Migraine

Alternative Names

Headache - migraine

Treatment

There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or altering triggers. When you do get migraine symptoms, try to treat them right away. The headache may be less severe.

A good way to identify triggers is to keep a headache diary. See headache.

When migraine symptoms begin:

• Rest in a quiet, darkened room
• Drink fluids to avoid dehydration (especially if you have vomited)
• Try placing a cool cloth on your head

Over-the-counter pain medications like acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. (Be aware, however, that chronic usage of such pain medications may result in rebound headaches.) If these don't help, ask your doctor about prescription medications.

Your doctor will select from several different types of medications, including:

• Ergots like dihydroergotamine or ergotamine with caffeine (Cafergot)
• Triptans like sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), frovatriptan (Frova), and zolmitriptan (Zomig); these are available as a tablet, nasal spray, or self-administered injection
• Isometheptene (Midrin)
• Stronger pain relievers (narcotics)

Many of the prescription medications for migraines narrow your blood vessels. Therefore, these drugs should not be used if you have heart disease, unless specifically instructed by your doctor.

If you wish to consider an alternative, feverfew is a popular herb for migraines. Several studies, but not all, support using feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, know that herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.

Support Groups

American Council for Headache Education - www.achenet.org

The National Migraine Association - www.migraine.org

National Headache Foundation - www.headaches.org

Outlook (Prognosis)

Every person responds differently to treatment. Some people have rare headaches that require little to no treatment. Others require the use of several medications or even occasional hospitalization.

Possible Complications

Migraine headaches generally represent no significant threat to your overall health. However, they can be chronic, recurrent, frustrating, and they may interfere with your day-to-day life.

Stroke is an extremely rare complication from severe migraines. This risk may be due to prolonged narrowing of the blood vessels, limiting blood flow to parts of the brain for an extended period of time.

When to Contact a Medical Professional

Call 911 if:

• You have unusual symptoms not experienced with a migraine before, like speech or vision problems, loss of balance, or difficulty moving a limb
• You are experiencing "the worst headache of your life"

Call your doctor immediately if:

• Your headache pattern or intensity is different
• Your headache gets worse when you lie down

Also, call your doctor if:

• Previously effective treatments no longer help
• Side effects from medication occurs (irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, extreme thirst, or others)
• You are likely to become pregnant -- some medications should not be taken when pregnant

References

Morantz C. Practice Guideline Briefs. Am Fam Physician. Mar 2005; 71(5); 1019-899.

Schroeder BM . AAFP/ACP-ASIM release guidelines on the management and prevention of migraines.  Am Fam Physician. Mar 2003; 67(6): 1392, 1395-7.

Noble J, ed. Textbook of Primary Care Medicine. 3rd ed. St. Louis, MO: Mosby; 2001.

Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, MO: Mosby; 2002.

Goetz CG, Pappert EJ. Textbook of Clinical Neurology. 2nd ed. Philadelphia, PA: Saunders; 2003.