Migraine Headache

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KEY POINTS

• A migraine headache can cause intense pain, nausea, or changes in your vision just before or during the headache. Migraines can last for hours to days.
• Migraine headaches are usually treated with both medicine for a current headache and sometimes, a second medicine for preventing further headaches.
• If you can, rest in a quiet, dimly lit room until the symptoms are gone. Put a cool, moist washcloth on the painful side of your head. You might also try a heating pad set on the lowest setting. Experiment to learn which works better for you.

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What is a migraine headache?

A migraine headache is a type of headache that can last for hours to days. It can cause intense pain as well as other symptoms. For example, you may have changes in your vision just before or during the headache, or you may feel sick to your stomach during the headache.

What is the cause?

The exact cause of migraines is not known. They may be related to a problem with the blood flow in the brain, or they may happen with changes in brain chemicals and hormones, such as the female hormone estrogen. You may find that your migraine headaches seem related to:

• Stress
• A change in your sleep habits
• Missing a meal
• Changes in the weather
• Loud noises
• Bright lights or glare
• Certain foods, such as red wine, cheese, or chocolate
• MSG or food preservatives, such as nitrates
• Some medicines

Migraines may tend to run in families. They affect women 3 times more often than men. They often happen right before or during a woman's menstrual period. Or they may happen when a woman is taking birth control pills or hormone replacement pills.

What are the symptoms?

More than half of the people who have migraines have warning symptoms before the migraine starts. Not everyone has the same symptoms, but most people have a pattern with their symptoms. Symptoms that you may have in the minutes, hours, or even a few days before a migraine include:

• Sensitivity to light, noise, or smells
• Feeling unusually tired
• Craving certain foods, such as chocolate, or not wanting to eat at all
• Feeling angry, irritable, or depressed
• Increased thirst and urination
• Changes in bowel movements, either constipation or diarrhea

You may also have vision changes in the hour before your head starts hurting. You may lose all or part of your vision for a brief time or see bright spots or zigzag patterns. You may also have tingling, numbness, or weakness. These warning symptoms are called an aura. Aura symptoms usually start gradually and go away within 20 to 60 minutes. Usually aura symptoms go away before the headache begins, but some people have aura symptoms at the same time as the headache.

Some of the symptoms of a migraine aura can also be symptoms of a stroke. If you have tingling, numbness, or weakness on one side of your body along with problems with your vision, get medical help right away.

Migraine symptoms usually last from 4 hours to 3 days and may include:

• Throbbing or pounding headache, often on one side of the head
• Pain that gets worse with physical activity
• Extreme sensitivity to light, smells, and sounds
• Nausea or vomiting

After the headache goes away, you may have some of these symptoms for a day or so:

• Feeling unusually tired or irritable, or feeling unusually refreshed and happy
• Muscle soreness and weakness
• Craving certain foods, or not wanting to eat at all

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. There are no lab tests or X-rays for diagnosing migraine headaches.

It will help if you keep a record of:

• Date and time of each attack
• How long the headache lasted
• Type of pain (for example, dull, sharp, throbbing, or a feeling of pressure)
• Location of pain
• Any symptoms before the headache began
• Anything that happened before the headache, including foods and drinks you had before the headache began. This should include checking the ingredients on the labels of packaged foods you have eaten. Saving the labels of foods or drinks might be a good way to record this information.
• Use of cigarettes, caffeine, or alcohol, especially red wine, before the headache began
• Time you went to bed and time you got up before the headache began
• If you are a woman, the dates of your menstrual periods and use of birth control pills or other female hormones

Your headache diary can help your provider know if you have migraines, or if your headaches are caused by tension, allergies, or other problems. You may have tests or scans to check for other possible causes of the symptoms.

How is it treated?

You may be able to stop mild migraine headaches by taking nonprescription pain medicine as soon as you start to have symptoms. Aspirin, acetaminophen, caffeine, ibuprofen, and naproxen have all been shown to be effective. You may find that any one of these medicines alone will treat your headache. Even just a caffeinated drink may help. However, some studies have shown that combinations of these medicines work better and faster. You can buy some combination medicines without a prescription. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.

• Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
• Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.

Your healthcare provider may prescribe medicine to treat headaches. It's best to take this medicine as soon as possible after a migraine begins. This means you need to recognize your warning symptoms.

Your provider may also prescribe a different medicine to prevent migraine headaches. You may need to take preventive medicine for several weeks before you know if it is helpful for you.

If you have headaches 15 or more days each month that don't respond to other treatments, Botox injections into the scalp muscles may help reduce the number of headaches you have. The injections are usually done every 2 to 3 months.

Women who have migraines triggered by their menstrual cycle may take preventive medicines for a few days around their period. Hormone therapy may also be helpful for women whose migraines are triggered by hormones. However, there is an increased risk of stroke for women with migraines who use products that contain estrogen. If you are planning to get pregnant, be sure to talk to your healthcare provider about whether the medicines you have been prescribed are safe during pregnancy. If they are not known to be safe, you will need a different treatment plan while you are trying to get pregnant and during pregnancy and breast-feeding.

Ask your provider if non-medicine treatments may help you, including devices that perform gentle electrical nerve stimulation before or when migraine pain starts.

How can I take care of myself?

When you start having signs of a migraine:

• As soon as possible after the symptoms start, take the medicine recommended or prescribed by your healthcare provider. Treating the headache early can keep the pain from getting severe and shorten the time you have the headache.
• If you can, rest in a quiet, dimly lit room until the symptoms are gone. The pain may go away with sleep.
• Put a cool, moist washcloth on the painful side of your head.
• Don't drive a car or operate machines that require your attention while you have the headache.

Learn your early warning symptoms of a migraine. When the warning symptoms appear, try going to a quiet place and doing relaxation exercises. This early care can make a big difference in how easily you can get over the migraine.

Follow the full course of treatment prescribed by your healthcare provider. Ask your healthcare provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests. Contact your healthcare provider if you have new or worsening symptoms.

How can I help prevent migraine headaches?

Prevention is an important part of treatment. To help prevent migraine headaches:

• Take medicine as directed by your healthcare provider.
• Avoid foods or activities that seem to be related to your headaches.
• Stay fit with the right kind of exercise for you.
• Limit caffeine if it seems related to your headaches.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
• If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink.
• Try to get at least 7 to 9 hours of sleep each night.

You can get more information from:

• American Migraine Foundation
  800-255-2243
  https://americanmigrainefoundation.org/
• National Headache Foundation
  800-843-2256
  http://www.headaches.org/