate before each attack. Avoid foods that may trigger migraine attacks.
Avoid alcohol.
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Call Your Doctor If
You have a migraine attack that persists longer than 24 hours, despite treatment.

Living with Migraine Headaches
What is a migraine?
A migraine is a very bad headache that tends to come back over and over again. You might feel nauseated and vomit when you have one. The pain is usually on one side of your head. When you have a migraine, you might be very sensitive to bright lights and noise. Moving around makes the headache feel worse. Migraine is a real disease, just like diabetes, heart disease and arthritis. If you have migraines, you need to be treated by your doctor.
Should I call my doctor right away about a migraine?
Migraines are not life-threatening. However, brain infections and brain tumors can also cause bad headaches. Life-threatening headaches caused by other problems are dangerous. If you have one, you should see your doctor right away. Here are signs of dangerous headaches:
A sudden, severe headache, or the "worst-ever" headache
A headache that gradually gets worse instead of getting better with time
A headache with memory loss or thinking difficulty, disturbed vision or speech changes, loss of strength, tingling or numb feelings in one part of the body, such as arms or legs, or a change in balance
A headache with fever, stiff neck, clumsiness, change in awareness, change in personality, vision problems that last more than an hour
A headache that lasts for more than a week after you have had a head injury
What causes migraines?
Doctors think migraines may be caused by a chemical or electrical problem in certain parts of the brain. Some things can cause (trigger) a migraine or make a migraine get worse. Headache triggers can be something you eat, smell, hear or see. These are common migraine triggers:
Stress and time pressure, major hassles, major losses, anger and conflict
Smells and fumes, tobacco smoke, light glare or dazzle, weather changes
Monthly period, birth control pills, estrogen therapy
Too much, too little or interrupted sleep
Hunger or fasting (not eating), and specific foods and beverages (see the box below)
Excessive activity (especially if you're not in good shape)
Foods That Might Trigger a Migraine

Aged cheese
Beer, wine and hard liquor
Caffeine in coffee, tea and cola, and some over-the-counter medicines, as well as caffeine withdrawal (if you try to give up caffeinated sodas, for example); chocolate in sweets, foods and drinks
Dairy products such as ice cream, milk, yogurt, cheese, whipped cream and sour cream
Fermented and pickled foods such as pickled herring
Most citrus fruits like oranges, grapefruit and lemons
Bananas, figs and raisins
Processed meats, deli sandwich meats, hotdogs and other nitrite-containing meats Monosodium glutamate (MSG), which is found in Chinese food, Accent seasoning, Lawry's seasoned salt, canned soups, TV dinners, processed meats, and some processed nuts and snack chips
Saccharin or aspartame in diet foods or diet sodas
Sulfites in shrimp and processed potatoes, like boxed mashed potato mix
Pea pods, or pods of lima or navy beans
Onions
Yeast-containing products, such as fresh breads and donuts
Nuts and peanuts
Certain medicines. If you take any of the medicines in the box below, talk to your doctor to see if they could be causing your migraines. Don't stop taking the medicine unless your doctor says to.
Medicines That Might Trigger Migraines

