Migraine  headaches are one of the most common problems seen in emergency departments and doctors’ offices. Migraines are due to changes in the brain and surrounding blood vessels.

Migraine headaches typically last from 4-72 hours and vary in frequency from daily to fewer than 1 per year. Migraine affects about 15% of the population. Three times as many women as men have migraines. More than 80% of people with migraines (called migraineurs) have other members in the family who have them too.

Different types of migraine headaches

• Common migraine accounts for 80% of migraines. There is no “aura” before a common migraine.

• People with classic migraines experience an aura before their headaches. Most often, an aura is a visual disturbance (outlines of lights or jagged light images). Classic migraines are usually much more severe than common migraines.

• Status migrainosus is a migraine that does not go away by itself.

Causes of migraine

The exact cause of migraine headaches is not clearly understood, though experts believe they are due to a combination of the expansion of blood vessels and the release of certain chemicals, which causes inflammation and pain.

The chemicals dopamine  and serotonin are among those involved in migraine. These chemicals are found normally in the brain and can cause blood vessels to act abnormally if they are present in abnormal amounts or if the blood vessels are unusually sensitive to them.

Various triggers are thought to bring about migraine in certain people prone to developing migraine. Different people may have different triggers:

• Certain foods, especially chocolate, cheese, nuts, alcohol, and MSG, bring on headaches in some people. (MSG is a food enhancer used in many foods including Chinese food.)
• Missing a meal may bring on a headache.
• Stress and tension are also risk factors. People often have migraines during times of increased emotional or physical stress.
• Birth control pills are a common rigger. Women may have migraines at the end of the pill cycle as the estrogen component of the pill is stopped. This is called an estrogen-withdrawal headache.
• Smoking may cause migraines or interfere with treatment.

Migraine Headache Symptoms

Symptoms vary from person to person and from migraine to migraine. Five phases can often be identified:

• Prodrome: A variety of warnings can come before a migraine. These may consist of a change in mood (for example, feeling “high,” irritable, or depressed) or a subtle change of sensation (for example, a funny taste or smell). Fatigue and muscle tension are also common
• Aura: This is commonly a visual disturbance that precedes the headache phase. Some migraineurs develop blind spots (called scotomas); see geometric patterns or flashing, colorful lights; or lose vision on one side (hemianopsia).
• Headache: Although migraine pain usually appears on one side of the head, 30-40% of migraines occur on both sides. Throbbing pain may be present. More than 80% of migraineurs feel nauseated, and some vomit . About 70% become sensitive to light (photophobia) and sound (phonophobia). This phase may last 4-72 hours.
• Headache termination: Even if untreated, the pain usually goes away with sleep.
• Postdrome: Other signs of the migraine (for example, inability to eat, problems with concentration, or fatigue) may linger after the pain has disappeared.

When to Seek Medical Care

Call a doctor if any of the following occur:

• A change in frequency, severity, or features of the migraine commonly experienced
• A new, progressive headache that lasts for days
• A headache brought on by coughing, sneezing, bearing down, straining while on the toilet, and so on
• Large, unintentional loss of body weight
• Weakness or paralysis that lasts after the headache

Go to a hospital emergency department if any of the following occur:

• Having the worst headache ever, especially if the headache came on very quickly
• Headache associated with trauma to the head
• Trauma to the head with loss of consciousness
• Fever or stiff neck associated with headache
• Decreased level of consciousness or confusion
• Paralysis of one side of the body
• Seizure

Exams and Tests

The diagnosis of migraine headache rests solely on what a patient describes to a doctor. A doctor’s physical examination of a typically migraineur reveals nothing out of the ordinary; however, a neurological examination will be performed to rule out other causes of headache.

Other causes include stroke, tumor, inflammation of a blood vessel, and infection of the brain’s coverings (meningitis) or of the sinuses. In such cases, the following tests may also be performed:

• Blood tests
• X-rays
• CT scan or MRI of the head to look for bleeding, stroke, or tumor
• A  spinal tap (also called a lumbar puncture) to look for evidence of infection or bleeding

Migraine Headache Treatment

Self-Care at Home

Most migraineurs can manage mild-to-moderate attacks at home with the following strategies:

• Using a cold compress to the area of pain
• Resting with pillows comfortably supporting the head or neck
• Resting in a room with little or no sensory stimulation (light, sound, odors)
• Withdrawing from stressful surroundings
• Sleeping
• Drinking a moderate amount of caffeine
• Trying certain  over-the-counter  headache medications
  • Nonsteroidal anti-inflammatory drugs (NSAIDS): These include medications like asprin,ibuprofen (Motrin, Advil),naproxen (Naprosyn, Aleve), and ketoprofen (Orudis). Stomach ulcers and bleeding are serious potential side effects. This type of medication should not be taken by anyone with a history of stomach bleeding. A doctor or pharmacist should be asked about possible medicine interactions if the migraineur is taking other drugs.
  • Acetaminophen : Acetaminophen may be safely taken with NSAIDs for an additive effect. Taking acetaminophen by itself is usually safe, even with a history of stomach ulcers or bleeding. Acetaminophen should not be taken if the migraineur has liver problems or has 3 or more alcohol drinks a day.
  • Combination medications: Some over-the-counter pain relievers have been approved for use with migraine. These include Excedrin Migraine, which contains acetaminophen and aspirin combined with caffeine. A similar effect can be achieved by taking 2 aspirin or acetaminophen tablets with a cup of black coffee.