Migraines
Severe Pain
Migraine headaches are easily misdiagnosed and often are incorrectly treated. Their causes may be environmental, dietary or stress related. They are more common in women and their occurrence may be related to estrogen levels since they are often seen with greater frequency during the premenstrual period. Migraine headaches may disappear completely during pregnancy when estrogen levels are continuously high.
Nausea, vomiting and diarrhea may accompany the throbbing pain of a migraine headache.
Migraine headaches are typically located on one side of the head (unilateral), and are accompanied by a throbbing sensation and sensitivity to light, sound and movement. The pain may be accompanied by nausea and vomiting and can continue for 4 to 24 hours. Migraine headaches may occur any time in life, but often begin in the early teen years and become less common in later years. Women are more commonly affected than men, and there is a strong genetic link to migraine, with up to 90% of all patients reporting a family history of migraines. Many factors have been identified as possibly precipitating migraine headaches, including certain foods, alcohol, bright sun exposure, intense emotional stress, irregular sleeping patterns and fluctuations in estrogen levels.
Symptoms: The classic migraine includes a group of warning symptoms, which last one-half hour or less, followed by the headache pain. These symptoms may begin with mood changes, which may begin 24 hours before the headache, increased appetite/thirst or tiredness. At headache onset, the patient may experience an “aura,” which includes visual disturbances, such as bright, flashing lights in lines or spots. Other warning symptoms include a numbness or tingling on one side of the face or body or speaking difficulties. The symptoms usually disappear completely before the headache begins.
Treatment: The best treatment for migraines is prevention (if precipitating factors can be identified). All medications the patient is taking should be reviewed to determine if any could be contributing to these headaches. The diet should be examined to identify foods commonly known to precipitate migraines, such as red wine, aged cheese, chocolate and nuts. If avoiding these factors is not effective, and the headaches occur frequently, a drug may be used to help prevent headaches. Drugs used to prevent migraines include beta-blockers, calcium channel blockers, tricyclic antidepressants, cyproheptadine and methysergide. Analgesics, such as aspirin or acetaminophen, may be used to reduce pain in less severe attacks. Metoclopramide has been used to help decrease the nausea and vomiting that accompanies migraines. In more severe attacks, ergotamine is used and can be given orally, by inhaler or suppositories (for patients with significant nausea and vomiting accompanying an attack). Ergotamine may also be given by injection if necessary. Ergotamine works by constricting the cranial blood vessels but has the potential for causing serious side effects. It must be carefully administered according to directions and should not exceed the recommended dosage for each attack. Other drugs used in treating an acute migraine attack that does not respond to ergotamine include phenothiazines and corticosteroids. Narcotics are not recommended for routine treatment of migraines due to the potential for addiction. Sumatriptan is a newer drug treatment that is available as a tablet or an injectable product. It can provide relief within 10 minutes following injection.