Cimetidine (brand name: Tagamet) Estrogens (including birth control pills)
Fenfluramine (brand name: Pondimin) Indomethacin (brand name: Indocin)
Nifedipine (brand names: Adalat, Procardia) Nitroglycerin (brand name: Nitrostat)
Theophylline (brand names: TheoDur, Theo-24) Reserpine-containing medicines (brand names: Ser-Ap-Es, Hydropres, Regroton)
Pain medicines in general (either overuse or withdrawal from them)
Can I do anything to avoid headaches?
You can try to spread your work load evenly during the day to avoid highs and lows of stress at work or at home.
Don't sleep later on weekends, because this often causes a "let-down" headache.
Don't get overtired.
Eat at regular times, and don't skip meals.
Don't eat or drink anything you think brings on a headache.
Limit the amount of tea, coffee and pain medicines you use. Too much of these may cause headaches.
Watch your posture. Try to keep your neck straight. Think "tall."
Keep your muscles relaxed when you're not physically active. Try not to frown or tighten your jaw.
Restrict your physical activities in hot weather.
Avoid bright or flickering lights, loud noises or strong smells, if they trigger headaches for you.
Remember the classic advice: "Moderation in all things."
What helps a headache besides medicine?
Hold an ice pack to your forehead or temples to reduce your pain.
Lie down in a quiet, dark room.
What else can I do about headaches?
You could try keeping a migraine diary (a headache journal). Writing down information about your headaches and what you were doing when they happened can help you find out what triggers your headaches. Then you can avoid those triggers. Write these things in your headache diary (see the sample below):
The date, the day of the week and the time a migraine headache started.
Any warning signs that happened before the headache started.
The place on your head where your headache was located.
How strong the headache pain was.
Any migraine triggers you were exposed to before the headache started.
What helped relieve the pain.
Sample Page of a Daily Migraine Diary
Date Time
pain
began Warning
signs Time
pain
stopped Pain
location Pain intensity
(circle one)
Low -- High Possible
triggers Treatment
Day 1 123456789
Day 2 123456789
Day 3 123456789
Day 4 123456789
Day 5 123456789
Day 6 123456789
Day 7 123456789
What are "rebound headaches"?
Headaches that happen every day or almost every day are sometimes caused by using too much of the medicines that treat migraine pain. These headaches are called "medicine rebound headaches." Over-the-counter and prescription painkillers, sedative/tranquilizer medicines, and ergotamine-type medicines can cause rebound headaches if they are taken too often. If you stop overusing these medicines, your headaches will get better. If you have any of the problems in the box on the right, see your doctor.
What are the signs of medicine rebound headaches?


Daily or almost-daily headaches, often early in the morning
Too-frequent use of pain-relief medicines (on more than 15 to 20 days per month)
A difference in type, severity and location of the headache
A headache caused by a very small physical or mental effort
One or more of the following with the headache: nausea, anxiety, irritability, memory problems, difficulty in concentrating, depression, sleep disturbances
Occasional very severe migraine headaches
A family history of frequent headaches



What can I do to stop having medicine rebound headaches?
Your doctor can help you. You can stop taking some medicines right away. Other kinds of medicine have to be slowly reduced, not just stopped all at once. It's important to remember these things: after stopping the medicine that is giving you rebound headaches, your headache may get worse for a few days. You might even have a very bad headache for about three days. If you work, consider stopping the medicine just before a weekend. If you take off Friday or Monday, you'll have a longer time to rest. Your doctor will help you with the pain. It might take 8 to 12 weeks before your body responds the right way to migraine pain medicines.
What medicines are available to treat migraines?
Three groups of medicines treat migraines. One group of medicines works to stop the pain. These medicines work best if taken when the migraine pain starts. Another group of medicines treats the nausea or vomiting that can happen along with a migraine. The third group of medicines prevents migraines from starting. These are called "preventive" medicines. Some people have migraines so often or the headaches are so bad, their doctors try to prevent the headaches by giving them preventive medicines. These should usually be taken every day. Your doctor will look at your headache history to find the best medicines for you.
Where can I get more information about migraines?
Newsletters and online computer resources can give you more information and advice about migraine headaches. You can contact the following places:

"Headache" newsletter
ACHE (American Council for Headache Education)
Telephone: 1-800-255-ACHE, extension 2243
Internet address: www.achenet.org "The Excedrin Headache Relief Update" newsletter
The Excedrin Headache Resource Center
Telephone: 1-800-580-4455
Internet address: www.excedrin.com "HeadWay" newsletter
Glaxo Wellcome Migraine Information Center
Telephone: 1-800-520-8508
Internet address: www.migrainehelp.com
This information provides a general overview on migraine headaches and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.