My daughter who suffers from severe migraine attacks, got me doing extensive research on the subject, as all those I spoke to did not have a clear understanding about it. This is what I found and hope this will help all those who suffer from migraine to have a clear understanding on the subject.
What is a migraine headache?
A migraine headache is a form of vascular headache. Migraine headache is caused by vasodilatation (enlargement of blood vessels) that causes the release of chemicals from nerve fibers that coil around the large arteries of the brain. Enlargement of these blood vessels stretches the nerves that coil around them and causes the nerves to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the arteries magnifies the pain.
Migraine attacks commonly activate the sympathetic nervous system in the body. The sympathetic nervous system is often thought of as the part of the nervous system that controls primitive responses to stress and pain, the so-called "fight or flight" response, and this activation causes many of the symptoms associated with migraine attacks; for example, the increased sympathetic nervous activity in the intestine causes nausea, vomiting, anddiarrhea.
· Sympathetic activity also delays emptying of the stomach into the small intestine and thereby prevents oral medications from entering the intestine and being absorbed.
· The impaired absorption of oral medications is a common reason for the ineffectiveness of medications taken to treat migraine headaches.
· The increased sympathetic activity also decreases the circulation of blood, and this leads to pallor of the skin as well as cold hands and feet.
· The increased sympathetic activity also contributes to the sensitivity to light and sound sensitivity as well as blurred vision.
Migraine afflicts 28 million Americans, with females suffering more frequently (17%) than males (6%). Missed work and lost productivity from migraine create a significant public burden. Nevertheless, migraine still remains largely underdiagnosed and undertreated. Less than half of individuals with migraine are diagnosed by their doctors.
What are the symptoms of migraine headaches?
Migraine is a chronic condition with recurrent attacks. Most (but not all) migraine attacks are associated with headaches.
· Migraine headaches usually are described as an intense, throbbing or pounding pain that involves one temple. (Sometimes the pain is located in the forehead, around the eye, or at the back of the head).
· The pain usually is unilateral (on one side of the head), although about a third of the time the pain is bilateral (on both sides of the head).
· The unilateral headaches typically change sides from one attack to the next. (In fact, unilateral headaches that always occur on the same side should alert the doctor to consider a secondary headache, for example, one caused by abrain tumor).
· A migraine headache usually is aggravated by daily activities such as walking upstairs.
· Nausea, vomiting, diarrhea, facial pallor,cold hands, cold feet, and sensitivity to light and sound commonly accompany migraine headaches. As a result of this sensitivity to light and sound, migraine sufferers usually prefer to lie in a quiet, dark room during an attack. A typical attack lasts between 4 and 72 hours.
An estimated 40%-60% of migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days. The symptoms may include:
· sleepiness,
· irritability,
· fatigue,
· depression or euphoria,
· yawning, and
· cravings for sweet or salty foods.
Patients and their family members usually know that when they observe these warning symptoms that a migraine attack is beginning.
Migraine aura
An estimated 20% of migraine headaches are associated with an aura. Usually, the aura precedes the headache, although occasionally it may occur simultaneously with the headache. The most common auras are:
1. flashing, brightly colored lights in a zigzag pattern (referred to as fortification spectra), usually starting in the middle of the visual field and progressing outward; and
2. a hole (scotoma) in the visual field, also known as a blind spot.
Some elderly migraine sufferers may experience only the visual aura without the headache. A less common aura consists of pins-and-needles sensations in the hand and the arm on one side of the body or pins-and-needles sensations around the mouth and the nose on the same side. Other auras include auditory (hearing) hallucinations and abnormal tastes and smells.
For approximately 24 hours after a migraine attack, the migraine sufferer may feel drained of energy and may experience a low-grade headache along with sensitivity to light and sound. Unfortunately, some sufferers may have recurrences of the headache during this period.
How Hormones May Trigger Migraines
Doctors believe that hormones, especially estrogen, may play a role in migraine headaches. While experts aren’t exactly sure how hormones affect migraines, they do know that a woman’s estrogen and progesterone levels drop sharply just before a menstrual cycle begins. They also know that estrogen controls chemicals in the brain affect sensitivity to pain. That’s why shortly before a woman gets her period, falling estrogen levels may make her more vulnerable to feeling the pain of cramps, muscle aches — and headaches.
Some of the evidence that supports a link between hormones and migraines:
· In children, girls and boys tend to get migraine headaches at about the same rate until they hit puberty, at
which point there is a sharp increase in migraine headaches among girls who begin menstruating.
which point there is a sharp increase in migraine headaches among girls who begin menstruating.
