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Migraine is a Neurological disease best known for severe headaches that are its most salient symptom.123 OVERVIEW Usually migraine causes episodes of severe or moderate Headache (which is often one-sided and pulsating) lasting between several hours to three days, accompanied by gastrointestinal upsets, such as nausea and vomiting, and a heightened sensitivity to bright lights ( Photophobia ) and noise ( Phonophobia ). Approximately one third of people who experience migraine get a preceding Aura .4 The word ''migraine'' is French in origin and comes from the Greek ''hemicrania'', as does the Old English term ''megrim''. Literally, ''hemicrania'' means "half (the) head". Migraine is widespread in the population. In the U.S., 18% of women and 6% of men report having had at least one migraine episode in the previous year. Silberstein S. Migraine. Lancet 2004;363:381-391 Wrongdiagnosis.com reports that 10% of people have been diagnosed with migraine and 5% have migraine but have not been diagnosed, wrongdiagnosis.com with seriousness varying from a rare annoyance to a life-threatening and/or daily experience. Treatments are typically expensive. Periodic or unpredictable disability can cause impoverishment due to patients' inability to work enough or to hold a job at all. Migraines' secondary characteristics are inconsistent. '' Triggers '' precipitating a particular episode of migraine vary widely. The efficacy of the simplest treatment, applying warmth or coolness to the affected area of the head, varies between persons, sometimes worsening the migraine."The Essential Book of Herbal Medicine" (also known as "Out of the Earth") by Simon Y. Mills, Viking Arkana, 1994(1991). Mills is former president of the UK licensed medical herbalists association. Mills' point is the traditional classification of migraines into "hot" and "cold" types, meaning that one's migraine type is determined by whether one's pain is reduced by hot/warm versus cold water. A particular migraine rescue drug may sometimes work and sometimes not work in the same patient. Some migraine types don't have pain or may manifest symptoms in parts of the body other than the head. Available evidence suggests that migraine pain is one symptom of several to many disorders of the Serotonergic control system, a dual Hormone - Neurotransmitter with numerous types of Receptors . Two disorders — classic migraine with Aura (MA, STG) and common migraine without aura (MO, STG) — have been shown to have a genetic factor.Ogilvie AD, Russell MB, Dhall P, ''et al.'' "Altered allelic distributions of the serotonin transporter gene in migraine without aura and migraine with aura." ''Cephalalgia''. 1998 Jan;18(1):23-6. PMID 9601620 Studies on twins show that genes have a 60 to 65% influence on the development of migraine (PMID 10496258 and PMID 10204850 ). Additional migraine types are suspected and could be proven to be genetic. Migraine understood as several or many disorders could explain the inconsistencies, especially if a single patient has more than one genetic type. However, still other migraine types might be functionally acquired due to hormone organ disease or injury. Three quarters of adult migraine patients are female, although pre- Pubertal migraine affects approximately equal numbers of boys and girls. This reveals the strong correlation to hormonal cycling and hormonal-related causes or triggers. Hormonal migraine is a likely consequence of periodically falling hormone levels causing reduction in Protein Biosynthesis of Metabolic components including intestinal tract Serotonin . SIGNS AND SYMPTOMS The signs and symptoms of migraine vary among patients. Therefore, what a patient experiences before, during and after an attack cannot be defined exactly. The four phases of a migraine attack listed below are common but not necessarily experienced by all migraine sufferers. Additionally, the phases experienced and the symptoms experienced during them can vary from one migraine attack to another in the same migraineur: # The Prodrome , which occurs hours or days before the headache. # The Aura , which immediately precedes the headache. # The Pain phase, also known as headache phase. # The Postdrome . Prodrome phase Prodromal symptoms occur in 40% to 60% of migraineurs. This phase may consist of altered mood, irritability, Depression or Euphoria , Fatigue , Yawning , excessive sleepiness, craving for certain Food (e.g., Chocolate ), stiff muscles (especially in the neck), constipation or diarrhea, increased urination, and other vegetative symptoms. These symptoms usually precede the headache phase of the migraine attack by several hours or days, and experience teaches the patient or observant family how to detect that a migraine attack is near. The headache can range from mild to moderate or intolerable. {Link without Title} Aura phase For the 20-30%Young, William B. and Silberstein, Stephen D., Migraine and Other Headaches. St. Paul, Minn: AAN Press, 2004.Evans, Randolph W., MD, and Matthew, Ninan T., MD. Handbook of Headache, Second Edition. Philadelphia: Lippincott Williams & Wilkins. 