| Subject | Contents |
| Definition | A classic migraine is a disorder involving repeated or recurrent headache, associated with temporary changes in the diameter of the blood vessels in the head. "Classic" migraine headaches refer to those migraine headaches that are preceded by a visual disturbance called an aura. This type of migraine is to be differentiated from "common" migraines (no warning or aura) or "complicated" migraines (associated with non-visual neurological symptoms such as disturbances in speech, movement, or sensory perception). |
| Alternative Names | Migraine - classic; Migraine - with aura |
| Causes, incidence, and risk factors | Headaches are a frequent cause of lost productivity and a common reason for seeking medical attention. Migraines are a common type of chronic headache, affecting about 6 out of 100 people. Migraines most commonly occur in women with onset between the ages of 10 and 46 years. They appear to run in families in some cases. Classic migraine accounts for about one-sixth of all migraines. Common migraine and other (rare) forms account for the rest. The symptoms of migraine may occur as a result of changes in blood vessel diameter. Initially, constriction or spasm of blood vessels to the brain and surrounding structures may decrease blood flow to these areas. This can result in neurological symptoms other than headache, including visual changes, difficulty speaking, weakness or numbness of one part of the body, tingling sensations, and others. Many patients with migraine become accustomed to these symptoms prior to a headache (called an aura) and may take measures to reduce the severity of the subsequent headache (see treatment). Minutes to hours later, the blood vessels dilate (enlarge), resulting in the severe headache. Classic migraine specifically refers to those migraines preceded by visual symptoms. Migraines have a multifactorial etiology. There are clear hereditary factors and environmental triggers contributing to a cascade of events causing abnormal blood vessel caliber and inflammation and resulting in the ensuing symptoms. Attacks of migraine headache may be associated with allergic reactions, bright lights, loud noises, physical or mental stress, changes in sleep patterns, smoking or exposure to tobacco smoke, missed meals, alcohol, caffeine, hormonal fluctuations (related to menstrual cycles or use of birth control pills), and other conditions. Foods associated with migraine include foods containing the amino acid tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, some beans), chocolates, nuts, peanut butter, fruits (avocado, banana, citrus fruit), onions, dairy products, baked goods, meats containing nitrates (bacon, hot dogs, salami, cured meats), foods containing monosodium glutamate (MSG -- an additive in many foods), and any processed, fermented, pickled, or marinated foods. |
| Symptoms | Migraine headaches are often described as a 'pounding' discomfort that frequently starts on one side of the head and then spreads to involve both sides or may remain localized. For many affected patients, headaches have a tendency to start on the same side each time. Many patients describe pain behind the eye or in the back of the head and neck. The headache typically begins as a dull ache that progressively worsens over several minutes to hours to the point of disabling pain. The headache may last several hours to days, during which patients may be intolerant to light (photophobia) or sound (sonophobia). Patients will frequently have the urge to rest in a quiet, dark room. Aura (preliminary or prodromal symptoms) may occur a few minutes to 24 hours before headache. Visual changes, one or both eyes (common, may occur in any combination): Seeing zigzag lines Seeing flashing lights Other visual hallucinations Temporary blind spots Photophobia (discomfort when in bright light) Blurred vision Eye pain Symptoms that may precede or accompany classic migraine headache: Loss of appetite Nausea Vomiting Chills Increased urination Increased sweating Swelling of the face Irritability Fatigue |
| Signs and tests | Headaches associated with abnormal neurological functions (such as speech, vision, balance, movement, sensation, among others) necessitate immediate evaluation by a qualified health care provider, particularly if the person has not had similar headaches before. Other symptoms that may herald a more serious diagnosis include loss of consciousness, a change in headache pattern, the presence of the worst headache in one's life, headaches that are more severe when lying down, or a headache that starts extremely abruptly. Such headaches may be the result of stroke, intracranial hemorrhage, aneurysm, or other serious condition and require the immediate attention of a physician. Also contact your healthcare provider if previously effective treatments are no longer helpful, or if symptoms indicating side effects of medications occur, including irregular heartbeat, changes in skin color (pale or blue), extreme sleepiness or sedation, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain or cramps, dry mouth, extreme thirst, among others. Depending on the history of the headache, a CT scan or MRI may be done to rule out any of the above conditions. |
