There are few benign acute health problems more disabling than a migraine. Yet, this common condition affects tens of millions of children and adults each year in the United States, resulting in considerable suffering – not to mention the social and economic costs of school and work absences.
It used to be thought a migraine resulted from the dilation and constriction of blood vessels in the central nervous system. However, this theory has been largely disproven. Rather, migraine results from the activation of central nerves. The subsequent inflammation of these nerves can produce prolonged symptoms.
Migraines affect 12 percent of the U.S. population and predominates in women. It is estimated up to one in six women will experience a migraine within a given year. It can be up to one in four women between the ages of 30 and 39, when migraine prevalence peaks. Migraines also are one of the most common causes of headache in men.
The most common symptoms that distinguish a migraine are headache, nausea and light or sound sensitivity. The presence of all three makes the diagnosis of a migraine likely.
A migraine headache commonly produces moderate or severe progressive head pain of a throbbing or pulsatile character. Pain on one side of the head is common. The headache may be associated with nausea, with or without vomiting. Many sufferers experience worse headaches with bright lights or loud noises.
The majority of people with migraine experience preliminary symptoms one to two days before headache onset. Known as a migraine “prodrome,” these symptoms can include sadness or irritability, constipation or neck stiffness. Some people report food cravings or increased yawning before migraine onset.
In a minority of migraine sufferers, about one in four, the prodrome is followed by neurological symptoms known as an aura. This also precedes the onset of headache, although usually by only a short time.
Aura may consist of many types of neurological symptoms ranging from mild to severe. Most commonly, aura consists of visual symptoms such as localized vision loss or the perception of a bright spot, geometric shapes or zigzagging lines. Facial numbness, tingling or even speech defects are less common symptoms of migraine aura.
An untreated migraine headache can last from several hours to several days. Patients often seek a quiet, dark room and the respite afforded by sleep.
Fortunately for migraine sufferers, prompt identification and treatment can effectively alleviate symptoms.
Migraine medications come in two general categories – preventive and abortive. Abortive medications range from common over-the-counter medications, such as ibuprofen, to effective prescription medications. Such medications are most useful when taken immediately after onset of migraine symptoms and can prevent progression to a full-blown headache.
For those with frequent headaches, preventive medications taken on a daily basis can reduce headache frequency. Preventive medications require a health-care provider’s prescription.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.