[Fr. fr. L. hemicrania, fr. Gr. hemikrania, (headache in) half (of the) skull]
A familial disorder marked by periodic, usually unilateral, pulsatile headaches that begin in childhood or early adult life and tend to recur with diminishing frequency in later life.
SYN: SEE: migraine headache
Migraine is a common problem that affects about 30 million Americans, three times as many females as males. During their reproductive years, women experience a much higher rate of migraine, and their headaches tend to occur during periods of premenstrual tension and fluid retention.
A family history of migraine will be found in over 70% of patients. Many patients link their attacks to ingesting certain foods, which they should avoid. Such foods include aged cheeses, beer, soy sauce, monosodium glutamate (MSG), processed meats, and some wines. Some patients link their attacks to exposure to glare or to sudden changes in barometric pressure.
SYMPTOMS AND SIGNS
Migraine consists of two closely related syndromes: classic migraine (migraine with aura) and common migraine (migraine without aura). The classic type may begin with aura, which consists of episodes of well-defined, transient focal neurologic dysfunction that develops over the course of several minutes and may last as long as an hour. Visual symptoms include teichopsia, seeing stripes, spots, lines, and scotomata. In most people, the aura precedes the headache; occasionally, however, the aura will appear or recur at the height of the headache. Before the onset of symptoms, some people experience mood changes, fatigue, difficulty in thinking, depression, sleepiness, hunger, thirst, frequent urination, or altered libido. Others report a feeling of well-being, increased energy, clarity of thought, and increased appetite, esp. for sweets. The headache follows. Pain is usually confined to one side but is occasionally bilateral. Nausea and vomiting may be present and may last a few hours or for as long as two days. Common migraine has a similar onset with or without nausea. Sensitivity to light and noise is present in both types.
Many medications help migraine sufferers, esp. when combined with treatments like cognitive behavioral therapy. For most mild or moderate headaches, nonsteroidal anti-inflammatory drugs (such as ibuprofen, ketorolac, or naproxen) alleviate pain and restore the ability to function normally within a few hours. These agents work alone or when combined with antiemetic drugs such as metoclopromide or promethazine, as well as rest or relaxation. Triptan drugs (such as sumatriptan or naratriptan), ergotamine derivatives (such as dihydroergotamine or ergotamine with caffeine), prednisone, and other agents are also helpful although each has its own side effects and precautions for use. Patients who experience many migraine headaches each month may benefit from preventive medications such as beta-blocking drugs (such as propranolol), calcium channel blocking drugs (such as verapamil), or tricyclic antidepressants taken on a regular basis. Narcotics (morphine, fentanyl, and others) are given to abort some severe migraine attacks, but habitual use of narcotics may result in tolerance to their effects and drug dependence.
According to the FDA, placebo treatments also help many migraine sufferers.
The health care provider monitors the nature and character of the patient's pain, helps the patient relax by creating a dark, quiet environment, helps the patient recognize and avoid exacerbating factors (based on the patient’s history), and teaches the patient ways to cope with discomfort (such as imagery, relaxation techniques). The patient is taught to take prescribed medications at the first signs of headache and to increase fluid intake to prevent dehydration once nausea is under control. Prescribed medications are administered and evaluated for desired effects and adverse reactions. To enhance the effects of medications and pain relief, noninvasive pain relief measures should be instituted before pain becomes severe. Many headache experts recommend that patients with migraines learn to keep detailed diaries of their illness. Analysis of the diary may help headache sufferers recognize factors such as lack of sleep; irregular meals; and particular foods, odors, or stressors that are likely to trigger a migraine (and therefore should be avoided). Headache diaries are also used to help distinguish migraine headaches from other types of head pain.
migrainous (mī′grā-nŭs″), adj.
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