2005. of migraineurs who suffer migraine with aura, this aura comprises focal neurological phenomena that precede or accompany the attack. They appear gradually over 5 to 20 minutes and generally last less than 60 minutes. The headache phase of the migraine attack usually begins within 60 minutes of the end of the aura phase, but it is sometimes delayed up to several hours, and it can be missing entirely. Symptoms of migraine aura can be visual, sensory, or motor in nature.Silberstein, Stephen D.; Lipton, Richard B.; Goadsby, Peter J. Headache in Clinical Practice Second Edition. Andover: Thomson Publishing Services. 2002. Visual Aura is the most common of the neurological events. There is a disturbance of vision consisting usually of unformed flashes of white and/or black or rarely of multicolored lights ( Photopsia ) or formations of dazzling zigzag lines ( Scintillating Scotoma ; often arranged like the battlements of a castle, hence the alternative terms "fortification spectra" or "teichopsia"). Some patients complain of blurred or shimmering or cloudy vision, as though they were looking through thick or smoked Glass , or, in some cases, Tunnel Vision and Hemianopsia . The somatosensory aura of migraine consists of digitolingual or cheiro-oral Paresthesia s, a feeling of pins-and-needles experienced in the hand and arm as well as in the ipsilateral nose-mouth area. Paresthesia migrate up the arm and then extend to involve the face, lips and tongue. Other symptoms of the aura phase can include auditory or olfactory hallucinations, temporary Dysphasia , Vertigo , tingling or numbness of the face and extremities, and hypersensitivity to touch. Pain phase The typical migraine headache is unilateral, throbbing, moderate to severe and can be aggravated by physical activity. Not all of these features are necessary. The pain may be bilateral at the onset or start on one side and become generalized, and usually alternates sides from one attack to the next. The onset is usually gradual. The pain peaks and then subsides, and usually lasts between 4 and 72 hours in adults and 1 and 48 hours in children. The frequency of attacks is extremely variable, from a few in a lifetime to several times a week, and the average migraineur experiences from one to three headaches a month. The head pain varies greatly in intensity. The pain of migraine is invariably accompanied by other features. Nausea occurs in almost 90 percent of patients, while vomiting occurs in about one third of patients. Many patients experience sensory hyperexcitability manifested by Photophobia , Phonophobia , Osmophobia and seek a dark and quiet room. Blurred vision, nasal stuffiness, diarrhea, Polyuria , Pallor or sweating may be noted during the headache phase. There may be localized Edema of the scalp or face, scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness of the neck. Impairment of concentration and mood are common. Lightheadedness, rather than true Vertigo and a feeling of faintness may occur. The extremities tend to be cold and moist. Postdrome phase The patient may feel tired, "washed out", irritable, or listless and may have impaired concentration, scalp tenderness or mood changes. Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and Malaise . Often, some of the minor headache phase symptoms may continue, such as loss of appetite, photophobia, and lightheadedness. DIAGNOSIS The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":
For migraine with aura, only two attacks are required to justify the diagnosis. The presence of either disability, nausea or sensitivity, can diagnose migraine with5:
PATHOPHYSIOLOGY Migraine was once thought to be initiated by problems with Blood Vessels . This theory is now largely discredited.6 Current thinking is that a phenomenon known as Cortical Spreading Depression is responsible for the disorder.7 In Cortical Spreading Depression , Neurological Activity is depressed over an area of the Cortex of the brain. This situation results in the release of Inflammatory mediators leading to irritation of Cranial Nerve roots, most particularly the Trigeminal Nerve , which conveys the sensory information for the face and much of the head. This view is supported by Neuroimaging techniques, which appear to show that migraine is primarily a disorder of the brain (neurological), not of the blood vessels (vascular). A spreading depolarization (electrical change) may begin 24 hours before the attack, with onset of the headache occurring around the time when the largest area of the brain is depolarized. The effects of migraine may persist for some days after the main headache has ended. Many sufferers report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed. In 2005, research8 was published indicating that in some people with a Patent Foramen Ovale (PFO), a hole between the upper chambers of the heart, suffer from migraines which may have been caused by the PFO. The migraines end instantly if the hole is patched. Several clinical trials are currently under way in an effort to determine if a causal link between PFO and migraine can be found. Early speculation as to this relationship has centered on the idea that the lungs detoxify blood as it passes through. The PFO allows uncleaned blood to go directly from the right side of the heart to the left without passing through the lungs. Migraine headaches can be a symptom of Hypothyroidism . TYPES Migraine without aura This is the most commonly seen form of migraine; patients who primarily suffer from migraine without aura may also have attacks of migraine with aura. According to the International Classification of Headache DisordersCephalalgia 2004;24 (suppl 1):24-5 http://216.25.100.131/upload/ct_clas/ihc_II_main_no_print.pdf it is a recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia. In order to diagnose migraine without aura, there must have been at least 5 attacks not attributable to another cause that fulfill the following criteria: :1. Headache attacks lasting 4-72 hours when untreated :2. At least two of the following characteristics:
:3. During the headache there must be at least one of the following associated symptom clusters:
Where these criteria are not fully met, the problem may be classified as "probable migraine without aura" but other diagnoses such as "episodic tension type headache" must also be excluded. Migraine with aura This is the second most commonly seen form of migraine: patients who primarily suffer from migraine with aura may also have attacks of migraine without aura. According to the International Classification of Headache DisordersCephalalgia 2004;24 (suppl 1):25-27 http://216.25.100.131/upload/ct_clas/ihc_II_main_no_print.pdf it is a recurrent disorder manifesting in attacks of reversible focal neurological symptoms that usually develop gradually over 5-20 minutes and last for less than 60 minutes. Headache with the features of "migraine without aura" usually follows the aura symptoms. Less commonly, the aura may occur without a subsequent headache or the headache may be non-migrainous in type. In order to diagnose migraine with aura, there must have been at least 2 attacks not attributable to another cause that fulfill the following criteria: :1. Aura consisting of at least one of the following, but no muscle weakness or paralysis:
:2. Aura has at least two of the following characteristics:
Where these criteria are not fully met, a diagnosis of "probable migraine with aura" may be considered, although other neurological causes must also be excluded. If the picture complies with the criteria but includes one-sided muscular weakness or paralysis, a diagnosis of "sporadic hemiplegic migraine" or "familial hemiplegic migraine" should be considered. Basilar type migraine Basilar type migraine (BTM), formerly known as basilar artery migraine (BAM) or basilar migraine (BM), is an uncommon type of complicated migraine with symptoms that result from Brainstem dysfunction. Serious episodes of BTM can lead to stroke, coma, or even death. The use of Triptan s and other Vasoconstrictor s as abortive treatments in BTM is contraindicated. Abortive treatments for BTM often focus on vasodilation and restoration of normal blood flow to the vertebrobasilar territory and subsequent return of normal brainstem function. Familial hemiplegic migraine ''See also the main article on Familial Hemiplegic Migraine '' Familial hemiplegic migraine 'FHM' is a type of migraine with a possible polygenetic component. These migraine attacks may last 4-72 hours The International Classification of Headache Disorders, 2nd Edition and are apparently