· An estimated 60 percent of women experience migraine headaches several days before or during their menstrual cycle (though most will also experience attacks when they are not having their periods).
· Women are also more likely to have migraine attacks around the middle of their menstrual cycles, when they are ovulating.
· Pregnancy also seems to affect migraines. Many women report that their symptoms occur less frequently, are less severe, or even disappear completely during pregnancy. Others say the opposite, that pregnancy makes their migraine attacks worse.
· As women near menopause, there is often an increase in migraine attacks.
Since women are more vulnerable to migraine attacks shortly before or during their period, they should be particularly careful to avoid common migraine headache triggers around that time. Avoiding triggers is a good idea anytime, but it is especially important to be vigilant when the body is experiencing changes in hormone levels.
Some smart moves to keep migraines at bay:
· Eat right. About a week before your period, try to stay away from carb-heavy foods, especially sweets and chocolate; these affect blood-sugar levels and can trigger migraine attacks. Other foods to avoid include alcohol and aged cheeses such as Brie and cheddar.
· Don’t skip meals. Not eating can lower your blood sugar levels and make you hungry, which are common triggers for migraines.
· Get enough rest. Sticking to a regular sleep schedule and getting about the same amount of sleep each night is important for reducing the risk of migraine attacks.
· Exercise regularly. Working out for at least 30 minutes a day can help relieve stress, a common migraine trigger.
· Try relaxation exercises and techniques. These include meditation and yoga, and have been shown to be effective in reducing stress.
· Consider medications. If nothing else is working to prevent migraine attacks, talk to your doctor about taking medications a day or two before you expect migraine symptoms to strike. Some common drugs women can take to prevent migraine attacks include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen; an older class of drugs called ergot drugs; or one of the triptan drugs, a newer class of medications that has shown great results.
Work with your doctor to identify and avoid your migraine triggers, especially around the time that your body undergoes changes in hormone levels. With sustained effort, you may be able to prevent or at least better manage your migraine attacks.
Complicated migraines are migraines that are accompanied by neurological dysfunction. The part of the body that is affected by the dysfunction is determined by the part of the brain that is responsible for the headache.
Other variants of migraine headaches?
Vertebrobasilar migraines are characterized by dysfunction of the brainstem (the lower part of the brain that is responsible for automatic activities like consciousness and balance).
The symptoms of vertebrobasilar migraines include:
· fainting as an aura,
· double vision.
Hemiplegic migraines are characterized by:
· paralysis or weakness of one side of the body,
· mimicking a stroke.
The paralysis or weakness is usually temporary, but sometimes it can last for days.
Retinal, or ocular, migraines are rare attacks characterized by repeated instances of scotomata (blind spots) or blindness on one side, lasting less than an hour, that can be associated with headache. Irreversible vision loss can be a complication of this rare form of migraine.
Migraine headaches are usually diagnosed when the symptoms described previously are present. Migraine generally begins in childhood to early adulthood. While migraines can first occur in an individual beyond the age of fifty, advancing age makes other types of headaches more likely. A family history usually is present, suggesting a genetic predisposition in migraine sufferers. The examination of individuals with migraine attacks usually is normal.
Patients with the first headache ever, worst headache ever, a significant change in the characteristics of headache or an association of the headache with nervous system symptoms, like visual or hearing or sensory loss, may require additional tests to exclude diseases other than migraine. The tests may include blood testing, brain scanning (either CT or MRI), and a spinal tap.
Treatment includes therapies that may or may not involve medications.
Non-medication therapies for migraine
Therapy that does not involve medications can provide symptomatic and preventative therapy.
· Using ice, biofeedback, and relaxation techniques may be helpful in stopping an attack once it has started.
· Sleep may be the best medicine if it is possible.
Preventing migraine takes motivation for the patient to make some life changes. Patients are educated as to triggering factors that can be avoided. These triggers include:
· smoking, and
· avoiding certain foods especially those high in tyramine such as sharp cheeses or those containing sulphites (wines) or nitrates (nuts, pressed meats).
Generally, leading a healthy life-style with good nutrition, an adequate intake of fluids, sufficient sleep and exercise may be useful. Acupuncture has been suggested to be a useful therapy.
