Migraine

Overview

Migraine is the most common cause of disabling headache, affecting 35 million Americans. While often thought to be a condition of adults, migraine is common in children, affecting 3 percent of preschool-aged children, 4 to 11 percent of elementary school-aged children, and 8 to 23 percent of high schoolers.

Before puberty, migraine is more common in boys, while after puberty it is more common in girls. Migraine often becomes more troublesome at the onset of puberty or even a bit before the outward signs of puberty are apparent. In girls, menstrual periods can be a potent migraine trigger, particularly for the first several years of cycling.

Migraine is most often hereditary. If you have migraine, it is likely that another family member suffers from it too. However, the severity and frequency of migraine attacks can differ dramatically between family members. One family member may experience very rare migraine attacks, such as just after consuming alcohol (a "hangover headache") or with menstrual cycles, while another may have very difficult daily, debilitating migraine.

Migraine attacks are characterized by recurrent episodes of head pain that may be throbbing or pounding. The headache is accompanied by other symptoms such as nausea, vomiting and sensitivity to light and sound, as well as sensitivity to head movement. Migraine can occur at any time of day or night. In children, migraine attacks can be as short as one hour and often involve both sides of the head.

Young children may experience a form of migraine that expresses itself as regular episodes of vomiting or abdominal pain without any other sign of illness; later in childhood, the migraine headache attacks become apparent.

Signs & symptoms

Signs and symptoms of migraine include:

• Throbbing or pounding pain, often on one side of the head
• Sensitivity to light or sound
• Nausea and vomiting
• Worsening of pain with movement
• Dizziness or vertigo
• Scalp tenderness
• Visual disturbances, such as flashes of light or blind spots in your vision
• Abnormal body sensations, called paresthesias, such as tingling, numbing or prickling

Diagnosis

Migraine is diagnosed based on the description of your symptoms and a neurological examination. No laboratory or imaging tests are needed to identify the condition. Your doctor will ask about the severity, frequency and duration of your headaches as well as other symptoms you experience and any medications you take.

Before meeting with a headache specialist, maintaining a headache journal that tracks headache patterns can provide helpful information for your diagnosis and treatment. Information to note in your journal includes:

• Duration of pain
• Location and severity of pain
• Other symptoms that accompany headache, such as sound or light sensitivity
• Medications taken
• Possible headache triggers

If your headache is associated with visual symptoms such as flashing or zigzagging lights, blind spots or numbness on one side of the head, it is called migraine with "aura," previously known as classic or classical migraine. About 20 percent of people with migraine experience this type of headache.

Treatment

Identifying Triggers

Migraine attacks can be triggered by a number of factors. By identifying and avoiding these triggers, you can help manage your headaches. Keeping a headache journal that tracks the date, time of onset of your headache, a list of medications and other external factors can help you and your doctor track patterns and plan treatment.

Common trigger factors include:

• Environmental Factors — Migraine headaches can be triggered by environmental conditions including weather or temperature changes, glaring or fluorescent lights, computer screens, strong odors and high altitude.
• Hormones — Many women and girls have migraine attacks just prior to or during the first few days of their menstrual period. This is due to fluctuations in estrogen levels. Menstrual-related migraines can be more debilitating, difficult to treat and longer lasting than other migraines. They typically subside as women age, particularly after menopause.
• Sleep — Too much or too little sleep can trigger a migraine in some people.
• Stress and Anxiety — Emotional stress or daily pressure can trigger a migraine attack in some people. Practicing stress-relieving techniques, such as exercise or biofeedback, may help alleviate migraine.
• Diet — Alcohol can trigger a migraine attack. Nitrates in foods such as cured meats can trigger migraine within a couple hours of eating them.

Medications

Acute Migraine Treatments

Typically, over-the-counter pain relievers such as naproxen, acetaminophen and ibuprofen are recommended as initial treatments. If these do not relieve the pain, your doctor may prescribe a migraine-specific medication such as a triptan. Some triptans are FDA-approved for use in children and adolescents.

Many drugs for acute migraine attacks work best when taken as soon as you feel a migraine coming on. Your doctor will work with you to determine the treatments that are best for you, based on the severity of your attacks and whether you experience other symptoms such as nausea. Treatments, however, don't cure the condition.

Preventive Migraine Treatments

If you experience frequent migraine attacks, your doctor may recommend a preventive medication to make your headaches strike less often and last for shorter periods of time.

Some medications used to treat other conditions — such as beta-blockers for high blood pressure and tricyclics for depression — are also effective in preventing migraine. The benefits and dosages of these drugs when used for migraine, however, are sometimes different than those in the treatment of other conditions.

• Tricyclic Antidepressants — Although you may not be depressed, your doctor may prescribe drugs such as amitriptyline or doxepin to help reduce the frequency and severity of your headaches.
• Beta-blockers — A drug such as propranolol may be helpful, and is typically well-tolerated even by people with normal blood pressure.
• Anti-seizure Medications — Several medicines used in epilepsy (seizures) have been found to be effective in migraine and may be used to prevent attacks.

Be sure to continue taking your preventive medications even while being treated for an acute attack.

If your doctor prescribes medication, be sure to ask:

• How often to take the medication
• Should the medication be taken with meals or on an empty stomach
• What to do if pain or other symptoms persist