Is it a headache or a migraine?

Posted on Tue., March 3, 2009
By Dr. Veda Bhatt

Recently, a patient I´ll call Sarah, began to experience a mild headache. Thinking it would go away, she took a pain pill from the drugstore, and went to work. By the following day, however, her headache was so unbearable she spent the day at home, resting in the dark.

It turned out that Sarah was suffering a migraine headache, which might have been avoided — or at least made better — if she had worked with her doctor to find an effective medicine.

Although some people use the word "migraine" for any severe headache, it actually refers to specific types of headaches, which are currently thought to be caused by reactions in the brain and nerves to changes in the body or environment. Migraine sufferers often have parents or relatives with migraines, suggesting a genetic component.

Migraines often cause a throbbing pain on one side of the head, but may be on both sides and may be constant. Migraines may be preceded by an aura (such as visual objects that seem shimmering or wavy, dizziness, tingling or numbness), and are often accompanied by nausea, vomiting and light sensitivity.

Triggers

The following are commonly identified as triggering migraines:

Stress from anxiety, lack of sleep, hunger or exertion
Foods and chemicals, such as red wine, coffee, chocolate, MSG, and nitrates (found in processed meats such as salami and hot dogs)
Bright lights
Female hormone changes
Environmental changes such as weather and altitude, and even smells
Medications, including some used to treat migraines

There are two types of medicines to treat migraines: pain relieving and preventive.

Pain-relieving drugs are taken during a migraine to stop the symptoms. Sometimes these include over-the-counter medicines such as aspirin and ibuprofen. Other drugs that can reduce or eliminate the pain from migraine attacks include triptans (e.g. Imitrex and Imigran) and ergot alkaloids (e.g. Bellergal-S, Bellamine and Cafergot).

Triptans and ergot alkaloids should not be taken together. These drugs need to be taken at the onset of a migraine attack to be most effective.

Preventive drugs, on the other hand, have the ability to reduce a migraine´s frequency and intensity. These are helpful for people who have frequent, disabling migraines.

Preventive medications range from antidepressants (like Prozac, Paxil and Aventyl) and calcium channel blockers (e.g. Calan and Isoptin) to beta-blockers (e.g. Inderal) and anticonvulsants (such as Tegretol and Neurontin). These medicines must be taken hours or days before the migraine to be effective.

Although it´s often a matter of trial and error, a doctor who treats a lot of migraine sufferers may be in the best position to know which drugs or drug combinations will be most likely to help.

Continuing the care

A healthy diet, regular exercise and calm environment will go a long way toward reducing migraines.

The following symptoms, when combined with a headache, could mean you have a more serious medical condition, and you should call 911:

Trouble speaking or slurred words
Stiff neck, weakness and numbness
Dizziness
Sudden, persistent weakness of one side of the face, or of an arm, leg, foot or hand
Recent head injury

To find out more, visit the Contra Costa Health Services Web site at www.cchealth.org.

Bhatt practices family medicine at the Contra Costa Regional Medical Center in Martinez.