Medication for migraine
Individuals with occasional mild migraine headaches that do not interfere with daily activities usually medicate themselves with over-the-counter (OTC or non-prescription) pain relievers (analgesics). Many OTC analgesics are available. OTC analgesics have been shown to be safe and effective for short-term relief of headache (as well as muscle aches, pains, menstrual cramps , and fever) when used according to the instructions on their labels.
There are two major classes of OTC analgesics:
· acetaminophen (Tylenol), and
Acetaminophen
Acetaminophen reduces pain and fever by acting on pain centers in the brain. Acetaminophen is well tolerated and generally is considered easier on the stomach than NSAIDs. However, acetaminophen can cause severe liver damage in high (toxic) doses or if used on a regular basis over extended periods of time. In individuals who regularly consume moderate or large amounts of alcohol, acetaminophen can cause serious damage to the liver in lower doses that usually are not toxic. Acetaminophen also can damage the kidneys when taken in large doses. Therefore, acetaminophen should not be taken more frequently or in larger doses than recommended on the package label.
NSAIDS
The two types of NSAIDs are 1) aspirin and 2) non-aspirin.
Examples of non-aspirin NSAIDs are ibuprofen (Advil, Nuprin, Motrin IB, and Medipren) and naproxen (Aleve). Some NSAIDs are available by prescription only. Prescription NSAIDs are usually prescribed to treat arthritis and other inflammatory conditions such as bursitis, tendonitis, etc. The difference between OTC and prescription NSAIDs usually is the amount of the active ingredient contained in each pill. For example, OTC naproxen (Aleve) contains 220 mg of naproxen per pill, whereas prescription naproxen (Naprosyn) contains 375 or 500 mg of naproxen per pill.
NSAIDs relieve pain by reducing the inflammation that causes the pain (they are called nonsteroidal antiinflammatory drugs or NSAIDs because they are different from corticosteroids such as prednisone, prednisolone, and cortisone which also reduce inflammation). Corticosteroids, though valuable in reducing inflammation, have predictable and potentially serious side effects, especially when used long-term. Their full effects also require hours or days. NSAIDs do not have the same side effects that corticosteroids have and their onset of action is faster.
Aspirin, Aleve, Motrin, and Advil all are NSAIDs and are similarly effective in relieving pain and fever. The main difference between aspirin and non-aspirin NSAIDs is their effect on platelets, the small particles in blood that causeblood clots to form. Aspirin prevents the platelets from forming blood clots. Therefore, aspirin can increase bleeding by preventing blood from clotting though it also can be used therapeutically to prevent clots from causing heart attacks and strokes. The non-aspirin NSAIDs also have antiplatelet effects, but their antiplatelet action does not last as long as aspirin, i.e. hours rather than days.
Aspirin, acetaminophen, and caffeine also are available combined in OTC analgesics for the treatment of headaches including migraine. Examples of such combination analgesics are Pain-aid, Excedrin, Fioricet, and Fiorinal.
Finding an effective analgesic or analgesic combination often is a process of trial and error because individuals respond differently to different analgesics. In general, a person should use the analgesic that has worked in the past. This will increase the likelihood that an analgesic will be effective and decrease the risk of side effects.
There are several precautions that should be observed with OTC analgesics:
· Children and teenagers should not use aspirin for the treatment of headaches, other pain, or fever, because of the risk of developingReye's Syndrome, a life-threatening neurological disease that can lead to coma and even death.
· People with balance disorders or hearing difficulties should avoid using aspirin because aspirin may aggravate these conditions.
· People taking blood thinners such as warfarin (Coumadin) should not take aspirin and non-aspirin NSAIDs without a doctor's supervision because they add further to the risk of bleeding that is caused by the blood thinner.
· People with active ulcers of the stomach and duodenum should not take aspirin and non-aspirin NSAIDs because they can increase the risk of bleeding from the ulcer and impair healing of the ulcer.
· People with advanced liver disease should not take aspirin and non-aspirin NSAIDs because they may impair kidney function. Deterioration of kidney function in these patients can lead to failure of the kidneys.
· OTC or prescription analgesics should not be overused. Overuse of analgesics can lead to the development of tolerance (increasing ineffectiveness of the analgesic) and rebound headaches (return of the headache as soon as the effect of the analgesic wears off, usually in the early morning hours). Thus, overuse of analgesics can lead to a vicious cycle of more and more analgesics for headaches that respond less and less to treatment.
What Foods Trigger Headaches and Migraines?
