Migraine
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A migraine can cause severe throbbing pain or a pulsing sensation, usually on just one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.
Migraine attacks can cause significant pain for hours to days and can be so severe that the pain is disabling.
Warning symptoms known as aura may occur before or with the headache. These can include flashes of light, blind spots, or tingling on one side of the face or in your arm or leg.
Medications can help prevent some migraines and make them less painful. Talk to your doctor about different migraine treatment options if you can’t find relief. The right medicines, combined with self-help remedies and lifestyle changes, may help.
Migraines often begin in childhood, adolescence or early adulthood. Migraines may progress through four stages: prodrome, aura, headache and post-drome, though you may not experience all stages.
One or two days before a migraine, you may notice subtle changes that warn of an upcoming migraine, including:
Aura may occur before or during migraines. Most people experience migraines without aura.
Auras are symptoms of the nervous system. They are usually visual disturbances, such as flashes of light or wavy, zigzag vision.
Sometimes auras can also be touching sensations (sensory), movement (motor) or speech (verbal) disturbances. Your muscles may get weak, or you may feel as though someone is touching you.
Each of these symptoms usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes. Examples of migraine aura include:
Sometimes, a migraine with aura may be associated with limb weakness (hemiplegic migraine).
A migraine usually lasts from four to 72 hours if untreated. The frequency with which headaches occur varies from person to person. Migraines may be rare, or strike several times a month. During a migraine, you may experience:
The final phase, known as post-drome, occurs after a migraine attack. You may feel drained and washed out, while some people feel elated. For about 24 hours, you may also experience:
Migraines are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.
Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.
See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate a more serious medical problem:
Though migraine causes aren’t understood, genetics and environmental factors appear to play a role.
Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway.
Imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system — also may be involved. Researchers are still studying the role of serotonin in migraines.
Serotonin levels drop during migraine attacks. This may cause your trigeminal nerve to release substances called neuropeptides, which travel to your brain’s outer covering (meninges). The result is migraine pain. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).
A number of factors may trigger migraines, including:
Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen.
Others have an increased tendency to develop migraines during pregnancy or menopause.
Hormonal medications, such as oral contraceptives and hormone replacement therapy, also may worsen migraines. Some women, however, find their migraines occur less often when taking these medications.
Several factors make you more prone to having migraines, including:
Hormonal changes. If you are a woman who has migraines, you may find that your headaches begin just before or shortly after onset of menstruation.
They may also change during pregnancy or menopause. Migraines generally improve after menopause.
Some women report that migraine attacks begin during pregnancy, or their attacks worsen. For many, the attacks improved or didn’t occur during later stages in the pregnancy. Migraines often return during the postpartum period.
Sometimes your efforts to control your migraine pain cause problems, such as:
Medication-overuse headaches. Taking over-the-counter or prescription headache medications more than 10 days a month for three months or in high doses may trigger serious medication-overuse headaches.
Medication-overuse headaches occur when medications stop relieving pain and begin to cause headaches. You then use more pain medication, which continues the cycle.
Serotonin syndrome. Serotonin syndrome is a rare, potentially life-threatening condition that occurs when your body has too much of the nervous system chemical called serotonin.
While the risk is considered extremely low, taking migraine medications called triptans and antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) may increase the risk of serotonin syndrome. These medications naturally raise serotonin levels, and it is possible that combining them could cause levels that are too high.
Triptans and SSRIs or SNRIs may be used together, but it’s important to watch out for possible symptoms of serotonin syndrome such as changes in cognition, behavior and muscle control (such as involuntary jerking).
Triptans include medications such as sumatriptan (Imitrex) or zolmitriptan (Zomig). Some common SSRIs include sertraline (Zoloft), fluoxetine (Sarafem, Prozac) and paroxetine (Paxil). SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor XR).
Also, some people experience complications from migraines such as:
Until recently, experts recommended avoiding common migraine triggers. Some triggers can’t be avoided, and avoidance isn’t always effective. But some of these lifestyle changes and coping strategies may help you reduce the number and severity of your migraines:
These medications include birth control pills and hormone replacement therapy. Talk with your doctor about the appropriate alternatives or dosages for you.
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Migraine
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