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Colds, aches, pains, and other ailments
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Migraine headaches
Originally Published: January 27, 1995
~ Last Updated / Reviewed on: January 30, 2004
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Alice, My wife has terrible migraine headaches. She has tried caffeine, vitamins, and Motrin. Motrin works occasionally. Any suggestions? —Low tolerance
Dear Low tolerance, There are three major types of headaches: tension (most common), vascular, and organic (rarest of the three that's associated with an underlying medical condition, such as a tumor, infection, disease, or hemorrhage). Migraines fall under the vascular headache category, which are due to constriction and then dilation of blood vessels in the head. Migraines are severe headaches, lasting from several minutes to several days, often accompanied by light and noise sensitivity, nausea, possible vomiting, and sometimes disturbances of vision (known as auras, which include flashing lights and blind spots). According to the Journal of the American Medical Association (JAMA) Migraine Information Center, migraines affect approximately twenty-six million Americans, nearly 75 percent of whom are women. Occasionally, people experience only a single migraine; more typically, however, they have recurrent episodes at varying intervals. Migraines seem to run in families. It is believed that migraines can be caused by biochemical changes in the brain, particularly a low level of the neurotransmitter, serotonin. People with migraines do not have enough serotonin to quiet the body's response to various triggers, such as:
Migraines come in two types: common and classic. In common migraines, which affect about 80 percent of people with migraines, the pain of the headache develops slowly, sometimes mounting to a throbbing pain that is made worse by the slightest movement or noise. The pain is often, but not always, on one side of the head only, and usually occurs with nausea and sometimes vomiting (many recover after they have vomited). The difference between common and classic migraines is that classic ones are accompanied by auras. Most people find that they recover more quickly from a migraine if they can sleep in a darkened, quiet room and use an ice pack. The best-known prevention of migraine headaches is to avoid any known triggers. What may bring about one migraine may not necessarily give rise to others, which could be caused by other trigger(s). Keeping a careful diary can help pinpoint triggers, including certain foods or ingredients, such as:
These may need to be limited or cut out of the eating plan as they have been implicated in setting off migraines in many people. Managing stress levels, treating any underlying depression, quitting smoking (if already a smoker), limiting salt and caffeine intake, and following regular eating, exercise, and sleep schedules can also help. Not having enough sleep or oversleeping is a common cause of migraines. Try getting up at the same time each day. If it's the weekend, regardless of bedtime, arise at the usual time anyway, have something to eat, wash up, and then go back to bed or take a nap later on in the day. Relaxation, physical therapy, and massage can help the migraine affected as well. If making lifestyle changes is not enough in managing migraine episodes, then this person will need to see a health care provider to discuss more powerful treatment options and what'll work best for him or her, including trying different medications to see what's effective or alternating between two or more meds depending on the type of migraine s/he has. Follow directions carefully and avoid overmedicating and overusing (i.e., chronic or daily use) pain relievers, which could lead to rebound headaches as the last dose leaves the system: As a first step in treating mild migraine pain, someone can try an over-the-counter (OTC) analgesic, such as acetaminophen, aspirin, ibuprofen, naproxen sodium, and ketoprofen, at the first signs of a migraine. An aspirin, acetaminophen, and caffeine combination, such as Excedrin Migraine, is also available, which is the first OTC product approved by the U.S. Food and Drug Administration (FDA) for treating mild to moderate migraines. Aspirin helps relieve pain, lessen inflammation, and decrease platelet aggregation. Caffeine enhances the effectiveness of the other two drugs. However, recent research suggests that an overuse of these medications can actually exacerbate the problem rather than fix it. If one is taking numerous doses of these pills a day, talk with a primary care provider about other treatment options and possible complications. For more moderate migraine pain, a combination of a narcotic pain reliever and aspirin or acetaminophen could be taken as long as episodes are not recurrent, since a person can develop a dependency to these drugs. Another option is aspirin or acetaminophen plus a sedative, which is relaxing but also may be habit-forming. For moderate to severe migraines, ergot alkaloids (e.g., ergotamine, dihydroergotamine), an alternative to analgesics that constricts the dilated blood vessels surrounding the brain, can be considered. Also available for the treatment of acute episodes are the triptans, which are serotonin agonists (see below for more information), and isometheptene-acetaminophen-sedative mixtures for pain relief, relaxation, and blood vessel narrowing. For migraine prevention, there are beta-blockers, calcium channel blockers, antidepressants, serotonin antagonists (e.g., methysergide), and anti-seizure meds (e.g., divalproex sodium), all of which can help decrease the number, duration, and severity of migraines. These drugs are recommended for people who have at least two incapacitating migraines a month or who have such severe episodes that daily life routines are disrupted. Some people have been able to treat their migraines without drugs through a method known as biofeedback. With biofeedback, a person learns how to manage both muscle tension and blood vessel constriction and dilation that are often involved in the development of a migraine. Anti-nausea, or anti-emetic, meds could also be considered to help relieve the nausea and possible vomiting symptoms that can accompany migraine pain. Much progress has been made recently in the field of migraine therapy. Powerful new drug offerings have made a dramatic difference in improving the quality of life of many people who have acute or chronic migraines, in particular, and who have not had much success, or who had too many intolerable side effects, with past treatment options. One such medication is the triptans (e.g., sumatriptan, naratriptan, rizatriptan, and zolmitriptan), which are available in several forms depending on how quickly someone wants the drug to act on his or her migraine. From slowest to fastest acting, there are pills taken by mouth, nasal sprays, and self-injectable forms. A 5-HT agonist, sumatriptan, has received a lot of attention and is the most commonly taken triptan. Sumatriptan is a migraine abortive medication that binds to 5-HT receptors on the trigeminal nerve for serotonin, which then stops the migraine from progressing. Side effects, such as chest tightness, warmth, and dizziness, are mild and fleeting in most people. Depending on a person's medical history and what drugs and supplements s/he is currently taking, a health care provider will determine whether or not s/he can take sumatriptan. Unfortunately, sumatriptan pills are priced at around fourteen dollars each and injectable forms can cost about forty-two bucks. And, it doesn't work for everyone. Considering there are more migraine treatment options than ever before, your wife could benefit from seeing a health care provider to get a proper diagnosis of what she has and to discuss her prescription possibilities. She can work with her provider in coming up with a migraine management plan that'll meet her needs and be effective for her. Hopefully she'll find some more lasting relief soon. For more information about migraines, check out: National Headache Foundation
An information resource providing written information, physician names for treatment through the mail, educational materials, and membership (for a nominal fee). American Council for Headache Education (ACHE)
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