| Treatment | It is valuable to maintain a headache diary -- a calendar record of headaches and associated symptoms. Diet, sleep patterns, menstrual cycles, and other relevant environmental factors should also be noted on the calendar. With this diary, a relationship between migraines and a particular environmental factor may become apparent and provide a mechanism of reducing the frequency of attacks. For example, the diary may reveal that headaches tend to occur more often on days when the patient awakens earlier than usual. A subsequent change in sleep schedule may then result in fewer migraine attacks. Even in the absence of a clear factor that provokes migraine attacks, changes in lifestyle are frequently useful. Many patients may benefit from a regular sleep schedule and exercise. Avoidance of smoking, caffeine, and alcohol is also beneficial. Some patients have found biofeedback and self-hypnosis to be effective at reducing the frequency of migraine attacks. Joining a support group where members share common experiences and problems can often help the stress of illness. Some oral contraceptive pills and other medications may increase headache frequency and may be contra-indicated in some migraine sufferers. Your health care provider should address questions regarding their use. Although there is no cure for migraine headaches, numerous treatment options are available. Methods of migraine treatment include: Prevention of migraine or reducing the frequency of their occurrence Aborting the migraine, once early symptoms develop Treating the symptoms of migraine (e.g., pain, nausea) All medications have potential side effects and may be incompatible with other medications used to treat co-existing medical problems or may worsen an underlying medical problem. Also, many of these medications are associated with birth defects and are therefore not safe to use during pregnancy. A physician will individualize treatment based on these factors. Often, several classes of medications are tried before one (or a combination) is found to be effective. Many medications can reduce the frequency of migraines. Generally, these preventative medications need to be taken daily in order to be effective. Because they must be taken even in-between headaches, they are less useful and tolerable to patients with infrequent headaches. Medications in this category include: Beta-blockers (e.g., propanolol) Anti-depressants (e.g., amitriptyline) Anti-convulsants (e.g., valproic acid) Calcium-channel blockers (e.g., verapamil) Serotonin re-uptake inhibitors Other medications are taken when there is the first sign of an impending migraine attack. In the case of classic migraine, this is typically when visual disturbances are first noted. These medications can effectively stop the migraine in its tracks, preventing the progression to other migraine symptoms or reducing the severity of the attack. Many of these medications cause constriction of blood vessels and cannot be given to patients at risk of heart attack or other conditions. These medications include: Ergots (e.g., DHE-45) Serotonin agonists / triptans (e.g., sumatriptan) Isometheptene Many of these medications come in various preparations to enable administration via different routes. For example, patients who experience vomiting and cannot keep pills down may benefit from a nasal spray or injectable dose. Call for an appointment with your health care provider if taking an ergotamine-containing medication and you are likely to become pregnant (these medications can have serious side effects to a developing fetus). Other medications are primarily given to treat the symptoms of migraine. Used alone or in combinations, these drugs can minimize pain, nausea, or emotional distress caused by the migraine. Some of these medications may also have some effect on the underlying process in addition to providing symptomatic relief. Medications in this category include: Anti-emetics (e.g., prochlorperazine) Sedatives (e.g., butalbital) Anti-inflammatories (e.g., ibuprofen) Acetaminophen Narcotic analgesics (e.g., meperidine) |
| Support Groups | The stress of illness can often be helped by joining a support group where members share common experiences and problems. See migraine - support group . |
| Expectations (prognosis) | Migraine headaches usually represent no significant threat to overall health. However, there are rare circumstances when patients with migraine are at risk of other, serious medical illnesses such as stroke. Experienced physicians can identify certain patients who may be at increased risk from these complications and who can implement treatment to reduce such risk. The large number of people affected by migraine has initiated extensive research into the finding the cause for and effective treatment of the disorder. Numerous medications have recently been released and many others are in the development stages. |
| Complications | |
| Calling your health care provider | Call for an appointment with your health care provider if symptoms of migraine are severe, persistent, recurrent, or accompanied by other symptoms. |
| Prevention | Development of migraine may be lessened in high-risk people who avoid factors that have been associated with previous migraine. Preventive medications may be advised for some people (see Treatment). Frequently Asked Questions: Q. Do migraine headaches mean that I may have a brain tumor? A. True migraine headaches are not a result of underlying brain tumors or other serious medical problems. However, only an experienced physician can determine whether headache symptoms represent migraine or some underlying medical condition that requires further tests. This assessment can only be made after a review of a patient's history and a thorough neurological examination. Q. I have been diagnosed with migraines. Do I have to stop eating all of the foods mentioned above? A. Generally, most patients with migraine can identify select foods that are closely associated with a migraine headache. A method of finding out which food(s) are responsible is to initially avoid all of the above foods and then gradually work each food back into the diet. In this manner, many patients can identify specific foods that need to be avoided. An accurate headache diary helps determine which foods may be responsible. |
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