Dr. MJ Bazos MD, Patient Handout
Migraine Headaches –
Ways to deal with the pain

What causes migraine headaches?
Migraine headaches seem to be caused in part by changes in the level of a chemical, serotonin, in the body and in part by changes in blood vessels in the brain. Serotonin plays many roles in the body, including effects on mood and effects on blood vessels. When serotonin levels are high, blood vessels constrict, or shrink. When serotonin levels fall, the blood vessels dilate, or swell. In people with migraines, this swelling seems to cause pain or other problems in the nearby nerves. Many things can affect the level of serotonin in your body, including your level of blood sugar, changes in your estrogen levels if you’re a woman and certain foods.

What does a migraine feel like?
The pain of a migraine headache can be intense. It can get in the way of your daily activities. Migraines aren’t the same in all people. Possible symptoms of migraines are listed below.

Are there different kinds of migraine headaches?
Yes. The two most common are classic migraine and common migraine.

Classic migraines start with a set of warning signs. These warning signs are called the aura. The aura often involves changes in the way you see. You may see flashing lights and colors or zigzags of light. You may temporarily lose some of your vision, such as your side vision, in one or both eyes. Things may also seem like they are different sizes or shapes or are in different locations. You may also feel a strange prickly or burning sensation, or have muscle weakness on one side of your body. These sensations may seem to march through your body. You may have trouble communicating. The aura may also include feelings of depression, irritability and restlessness. Auras last about 15 to 30 minutes. Head pain usually follows the aura, though sometimes the two overlap or the head pain never occurs. The head pain of classic migraines may occur on one or both sides of your head.

Common migraines don’t start with an aura. Two hours to 3 days before the pain begins, you may feel tired, crave certain foods, yawn more than usual, feel depressed, have a surge of energy, feel irritable, anxious or restless, or be more talkative than usual. Common migraines may start more slowly than classic migraines, last longer and interfere more with daily activities. The pain of common migraines may be on only one side of your head. If you have severe headaches that don’t seem to be caused by muscle tension and don’t have an aura, they may be common migraines.

Possible symptoms of migraines
• Intense throbbing or dull aching pain on one or both sides of your head
• Nausea or vomiting
• Changes in how you see, including blurred vision or blind spots in your vision
• Being bothered by light, noise and odors
• Feeling tired
• Confusion
• Stopped-up nose
• Feeling cold or sweaty
• Stiff or tender neck
• Feeling annoyed
• Lightheadedness
• Tender scalp
• Cold hands and feet

What are the other types of migraine headache?
There are many other, less common types of migraine. For example, one type of migraine has an aura that isn’t followed by head pain, one type lasts longer than 3 days, another type has one or more aura symptoms that last longer than 3 weeks, and one type of classic migraine causes temporary paralysis of one side of the body or of the eyes.

How long do migraines usually last?
Migraines may last from 4 to 24 hours. They may happen once or twice a year or as often as daily. Migraines tend to get less severe after middle age.

What things may set off a migraine?
Certain things can set off migraines in some people. Foods that contain tyramine, sodium nitrite or phenylalanine (see the list above) can lead to migraines.

Other things that may also contribute to migraines include the following:

Foods that may trigger migraines

What medicines may help the pain?
Some migraine treatments are used to try to stop the headache as it’s beginning. Most of these treatments should be started as soon as you think you’re getting a migraine. Nonprescription medicines that can be used include aspirin, acetaminophen (one brand name: Tylenol), an acetaminophen and aspirin combination (brand name: Excedrin Migraine), ibuprofen (brand names: Advil, Motrin, Nuprin), naproxen (brand name: Aleve), and ketoprofen
(brand name: Orudis KT). A prescription medicine called ergotamine (brand name: Ergostat) can be effective alone or combined with other medicines (some brand names: Cafergot, Ercaf,Wigraine). Ergotamine can be taken as a pill, under the tongue, as an aerosol, or as a suppository. Dihydroergotamine is related to ergotamine and can be taken as a shot (DHE 45) or as a nasal spray (Migranol). Ergotamine must be used carefully. Using it every day can cause tolerance so that when a dose is missed, symptoms start. Some newer prescription medicines for migraine include sumatriptan (brand name: Imitrex), zolmitriptan (brand name: Zomig), naratriptan (brand name: Amerge) and rizatriptan (brand name: Maxalt). All of these medicines come in pill form. Sumatriptan also comes in a shot and nasal spray. Rizatriptan also comes in a tablet that dissolves in your mouth. If the pain won’t go away, a narcotic type of medicine may be needed. Narcotics can be addictive, so they must be used carefully. One is now available as a nasal spray (brand name: Stadol NS). Many combinations of medicine are available and are often used when a single medicine isn’t effective. You may need to try several different combinations to find the one that helps you.

Tips on reducing the pain of an attack

Can medicine help prevent migraines?
Yes. Medicine to prevent migraines may be helpful if your headaches happen more than twice a month or if your headaches make it hard for you to work and function. There are many different medicines available. Two of the drugs used for migraine prevention are propranolol (brand name: Inderal) and divalproex sodium (brand name: Depakote).

What else can I do to prevent migraines?
Tips for preventing migraines include avoiding foods or other things that seem to cause migraines for you. Getting plenty of restful sleep is a good idea. Trying to relax and lower your stress may also reduce the number of migraines you have. Biofeedback may help you relax—ask your doctor about it.