caused by ion channel mutations, three types of which have been identified to date. Patients who experience this syndrome have relatively typical migraine headaches preceded and/or accompanied by reversible limb weakness on one side as well as visual, sensory or speech difficulties. A non-familial form exists as well, "sporadic hemiplegic migraine" (SHM). It is often difficult to make the diagnosis between basilar-type migraine and hemiplegic migraine. When making the Differential Diagnosis is difficult, the deciding symptom is often the motor weakness or unilateral paralysis which can occur in FHM or SHM. While basilar-type migraine can present with tingling or numbness, true motor weakness and/or paralysis occur only in hemiplegic migraine. Abdominal migraine According to the International Classification of Headache DisordersCephalalgia 2004;24 (suppl 1):30-31 http://216.25.100.131/upload/ct_clas/ihc_II_main_no_print.pdf abdominal migraine is a recurrent disorder of unknown origin which occurs mainly in children. It is characterised by episodes of moderate to severe central abdominal pain lasting 1-72 hours. There is usually associated nausea and vomiting but the child is entirely well between attacks. In order to diagnose abdominal migraine, there must be at least 5 attacks, not attributable to another cause, fulfilling the following criteria: :1. Attacks lasting 1-72 hours when untreated :2. Pain must have ALL of the following characteristics:
:3. During an attack there must be at least two of the following:
Most children with abdominal migraine will develop migraine headache later in life and the two may co-exist during adolescence. Acephalgic migraine Acephalgic migraine is a neurological syndrome. It is a variant of migraine in which the patient may experience Aura Symptoms such as Scintillating Scotoma , Nausea , Photophobia , Hemiparesis and other migraine Symptoms but does not experience Headache . Acephalgic migraine is also referred to as amigrainous migraine, '''ocular migraine''', or '''optical migraine'''. Sufferers of acephalgic migraine are more likely than the general population to develop classical migraine with headache. The prevention and treatment of acephalgic migraine is broadly the same as for classical migraine. However, because of the absence of "headache", diagnosis of acephalgic migraine is apt to be significantly delayed and the risk of misdiagnosis significantly increased. Visual Snow might be a form of acephalgic migraine. If symptoms are primarily visual, it may be necessary to consult an Ophthalmologist to rule out potential eye disease before considering this diagnosis. EPIDEMIOLOGY Migraine is an extremely common condition which will affect 12-28% of people at some point in their lives.Stovner LJ, Zwart J-A, Hagen K, ''et al.'' Epidemiology of headache in Europe. Eur J Neurol 2006;13:333-45 However this figure — the lifetime prevalence — does not provide a very clear picture of how many patients there are with active migraine at any one time. Typically, therefore, the burden of migraine in a population is assessed by looking at the one-year prevalence — a figure that defines the number of patients who have had one or more attacks in the previous year. The third figure, which helps to clarify the picture, is the incidence — this relates to the number of first attacks occurring at any given age and helps understanding of how the disease grows and shrinks over time. Based on the results of a number of studies, one year prevalence of migraine ranges from 6%-15% in adult men and from 14%-35% in adult women. These figures vary substantially with age: approximately 4-5% of children aged under 12 suffer from migraine, with little apparent difference between boys and girls.3. Mortimer MJ, Kay J, Jaron A. Epidemiology of headache and childhood migraine in an urban general practice using ad hoc, Vahlquist and IHS criteria. Dev Med Child Neurol 1992;34:1095-1101 There is then a rapid growth in incidence amongst girls occurring after pubertyLinet MS, Stewart WF, Celentano DD ''et al.'' An epidemiologic study of headache among adolescents and young adults. JAMA 1989;261:2211-16,Ziegler DK, Hassanein RS, Couch JR. Characteristics of life headache histories in a nonclinic population. Neurology 1977;27:265-269Selby G, Lance JW. Observations on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiat 1960;23:23-32 which continues throughout early adult life.Anttila P, Metsahonkala L, Sillanpaa M. Long-term trends in the incidence of headache in Finnish schoolchildren. Pediatrics 2006;117:e1197-e1201 By early