Migraine



What is a Migraine?

Migraine is a common form of headache. It is often extremely severe, commonly occurs on wakening in the morning, and is frequently one-sided. The attacks are often associated with nausea and vomiting, and sometimes with other vivid sensory symptoms. They may start from childhood, but more frequently come on during adult life. Often they commence at puberty when hormonal changes start to occur in the system.

Once they set in, they tend to persist, but may vary considerably in intensity and frequency. Often the migraine patient is an energetic, tireless, perfectionist worker. With some, the desire to be precise and accurate may reach almost obsessional levels. These personality characteristics arc considered an important cause of the problem itself.



A large number of precipitating factors exist, and most patients are aware of at least some of these. Any of the psychological factors may be involved. These include frustration, tension, anxiety and stress in all of its forms, physical overwork, fatigue, overexertion, food irregularities, exposure to excessive noise or light and prolonged eyestrain, particularly if there arc errors of refraction present.

Women often have attacks coincidental with their menstrual periods. The contraceptive pill is notorious for producing migraine in some women, and it may be sufficiently severe to cause them to stop taking it on a permanent basis.



It is well-known that certain foods may precipitate attacks. This may vary from person to person, but almost all foods have been incriminated. Chocolate and citrus fruits in particular appear to produce migraine in many. Most sufferers know what food upsets them.

It is believed that migraine is essentially a disorder of the blood vessels of the brain. To start with, there is a constriction of the vessels, producing some of the early symptoms (called the prodromata). This is followed rapidly by a dilation of the same vessels, and severe, burning, throbbing then ensues. It will continue for as long as the dilated vessels remain that way.



Migraine Symptoms

Although many people with simple tension headaches claim they have a “migraine,” this is usually not so. A true migraine follows a fairly typical course and exhibits a wide range of distressing symptoms.

It frequently occurs in persons who are normally healthy and robust. There may be “premonitory signs”—certain telltale symptoms preceding the actual attack. These vary, but may be the same for a particular person each time. The patient may feel abnormally well and alert, or drowsy, lazy and depressed.



Often patients awaken with the migraine well established. On raising the head from the pillow, they may feel giddy, nauseated and as though they are about to experience seasickness. There may be visual disturbances at this stage, such as bright, flashing lights, floating spots, a mistiness of vision, or complete dislike of light, which produces pain; rings of light might dance before the eyes. However, these are rarer when considering the frequency with which migraine takes place.

Frequently the patients experience what they describe as a searing tube of fire that feels as though it is piercing the cranium, often through or above one eye. The throbbing may continue for hours. Vomiting and nausea are common and may recur frequently.



Although the pain is usually localized, it may spread to surrounding parts of the head, later even involving the neck and arm. Generally the pain is localized to one side of the head, frequently the front part or the back part, rarely all over the head. Usually the part affected is the same with any person with succeeding attacks.

As the headache increases, the face tends to become pale and grey. The patient may become prostrated, and mental and physical vigor tends to reduce. The thought of food is repelling, and the patient may be battling even to keep fluids down. Any form of light or noise or movement is avoided. The patient prefers to remain in bed in a quiet, darkened room, left alone and undisturbed. Frequently the patient will ultimately lapse into a sleep, to awaken many hours later (probably the following day) feeling somewhat exhausted, but otherwise mentally and physically normal and free from pain.

This description has many wide variations. The migraine may come on abruptly during the day, and it may last for a few hours only, and then subside. Alternatively it may last for several days. The pattern is wide-ranging.

Migraine may have various other phenomena accompanying it. The visual phenomenon has already been described briefly, and involves a general mistiness, associated with a variety of abnormal visual sensations. It is not common. Bright stars and colors or flashes of light may take place. Double vision or even temporary complete blindness may occur, which may be very frightening. However, it is purely temporary, and vision returns to normal later on.



Sensory auras may take place, and are diagnostic of migraine. These may consist of tingling pins-and-needles sensations starting at the tips of the extremities (fingers), and gradually working up the limb. Also, they may occur in the tip of the tongue and lips. They may be marked, and be extremely alarming.

Aphasia may occur rarely: this consists of confusion of words, and in the occasional case. an inability to form words at all for a short period of time. Sometimes the blood vessels supplying the eye-movement muscles are affected, so preventing, temporarily, the normal eye motions.

Neuralgic migraine is a variation in which there is an intense stabbing or a crushing sensation in and around the eye and cheek, with occasional swelling of the face, redness of the eye, and the nose on that side becomes engorged and stuffy. It is most often seen in the sixth decade of life, and particularly in those of a highly strung temperamental nature. It is not common.

Cluster headaches are an acute, extremely severe form of burning headaches that come on suddenly, often on one side of the head. One attack may precipitate another, hence the term “cluster.” In fact this pain has been described by patients as the most intense pain they have ever experienced.



Migraine Treatment

Treatment may be difficult. Over the past few years, more and more efforts in the research field have been directed to finding better methods of treating this disabling, but nonfatal disease. The simplest approach is for the patient to make an effort to maintain peak health at all times. This will at least keep attacks to the minimum and give the physical stamina to cope with them.

