Migraine is usually periodic attacks of headaches on one or both sides of the head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances, and other symptoms. Treatments for migraine headache include therapies that may or may not involve medications.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
A migraineheadache is a common form of headache that is believed to occur as a result of complex interactions between the nervous system and the vascular system as well as alterations in brain chemicals. It was formerly believed that migraine headache was simply caused by vasodilatation (enlargement of blood vessels) that caused the release of chemicals from nerve fibers that coil around the large arteries of the brain. While these blood vessels do indeed enlarge, advanced imaging studies of blood flow in the brain have shown that changes in blood flow cannot be solely responsible for all features of migraine. Instead, complex processes within the nervous system are believed to initiate the development of migraine headache. For example, it is known that certain neurological pathways become sensitized and are stimulated more easily during a migraine headache, and chemicals that promote inflammation are secreted by nerves around the blood vessels.
During migraine headaches the sympathetic nervous system in the body is stimulated. The sympathetic nervous system is often thought of as the part of the nervous system that controls primitive responses to stress and pain, the so-called "fight or flight" response, and this stimulation. This causes many of the symptoms associated with migraine attacks. For example, the increased sympathetic nervous activity in the intestine causes nausea, vomiting, and diarrhea.
Sympathetic nervous system activity also delays emptying of the stomach into the small intestine and thereby prevents oral medications from entering the intestine and being absorbed.
The impaired absorption of oral medications is a common reason for the ineffectiveness of oral medications taken to treat migraine headaches.
The increased sympathetic activity also decreases the circulation of blood, and this leads to pallor of the skin as well as cold hands and feet.
The increased sympathetic activity also contributes to the sensitivity to light and sound as well as blurred vision.
Migraine headaches afflict over 30 million Americans, with women suffering more frequently than men. (About 75% of migraine sufferers are women.). Missed work and lost productivity from migraine headaches create a significant public burden. Nevertheless, migraine still remains largely underdiagnosed and undertreated; less than half of individuals with migraine are diagnosed by their doctors.
A migraine headache that affects a woman each month between the 2nd day before the start of the menstrual period and the end of menstruation. Menstrual migraine is different from nonmenstrual attacks of migraine, even in the same women, in the regularity of its timing and its greater severity. Compared with other times in the menstrual cycle, a migraine is more than twice as likely to occur during the first 3 days of menstruation and more than three times as likely to be severe.
Prophylactic treatment with a triptan for 6 days beginning 2 days before the anticipated start of the menstrual migraine reduces the incidence of migraine by at least a half. The triptans act as agonists for 5-hydroxytryptamine (5-HT) receptors and include sumatriptan (Imitrex), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), eletriptan (Relpax), lmotriptan (Axert), and frovatriptan (Frova).
Menstrual migraine is also called menstrually associated migraine (MAM).