middle age, around 25% of women experience a migraine at least once a year, compared with fewer than 10% of men.Lipton RB,.Stewart WF. Migraine in the United States: a review of epidemiology and health care use. Neurology 1993;43:S6-10 After menopause, attacks in women tend to decline dramatically, so that in the over 70s there are approximately equal numbers of male and female sufferers, with prevalence returning to around 5%. At all ages, migraine without aura is more common than migraine with aura, with a ratio of between 1.5:1 and 2:1.Rasmussen BK,.Olesen J. Migraine with aura and migraine without aura: an epidemiological study. Cephalalgia 1992;12:221-8Steiner TJ, Scher AI, Stewart WF, ''et al.'' The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity. Cephalalgia 2003; 23:519-27 Incidence figures show that the excess of migraine seen in women of reproductive age is mainly due to migraine without aura.Rasmussen BK,.Olesen J. Migraine with aura and migraine without aura: an epidemiological study. Cephalalgia 1992;12:221-8 Thus in pre-pubertal and post-menopausal populations, migraine with aura is somewhat more common than amongst 15-50 year oldsAnttila P, Metsahonkala L, Sillanpaa M. Long-term trends in the incidence of headache in Finnish schoolchildren. Pediatrics 2006;117:e1197-e12017,10Bigal ME, Liberman JN, Lipton RB. Age-dependent prevalence and clinical features of migraine. Neurology 2006;67:246-51 Geographical differences in migraine prevalence are not marked. Studies in Asia and South America suggest that the rates there are relatively low,Wang SJ. Epidemiology of migraine and other types of headache in Asia. Curr Neurol. Neurosci. Rep. 2003;3:104-8Lavados PM,.Tenhamm E. Epidemiology of migraine headache in Santiago, Chile: a prevalence study. Cephalalgia 1997;17:770-7 but they do not fall outside the range of values seen in European and North American studies.Lipton RB,.Stewart WF. Migraine in the United States: a review of epidemiology and health care use. Neurology 1993;43:S6-10 TRIGGERS A migraine trigger is any factor that, on exposure or withdrawal, leads to the development of an acute migraine headache. Triggers may be categorized as behavioral, environmental, infectious, dietary, chemical, or hormonal. According to the National Library of Medicine's Medical Encyclopedia, Migraine attacks may be triggered by:
Many people report that one or more dietary, physical, hormonal, emotional, or environmental factors precipitate their migraines. The most-often reported triggers include: pesticides (sprayed fruits/vegetables), perfumes or fragrances (30% of sufferers) Stress , Over-illumination or glare, Alcohol , foods, too much or too little Sleep , and weather. Some women experience migraines in conjunction with monthly menstrual cycles. Sometimes the migraine occurs with no apparent "cause". The trigger theory supposes that exposure to various environmental factors precipitates, or triggers, individual migraine episodes. Migraine patients have long been advised to try to identify personal headache triggers by looking for associations between their headaches and various suspected trigger factors. Patients are urged to keep a "headache diary" in which to note what they eat and when they get a headache, to look for correlations, and to try to avoid headache by avoiding factors they identify as triggers. Typically this advice is accompanied by a list of trigger factors. Food In 2005, authors who reviewed the medical literature9 found that the available information about dietary trigger factors relies mostly on the subjective assessments of patients. Some suspected dietary trigger factors appear to genuinely promote or precipitate migraine episodes, but many other suspected dietary triggers have never been demonstrated to trigger migraines. The review authors found that alcohol, Caffeine withdrawal, and missing meals are the most important dietary migraine precipitants. The authors say dehydration deserves more attention, and that some patients are sensitive to red wine. The authors found little or no demonstrated evidence that notorious suspected triggers chocolate, cheese, or that Histamine , Tyramine , Nitrates , or Nitrites normally present in foods trigger headaches. The artificial sweetener Aspartame ( NutraSweet ®) has not been shown to trigger headache, but in a large and definitive study Monosodium Glutamate (MSG) in large doses (2.5 grams) was associated with adverse symptoms including headache more often than was Placebo . The review authors also note that while general dietary restriction has not been