Headache - migraine without aura

Definition

Migraine is a neurological disorder that generally involves recurring headaches. Other symptoms may occur with the headaches. Migraines are often classified based on whether they include an early symptom called an aura. Most migraines do not have this aura stage.

See also:

• Headache
• Migraine
• Migraine with aura

Alternative Names

Causes

Migraine headaches affect about 11 out of 100 people. They are a common type of chronic, recurring headache. They most commonly occur in women and usually begin between the ages of 10 and 46. In some cases, they appear to run in families.

A migraine is caused by abnormal brain activity, which is triggered by stress, food, or some other factor. The exact chain of events is not known. However, it seems to involve various nerve pathways and chemicals in the brain. These changes affect the flow of blood in the brain and surrounding membranes.

Migraine attacks may be triggered by:

• Allergic reactions
• Bright lights and loud noises
• Relaxation after a period of physical or mental stress
• Prolonged muscle tension (or tension headache)
• Lack of sleep
• Smoking or exposure to tobacco smoke
• Missed meals
• Specific foods
• Alcohol
• Menstrual periods
• Birth control pills

Foods that have been associated with migraine in some people include those containing the amino acid tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, some beans), chocolates, nuts, peanut butter, fruits (avocado, banana, citrus fruit), onions, dairy products, baked goods, meats containing nitrates (bacon, hot dogs, salami, cured meats), foods containing monosodium glutamate (an additive in many foods), and any processed, fermented, pickled, or marinated foods.

Symptoms

Common symptoms include:

• Throbbing, pulsating headache
  • Usually worse on the sides of the forehead
  • May be on only one side of the forehead
  • May be severe or dull
  • Commonly lasts 6 to 48 hours
• Dizziness
• Feeling that the room is moving (vertigo)
• Loss of appetite
• Nausea
• Vomiting
• Fatigue

The symptoms after an attack may include:

• Dullness
• Need for more sleep
• Neck pain

A migraine may be accompanied by symptoms other than headache, but only rarely includes any early warning symptoms. (See migraine with aura

Exams and Tests

A health care provider should be consulted to rule out other disorders that may be causing the headache. This is especially true if the headache:

• Disturbs sleep
• Occurs whenever the person is active
• Is severe (especially in a previously well person) or persistent
• If other symptoms accompany the headache (such as drowsiness, vision changes, changes in movement or sensation, seizures, changes in alertness, nausea and vomiting, or other symptoms)

Migraine headache may be diagnosed by the health care provider based on the pattern of symptoms, history of migraines in the family and response to treatment. A physical examination will reveal no detectable abnormalities.

Treatment

There is no cure for migraine. The goal is to control the symptoms and prevent further attacks.

Rest in a quiet, darkened room. This will often reduce the severity of the symptoms. Drink fluids to prevent dehydration, especially if vomiting occurs.

Several medications may help relieve symptoms. However, the effectiveness of migraine medications is highly variable in different people. If a medication has been effective in relieving a previous migraine, it may be tried before others.

Over-the-counter medicines may help reduce pain if they are taken early in the headache. If these are ineffective, talk to your doctor about other options.

Ergotamine tartrate preparations constrict the arteries of the head and may be used alone or in combination with other drugs such as caffeine (Cafergot), phenobarbital, or Fioricet.

Propoxyphene or other medications that relieve pain or inflammation may provide relief for some people. Nausea should be treated early with Reglan, Compazine, or other anti-emetics.

Some medicines can prevent migraines. These include propranolol, amitriptyline, ergonovine, cyproheptadine, clonidine, methysergide, calcium channel antagonists, valproic acid, carbamazepine, topiramate (Topamax), and many others.

Several medications may need to be tried before you find one that works. A class of drugs known as triptans can relieve a migraine once it starts. Various triptans can be injected, taken as a pill, or dissolved under the tongue.

Support Groups

For other organizations that provide information about migraine, see migraine resources.

Outlook (Prognosis)

Common migraine does not indicate a life-threatening disorder. It usually is painful and annoying at the time it occurs. It may be chronic and recurrent, which can interfere with a person's lifestyle.

Rarely, severe migraine may result in a stroke, possibly due to prolonged constriction of blood vessels. Some people may have side effects of medications. A physician should choose the appropriate medications based on symptoms and other conditions.

Possible Complications

• Frequent, recurrent attacks may interfere with lifestyle
• Side effects of medications
• Permanent neurologic impairments including stroke (rare)

When to Contact a Medical Professional

See your health care provider if symptoms of migraine are severe, persistent, or recurrent. Call if any other new symptoms develop or there is a change in the severity or pattern of symptoms.

Call your health care provider if previously effective treatments no longer are helpful, or if symptoms indicating side effects of medications occur, including irregular heartbeat, pale or blue skin color, extreme sleepiness or sedation, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain or cramps, dry mouth, extreme thirst, or others.

Also, call if you are taking an ergotamine-containing medication, and you are likely to become pregnant (these medications should not be taken when pregnant).

Prevention

Try to avoid any factors that have triggered a migraine in the past. Some people may benefit from medications that help prevent migraine attacks.