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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Headache, Migraine

What is it?

A migraine is a throbbing, intensely painful headache, usually beginning on one side of the head. It is sometimes preceded by distinct early warning symptoms, collectively called an aura. Incapacitating pain may last for up to two days, and the frequency of episodes may vary from several times a week to once every few years. Migraines afflict about 10 percent of the population, usually first appear ing during childhood or adolescence, and are more common among women than men. In women, migraines can occur just before or during the menstrual cycle. The pain of a migraine usually moderates with age, but auras often continue to occur and may be confused with transient ischemic attack (TIA) or stroke (see TIA or Stroke for more information). There is no cure, but symptoms can be prevented or controlled with proper treatment.

What Causes It?

  • The precise cause of migraines is unknown. One theory holds that abnormal constriction followed by dilation of arteries supplying the brain and scalp may be involved. Another possibility is a shift in the brain's electrical activity that triggers pain.
  • Hereditary factors may play a role.
  • Factors that may trigger migraines include: stress and overwork; relaxing periods following stressful ones (weekends, vacations); caffeine withdrawal; menstrual periods; oral contraceptives; vasodilating drugs; and exposure to bright lights or viewing certain visual patterns.
  • Nitrites (such as are found in bacon and cured meats) and, possibly, foods containing the chemical tyramine (pepperoni, red wine, chicken livers, active yeast preparations, and cheddar and other aged cheeses) may trigger an attack.

Prevention

  • Reduce stress and allow time for relaxation and recreation.
  • Keep a daily record of food and drink intake to help identify possible triggers, and then avoid suspected items.
  • Avoid oversleeping, which may lead to a migraine.

Diagnosis

  • Patient history and physical examination.
  • Brain imaging (CT scan or MRI) is not necessary unless apparent migraine coexists with seizures, stroke, or vision problems upon neurological exam.

How to Treat It

  • Over-the-counter analgesics may be effective for mild attacks.
  • Lying down in a dark, quiet room while symptoms last and using an ice pack on the forehead may be soothing.
  • Medications, including ergotamine tartrate, dihydroergotamine, or sumatriptan and related drugs, may abort symptoms of a severe migraine if taken at the onset of the headache.
  • Verapamil, propranolol or other beta-blockers, amitriptyline, and divalproex may prevent frequent recurrences.
  • Relaxation training or biofeedback may be advised if stress is a trigger.

When to Call a Doctor

  • Call a doctor if headaches are severe, frequent, or persist for more than 24 hours, if there is a change in the pattern of your headaches, or if you experience speech difficulty, weakness, or double vision.