demonstrated to be an effective migraine therapy, it is beneficial for the individual to avoid what has been a definite cause of the migraine. On the other hand, several headache clinics have had good results with individually tailored dietary restriction as a therapy. Dr. Ian Livingstone, director of the Princeton Headache Clinic, recommends eliminating the following common headache triggers from the diet: aged cheese, monosodium glutamate, processed fish and meats containing nitrates (such as hot dogs), dark chocolate, aspartame, certain alcoholic beverages (including red wine), citrus fruits, and caffeine. After a period of one to two months, these foods can be reintroduced one at a time to determine their trigger potential for that individual. Adding large amounts of the suspected trigger in a short time may generate a response that is easy to observe. Dr. David Buchholz, a neurologist who treats headaches at Johns Hopkins Hospital , has a longer list of suspected migraine triggers. He also recommends eliminating the triggers from the diet altogether, and then reintroducing them slowly after many weeks to measure the effects. His list includes: coffee (including decaf), chocolate, monosodium glutamate, processed meats and fish (aged, canned, preserved, processed with nitrates, and some meats that contain tyramine), cheese and dairy products (the more aged, the worse), nuts, citrus and some other fruits, certain vegetables (especially onions), fresh risen yeast baked goods, dietary sources of tyramine (including the foods listed above), and ''whatever gives you a headache''. Weather Several studies have found some migraines are triggered by changes in weather. One study 11''(Prince, 2004)'' noted that 62% of the subjects in the study thought that weather was a factor, in fact 51% were actually sensitive to weather changes. Among those whose migraines did occur during a change in weather, the subjects often picked a weather change other than the actual weather data recorded. Most likely to trigger a migraine were, in order: # Temperature mixed with humidity. High humidity plus high or low temperature was the biggest cause. # Significant changes in weather # Changes in barometric pressure (See Abortive Treatment) Another study12''(Cooke, 2000)'' researched whether chinook winds (warm westerly winds occurring along the Front Ranges of the Rocky Mountains) are a migraine trigger. Many patients had increased incidence of migraines immediately before and/or during the chinook winds. The number of people reporting migrainous episodes during the chinook winds was higher on high-wind chinook days. The probable cause is "through increased air positive ion concentrations." ''(Cooke, 2000; full text web search quote)'' Hair Wash Headache Another trigger for Migraine has been proposed by Dr.K.Ravishankar, a neurologist and headache specialist from India. He reported an unusual trigger for migraine seen among Indian women, ''Hair Wash Headache''. It is described as a migraine headache that originates with a head bath. Most Indian women have long hair and so they wash their hair 2-3 times a week. Very often they do not use a hair dryer and often plait their hair when wet. This results in a gradual build up of pain which ultimately results in migraine. 13 '' (Ravishankar, 2006)'' TREATMENT Conventional treatment focuses on three areas: trigger avoidance, symptomatic control, and preventive drugs. Patients who experience migraines often find that the recommended treatments are not 100% effective at preventing migraines, and sometimes may not be effective at all. Trigger avoidance Patients can attempt to identify and avoid factors that promote or precipitate migraine episodes. Moderation in alcohol and caffeine intake, consistency in sleep habits, and regular meals may be helpful. Beyond an often pronounced Placebo Effect , general dietary restriction has not been demonstrated to be an effective approach to treating migraine. {Link without Title} Nonetheless, some people fervently claim that they have successfully identified foods that are likely to result in migraines, and by avoiding them, can decrease the likelihood of an episode. Abortive treatment Migraine sufferers usually develop their own coping mechanisms for the pain of a migraine attack. A cold or hot shower directed at the head, a hot or cold wet washcloth, a warm bath, or resting in a dark and silent room may be as helpful as medication for many patients, but both should be used when needed. Some headache sufferers are surprised to learn that a simple cup of coffee is used daily