Some of the most common foods, beverages, and additives associated with headaches include:
· Aged cheese and other tyramine-containing foods: Tyramine is a substance found naturally in some foods. It is formed from the breakdown of protein as foods age. Generally, the longer a high-protein food ages, the greater the tyramine content. The amount of tyramine in cheeses differs greatly due to the variations in processing, fermenting, aging, degradation, or even bacterial contamination. For people who take monoamine oxidase (MAO) inhibitor medications to treat their headaches, it is especially important to avoid all foods containing tyramine, including aged cheeses, red wine, alcoholic beverages, and some processed meats, as these foods can trigger severe high blood pressure.
· Alcohol: Blood flow to your brain increases when you drink alcohol. Some scientists blame the headache on impurities in alcohol or by-products produced as your body metabolizes alcohol. Red wine, beer, whiskey, and champagne are the most commonly identified headache triggers.
· Food additives: Preservatives (or additives) contained in certain foods can trigger headaches. The additives, such as nitrates, dilate blood vessels, causing headaches in some people.
· Cold foods: Cold foods can cause headaches in some people. It's more likely to occur if you are over-heated from exercise or hot temperatures. Pain, which is felt in the forehead, peaks 25 to 60 seconds and lasts from several seconds to one or two minutes. More than 90% of migraine sufferers report sensitivity to ice cream and cold substances.
Do Other Foods Trigger Headaches and Migraines?
These foods have been identified as headache and migraine triggers by some sufferers.
· Peanuts, peanut butter, other nuts and seeds
· Pizza
· Potato chip products
· Chicken livers and other organ meats
· Smoked or dried fish
· Sourdough bread, fresh baked yeast goods (donuts, cakes, homemade breads, and rolls)· Pizza
· Potato chip products
· Chicken livers and other organ meats
· Smoked or dried fish
· Bread, crackers, and desserts containing cheese
· Certain fresh fruits including ripe bananas, citrus fruits, papaya, red plums, raspberries, kiwi, pineapple
· Dried fruits (figs, raisins, dates)
· Soups made from meat extracts or bouillon (not homemade broth)
· Cultured dairy products, sour cream, buttermilk, yogurt
· Caffeine found in chocolate and cocoa; beverages such as coffee, tea and colas; also found in certain
medications
· Aspartame and other artificial sweeteners
What Cheeses Have High Tyramine Levels?
The following types of cheeses have been reported to be high in tyramine:
· Blue cheeses
· Brie
· Cheddar
· Stilton
· Feta
· Gorgonzola
· Mozzarella
· Muenster
· Parmesan
· Swiss
· Processed cheese
Other foods high in tyramine are: aged, canned, cured or processed meats, certain beans (fava, broad, garbanzo, lima, pinto), onions, olives, pickles, avocados, raisins, canned soups, and nuts.
What Food Products Contain Additives?
· Hot dogs
· Ham
· Sausage
· Bacon
· Luncheon meats and deli-style meats
· Pepperoni
· Other cured or processed meats
· Some heart medications
· MSG (monosodium glutamate). MSG is a food additive/flavor enhancer found in soy sauce, meat tenderizer, Asian foods, and a variety of packaged foods.
What Are the Symptoms of Food Additive-Induced Headaches?
Most headache symptoms begin within 20-25 minutes after consuming these products. They include:
· Pressure in the chest
· Tightening and pressure in the face
· Burning sensation in the chest, neck, or shoulders
· Facial flushing
· Dizziness
· Headache pain across the front or sides of the head
· Abdominal discomfort
· Blue cheeses
· Brie
· Cheddar
· Stilton
· Feta
· Gorgonzola
· Mozzarella
· Muenster
· Parmesan
· Swiss
· Processed cheese
Other foods high in tyramine are: aged, canned, cured or processed meats, certain beans (fava, broad, garbanzo, lima, pinto), onions, olives, pickles, avocados, raisins, canned soups, and nuts.
What Food Products Contain Additives?
· Hot dogs
· Ham
· Sausage
· Bacon
· Luncheon meats and deli-style meats
· Pepperoni
· Other cured or processed meats
· Some heart medications
· MSG (monosodium glutamate). MSG is a food additive/flavor enhancer found in soy sauce, meat tenderizer, Asian foods, and a variety of packaged foods.
What Are the Symptoms of Food Additive-Induced Headaches?
Most headache symptoms begin within 20-25 minutes after consuming these products. They include:
· Pressure in the chest
· Tightening and pressure in the face
· Burning sensation in the chest, neck, or shoulders
· Facial flushing
· Dizziness
· Headache pain across the front or sides of the head
· Abdominal discomfort
