Migraine Headache

Migraine headaches are a group of headaches that are also known as vascular headaches. They include migraine without aura (formerly known as common migraine) and migraine with aura (formerly known as classic migraine). The cluster headache is described separately. These are fairly common headaches that affect up to 28 million people in the United States, almost three-fourths women. They cause significant economic loss as measured in time away from work.

Migraine Headache Causes

The specific cause of migraine headache is unknown. It used to be thought that the problem was primarily a vascular problem involving the blood vessels of the head. One current theory is that certain cells — neurons — in the brainstem are somehow responsible for causing the vascular problems.

Migraine headaches may be triggered by such things as stress, change in sleep patterns (too little or too much), alcohol consumption (red wine), menstruation, various foods. Much research still remains to be done.

Migraine Headache Symptoms

The symptoms of a migraine depend on the type of migraine. Although there is variability in the symptoms, the two types are quite distinct.

Migraine without aura is characterized by a recurring headache that is located on one side of the head and lasts between 4 and 72 hours. The headache is usually throbbing and may be moderate to severe. Activity usually makes the headache worse. There may also be nausea, vomiting and sensitivity to light (photophobia).

Migraine with aura is a recurring headache with neurological symptoms. These neurologic symptoms usually develop over the first 5 to 20 minutes of the headache and last for less than 60 minutes. Visual symptoms are the most common followed by sensory changes in the hands or face, weakness or trouble with speech. The headache usually starts after the aura and is similar to the headache in a migraine without aura.

Migraine Headache Diagnosis

As always, a careful history and physical examination are the first steps in diagnosis. Imaging studies such as CT scans and MRI scans are usually not needed if the diagnosis is straightforward. However, if there are unusual aspects to the diagnosis or presentation, then scanning may be warranted. Some things that may lead to scanning include increasing headache frequency, dizziness or coordination changes, numbness or tingling, weakness, headaches that wake the patient from sleep and new onset of headaches in older patients.

Migraine Headache Treatment

There are a number of different concepts in the treatment of migraine headaches including avoidance of triggering events, abortive treatments taken as soon as the headache starts, acute treatments used once the headache has established itself and prophylactic treatment used to prevent headache.