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What is migraine headache?
A migraine headache is a complex condition, involving the brain, blood vessel and other organ
systems of the body.
Are migraines hereditary?
Heredity appears to have some influence in 70 to 80 % of sufferers.
women are affected more frequently than men.
How common is migraine?
Migraine is very common, although the frequency of attacks and their severity
varies considerably from person to person.
Some people have only a few attacks over a lifetime, while others have several attacks
weekly for years, so that they seem never to be fully free of headaches.
Most migraine sufferers have one or two attacks a month.
each migraine con last from four hours to three days. Occasionally, a migraine may last longer.
Migraines attacks may begin at any age but usually first appear
between the ages of 10 and 30. In general, the frequency and severity of attacks is
greatest through the 20s and 30s with a tendency to decrease in middle age and
latter adult life.
Do children suffer from migraine?
Yes, frequently, but in young children it may be difficult to make the diagnosis because
the child is unable to describe the symptoms clearly.
Not all children with migraine continue to have attacks in adult life.
What causes a migraine?
A migraine begins when blood vessels on the brains surface narrow,
reducing the supply of blood and oxygen to the brain.
In response to the decreased blood flow, the brain sends a message that causes the blood
vessels to dilate (expand) and allow more blood to the brain tissue.
When the blood vessels expand, they throb and cause a pounding pain in
those who suffer from migraine. Migraine pain itself does not reflect any problem inside the brain.
Though it is not yet understood why people have pain when the blood vessels expand,
most of the painful symptoms that accompany migraine are caused by
activity inside the brain. Evidence suggests that this may be due to an altered electrical
charge that passes slowly over part of the brain.
What are the symptoms of an acute attack?
Symptoms may include:
* severs, pounding, throbbing pain on one side of the head.
It may shift to the other side of the head, or it can be generalized.
Nausea and vomiting.*
*sensitivity to light, noise and odors.
*loss of appetite.
Warm or cold sensations.*
Are there any warning signs?
Some migraine sufferers experience a warning, known as an aura.
An aura is a physiological warning sign that a migraine is about to begin.
It is believed to be due to a narrowing or constriction of the blood vessels supplying
the brain and its surrounding tissues, thereby reducing the blood flow to these areas.
What are the types of migraine dysfunction?
Migraine with aura (known as "classic" migraine)*
( migraine without aura ( known as " common " migraine *
What are the symptoms of migraine with aura?
Migraines with auras occur in about 15 to 20 % of migraine sufferers.
An aura can occur one hour before the onset of a migraine and generally lasts
about 15 to 20 minutes. Typically, auras include:
* visual disturbances , such as bright flashing lights , zigzag or jagged lines ,
blind spots or distorted or partial loss of vision.
* Sensory symptoms, such as tingling or numbness of limbs, and speech impairment.
What are the symptoms of migraines without aura?
Migraines without auras are more common, occurring in 80 to 85 % of migraine sufferers.
Several hours can experience several vague symptoms, including:
*fatigue or tiredness
There are other forms of migraines, involving the back part of the head,
which can cause dizziness, fainting and weakness on one side of the body.
What factors trigger attacks?
The most common triggering factors include:
Alteration of sleep-wake cycle.*
Certain chemical in foods.*
.skipping or delaying meals*
Tension and stress.*
.excessive fatigue or exertion*
. Bright lights, sunlight, TV and movie viewing*
Volatile weather, such as storm fronts.*
.withdrawal from caffeine*
Medications that cause a swelling of the blood vessels.*
How can migraine be treated?
1- Avoiding factors that trigger attacks.
Many attacks seem to be triggered by external factors.
Avoiding the triggers may reduce the frequency of migraine attacks.
Migraine and diet: *
Many different food items, most frequently chocolate, cheese, citrus fruits,
fried foods and caffeine-containing drinks, have been reported to trigger attacks.
Recalling what was eaten prior to an attack may help the migraine sufferer identify
chemical triggers. In some people attacks may be precipitated by skipping or delaying meals.
In this case, eating on a regular schedule seems to reduce the frequency of attacks.
Migraine and hormones: *
Approximately 65% of female migraine sufferers complain of headaches immediately before
, during or after menstruation. Attacks often become less frequent or disappear
completely during pregnancy and after menopause. Oral contraceptives,
however frequently make migraine worse, so, hormonal treatment of migraine has
not been satisfactory.
* Migraine and sleep:
Many people find that they can obtain relief from an attack by sleeping. Sometimes,
however, migraine attacks begin during the night and are present on awakening.
This is particularly likely to occur on the weekend when there is a change in
the sleep pattern (too much or too little sleep). it is best to get the same amount of sleep
each night and get up at the same time each day , even on the weekend.
Migraine and stress*
Attacks may occur more frequently at times of stress or anxiety.
While the frequency of attacks may be influenced by psychological factors,
migraine is not a psychiatric disease.
2-Treatment of Individual Attacks.
During an attack most migraine sufferers are more comfortable if they lie down
and avoid bright lights and loud noises. If they can sleep, they commonly feel
better after a nap. Various drugs can relieve an attack, and all are more likely to
help if taken as soon as possible.
a. Medication for the relief of pain:
A variety of analgesics are available, including over-the-counter and prescribed drugs.
Due to the severity of the headaches, some patients may require more powerful
analgesics. these drugs should be avoided, however, by patients experiencing
frequent migraine attacks, as they carry the risk of addiction.
b. Abortive medications:
An abortive medication is one that is taken to abort the attack, that is,
to stop headache pain once it has begun. Medications, such as ergotamine preparations
(tablets and suppositories) and sumatriptan (Imitrex) (tablets and injections),
constrict the blood vessels, bringing them back to normal and relieving the throbbing pain..
c. Prophylactic medications:
Prophylactic medications are preventive medications that are taken on
a regular basis to reduce the frequency and severity of attacks.
They are not generally prescribed unless a patient experiences at least two severe
migraine headaches per month. Many patients are helped by:
Calcium channel blockers. *
* Non steroidal anti-inflammatory drugs.
d. Medications to reduce nausea and prevent vomiting:
Antinauseants are often needed to relieve these symptoms and to allow other drugs,
taken by mouth, to be retained and absorbed.
4- Non-Drug Therapy:
* Biofeedback training can help. The patient learns to control skin temperature,
heart rate and other body functions in order to relax. The patient can also learn to recognize
stressful situations that trigger migraines and learn to control these situations.
* Relaxation techniques\ tapes.