April 25, 2017
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Migraine (cont.)

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What is migraine with aura?

In some cases, patients with migraines experience specific warning symptoms, or an aura, prior to the onset of their headache. These warning symptoms can range from flashing lights or a blind spot in one eye to numbness or weakness involving one side of the body. The aura may last for several minutes, and then resolves as the head pain begins or may last until the headache resolves. For patients who have never experienced an aura, the symptoms can be frightening and can mimic the symptoms of a stroke.

What are migraine triggers?

Many factors have been identified as migraine triggers.

  • The normal hormone fluctuations which occur with regular menstrual cycles may predispose some women to experience migraine headaches.
  • Some types of oral contraceptives (birth control pills) can trigger migraines.
  • Various foods such as:
  • Oversleeping
  • Alcohol beverages
  • Stress
  • Exposure to strong stimuli such as bright lights, loud noises, or strong smells.

Changes in barometric pressure have been described as leading to migraine headaches.

Not every individual who has migraines will experience a headache when exposed to these triggers. If a person is unsure what his or her specific triggers might be, maintaining a headache diary can be beneficial to identify those individual factors which lead to migraine.

What are the signs and symptoms?

The most common symptoms of migraine are:

  • Severe, often "pounding," pain, usually on one side of the head
  • Nausea and/or vomiting
  • Sensitivity to light
  • Sensitivity to sound
  • Eye pain

What is an episodic migraine?

The International Headache Society defines episodic migraine as being unilateral, pulsing discomfort of moderate-to-severe intensity, which is aggravated by physical activity and associated with nausea and/or vomiting as well as photophobia and/or phonophobia (sensitivity to light and sound).

Other symptoms and signs

  • Many patients describe their headache as a one-sided, pounding type of pain, with symptoms of nausea and sensitivity to light, sound, or smells (known as photophobia, phonophobia, and osmophobia). In some cases, the discomfort may be bilateral. The pain of a migraine is often graded as moderate to severe in intensity. Physical activity or exertion (walking up stairs, rushing to catch a bus or train) will worsen the symptoms.
  • Up to one-third of patients with migraines experience an aura, or a specific neurologic symptom, before their headache begins. Frequently, the aura is a visual disturbance described as a temporary blind spot which obscures part of the visual field. Flashing lights in one or both eyes, sometimes surrounding a blind spot, have also been described. Other symptoms, including numbness or weakness along one side, or speech disturbances, occur rarely.
  • Some people describe their visual symptoms of loss of vision, which lasts for less than an hour, and may or may not be associated with head pain once the vision returns, as an ocular migraine. These symptoms are also known as retinal migraine, and may be associated with symptoms similar to those described as an aura, such as blind spots, complete loss of vision in one eye, or flashing lights. If a patient experiences these symptoms regularly, evaluation to exclude a primary retinal problem is needed.
  • Eye pain which is different from sensitivity to light is not a common component of migraine. If eye pain is a persistent symptom, or if eye pain is present and accompanied by blurred vision or loss of vision, then prompt evaluation is recommended.

Migraine vs. tension headache: What's the difference?

A tension headache is described as being bilateral and the pain is not pulsating, but feels like pressure or tightness. While severity can be mild-to-moderate, the headache is not disabling and there is no worsening of the pain with routine physical activity; additionally, there is no associated nausea, vomiting, photophobia, or phonophobia.

How long do they last?

A migraine headache typically lasts for several hours up to several days.

What causes migraines?

The specific cause of migraines is not known, but there may be fluctuations in certain neurotransmitters, chemicals that send messages between brain cells. These changes may predispose some people to develop migraine headaches.

What are the risk factors?

Up to 25% of people experience a migraine headache at some point in their life. Most migraine sufferers are female. It is estimated that after adolescence, the ratio of female to male patients who experience migraines is about 3:1. There seems to be a genetic predisposition to migraine, as there is often a strong family history of migraine in patients with this disorder.

How can I tell if it's a migraine or a different type of headache?

No specific physical findings are found when patients are experiencing a routine migraine headache. If an abnormality is identified on physical examination, there should be suspicion of another cause for the headache.

According to the International Classification of Headache Disorders 3 (ICHD) criteria for migraine without aura, a patient must have had at least five headache attacks fulfilling the following criteria:

  • Headache attacks lasting 4 to 72 hours (untreated or unsuccessfully treated)
  • The headache has at least two of the following characteristics:
    • Unilateral location
    • Pulsating quality
    • Moderate or severe pain intensity
    • Aggravation by or causing avoidance of routine physical activity (for example, walking or climbing stairs)
  • During the headache, at least one of the following characteristics:
    • Nausea and/or vomiting
    • Photophobia and/or phonophobia
  • The headache cannot be attributed to another disorder

Imaging the brain with an MRI and CT scans or performing a brain wave test (electroencephalogram [EEG]) is not necessary if the patient's physical examination is normal.

Medically Reviewed by a Doctor on 3/13/2017

Source: MedicineNet.com
http://www.medicinenet.com/migraine/article.htm

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