around the world to control minor vascular headaches that are not quite migraines. Minor vascular headaches are frequently associated with the hormonal fluctuations of menstrual periods, irregular eating, and unusually hard work. For migraineurs, a well-timed cup of coffee can prevent outright migraine under the same conditions. A simple treatment, which has been effective for some, is a counteracting "ice cream headache", briefly provoked by placing spoonfuls of ice cream on the soft palate at the back of the mouth. (Hold them there with your tongue until they melt or become intolerable.) This directs cooling to the Hypothalamus , which is suspected to be involved with the migraine feedback cycle, and for some it can stop even a severe headache very quickly. For patients who have been diagnosed with recurring migraines, doctors recommend taking migraine abortive medicines to treat the attack as soon as possible. Migraine without aura presenting without prodrome or nausea can present with sudden onset. Many patients avoid taking their medications when an attack is beginning, hoping that "it will go away". However, in many cases once an attack is underway, it can become intensely painful, last for a long time (sometimes even for several days), and become somewhat resistant to medical treatment. In contrast, treating the attack at the onset can often abort it before it becomes serious, and can reduce the near-term frequency of subsequent attacks. For sufferers of weather-related migraines there is a simple treatment known as the Valsalva Maneuver , which pilots and frequent flyers employ to relieve discomfort from pressure change. By holding your nose and gently pushing the air in your mouth back towards your ears and "popping" them you are opening your eustachian tubes. These normally open and close with regular chewing and talking but in some people may stay closed due to allergies or genetics. Regular opening and closing of the eustachian tubes allows a person to continually equalize to any change in the ambient barometric pressure. When this does not occur regularly the difference in pressure between the head and the environment can cause vascular swelling/constricting and trigger a migraine. Migraines can be stopped by doing the Valsalva maneuver three or four times. During changeable weather patterns doing the maneuver fifteen times per day can eliminate the headaches. Acetaminophen or NSAIDs The first line of treatment is over-the-counter (OTC) Abortive Medication . Patients themselves often start off with Paracetamol (known as Acetaminophen in the USA), Aspirin , Ibuprofen , or other simple Analgesic s that are useful for tension headaches. Some patients find relief from taking Benadryl , an OTC sedative antihistamine, or anti-nausea agents. OTC drugs may provide some relief, although they are typically not effective for most sufferers. It is one of doctors' practical diagnoses of migraine head pain when patients say typical OTC drugs "won't touch it". If the patient hasn't tried it, doctors may suggest the simple analgesics combined with Caffeine . During a migraine attack, emptying of the stomach is slowed, resulting in nausea and a delay in absorbing medication. Caffeine has been shown to partially reverse this effect, and probably accounts for its benefit. Excedrin is an example of an aspirin with caffeine product. Caffeine is recognized by the U.S. FDA as an OTC treatment for migraine. Serotonin Agonists Sumatriptan and related selective Serotonin Receptor Agonist s are now the therapy of choice for chronic migraine attacks. Triptans are a mid-line treatment suitable for many migraineurs with typical migraines. They may not work for atypical or unusually severe migraines, transformed migraines, or status (continuous) migraines. Triptans are highly effective, reducing the symptoms or aborting the attack within 30 to 90 minutes in 70-80% of patients. Many patients have a recurrent migraine later in the day, and only one such recurrence in a day can be treated with a second dose of a Triptan . Triptans have few side effects if used in correct dosage and frequency. Although there is a theoretical risk of coronary spasm in patients with established heart disease, no clinically significant problems have ever been reported in practice. Evidence is accumulating that these drugs are effective because they act on serotonin receptors in nerve endings as well as the blood vessels. This leads to a decrease in the release of several Peptide s, including CGRP and Substance P . |
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