Mental happiness, a liking for one’s normal daytime occupation, mental adjustment, are all basically important. Endeavoring to avoid tensions, anxieties and stressful situations is recommended. If environmental factors are detectable, an alteration of these, if possible, is desirable. Unfortunately, when they are found, it is often quite impossible to achieve change.

Avoiding foods to which a person is obviously sensitive is essential. Chocolate products, citrus fruits, or anything else that seems to initiate attacks should be excluded as far as possible from the dietetic routine. If the contraceptive pill appears to produce attacks, it is worth following some other form of contraception. When an attack has started (as often it has by the time the person awakens), use of medicinal therapy is often essential for relief.

Recently it has been found that during a migraine, the valve between the stomach and bowel closes tightly. This allows vomiting and prevents any orally ingested medication from entering the bowel and being absorbed. This is why tablets are notoriously unsuccessful.



But recent research shows that an injection of metoclopramide will rapidly relax this valve, prevent vomiting and allow simple analgesics taken by mouth to be effectively absorbed. By this simple measure, the use of such mild analgesics as soluble aspirin (two to three 300 mg tablets) will often quickly cut short an attack, even a severe one.

Recently; therapy has taken a turn in the direction of using aspirin as a long-term “prophylactic” measure. One 300 mg aspirin tablet is taken after dinner each night, and the frequency of migraine often lessens. Aspirin is believed to marginally thin the blood, and this may be the reason it works.

The drug pizotifen is still used by some doctors (one to three tablets a day, depending on results), and is frequently effective in reducing attacks.

Clonidine, used for some years for treating high blood pressure—used much less often today with the plethora of new antihypertensive medication— still has a place (with some patients). A small 20 mcg tablet may be prescribed with success. A large number of options are currently available.

The blood-pressure preparation propranolol, one of the families of the so called beta-blocker group, is also being used with considerable success. A medication named bromocriptine, which lowers the excessive production of certain chemicals produced by the pituitary gland, has also been reported as being successful. This is also used in such diverse conditions as infertility and gigantism (acromegaly). It seems it also has a function with the unlucky migraine patient. Various other preparations are being tested right now at major research centers.

Newer medications, including tamoxifen (used for breast cancer patients), verapamil, nifedipine (heart conditions), and the anti-arthritis tablet naproxen, have all been mentioned in the medical journals as having a beneficial effect in some patients with migraine.



For many years the stand-by therapy for migraine has been ergotamine tartrate. This may be given orally in tablet form, by suppository (where absorption is rapid), or faster and more effectively by injection. However, although it will quickly relieve a severe migraine, it generally produces nausea and frequently violent vomiting. Often the patient would prefer a migraine to the unpleasant aftereffects of this form of therapy.

In an effort to overcome this, various antinausea elements have been incorporated into drug formations. These marginally assist some. The therapy is aimed at contracting the dilated cerebral blood vessels. For this reason, care in the use of these drugs is essential. One tablet may be followed by a second but half-hourly intervals are recommended, and a total of six tablets are considered to be the limit. However, few patients would require this number.

A variety of other forms of medication have been tried. For a time, methysergide rode the crest of the popularity wave until it was found it could produce serious side effects in a small number of people if taken for prolonged periods. So now it is used only in cases of long-standing, intractable migraine. Sedatives and tranquillizers are also used, but this will depend on the severity and nature of the migraine.

Most forms of drug therapy must be taken only under medical supervision, and prescriptions from the doctor are legally mandatory for the majority. However, a person will soon know from the results of medication the best way they may be taken to suit the individual case.

And as mentioned earlier, careful attention to simple commonsense items will do a lot to assist.

People who like natural remedies often try the herb feverfew. This has been written up in several recent medical journals. It is taken either as fresh leaf or in capsule form available from health food shops. Others might care to try “hydrotherapy,” the application of ice-cold packs (or a pack of frozen peas in a polythene bag) to the aching part. Then place the feet in hot water to a point about 12 cm above the ankles. The claim is that the blood vessels of the scalp shrink, and blood is transferred to the feet where it pools, so reducing the pain. Some firms have developed special packs and goggles that may be frozen, and then fitted over the scalp at the appropriate time. In times of need, any of these measures are probably worth a try if the usual methods fail.



With the upsurge of “alternative medicine” in recent years, many patients claim beneficial results from acupuncture. This must be done by a doctor trained in the field, but results are often excellent and rapid.

Very recently, more attention is being focused on the value of total mental and physical relaxation. Many patients find that this simple expedient can prevent a migraine from developing, even though the telltale symptoms are in evidence. A variation of this is called “biofeedback,” which uses a device attached to the body to demonstrate that complete relaxation has been achieved. A noise sounds if there is any voluntary tension developing and this suggests that the patient renew efforts to relax. The results have been extremely beneficial to many, and the promise for developments along this line in the future is good.