A severe, recurrent, throbbing headache which usually affects one side of the head (but sometimes affects both sides) is called a migraine headache. The word migraine comes from a Greek word hemikrania which means 'half a skull'. There is excessive contraction and dilation of the blood vessels in the brain and scalp. The migraine usually lasts between two hours and three days.
Several offenders
These headaches usually begin in people between 10 and 30 years old. Migraines can occur anywhere from once per week to once or twice per year. Although the exact cause of migraines is unknown, there are numerous factors which can trigger the release of chemicals in the bloodstream which result in a migraine. Stress, excitement, shock and physical exertion (lack of sleep) may instigate migraines, but some people find that during restful periods like weekends (too much sleep) they tend to have migraines. Hormonal changes in women (use of contraceptive medications) and menstruation, pregnancy or menopause may provoke an attack.
Foods like cheese, chocolate, some canned, pickled and seasoned foods (including MSG seasoning), the artificial sweetener aspartame, foods preserved with sodium nitrite, drugs like alcohol (especially red wine), caffeine, tobacco and some medications are the usual suspects. On the other hand, fasting has been shown to trigger migraines too. Weather changes, bright light or pleasant and unpleasant scents have been implicated in the onset of migraines. Hereditary connections (migraine running in the family) are being investigated since many people with migraines have close family members who have the condition.
Treatment
There is no specific cure for migraines. Avoiding the known triggers for migraines is an important treatment approach. Carefully planned exercise and relaxation techniques may be helpful too.There are two main treatment regimes which have different objectives:
1. Preventing an attack
For persons who have recurring migraine headaches, some drugs are taken daily for weeks or months to 'prevent' an attack. This preventive form of migraine management is really aimed at reducing the severity of the pain, reducing the frequency with which a migraine happens and how long the attack lasts. Some doctors prescribe the popular antihistamine, cyproheptadine (Peritol), especially for children with migraines. High blood pressure medications like Calcium Channel Blockers (verapamil and nifedipine) and ACE Inhibitors like lisinopril are good at 'preventing' migraines. Other similar drugs used for heart failure and high blood pressure such as candesartan are useful preventers of migraines. Some drugs which we use for seizures (fits) are also useful for migraines. Divalproex sodium (Depakene), topiramate (Topamax) and Gabapentin are among these. Antidepressants like amitriptyline are also useful.
2. Relieving an attack
Once the migraine has started, these drugs are used to stop it in its track within hours, and/or to relieve the pain. The simple Nonsteroidal Anti-inflammatory Drugs (NSAIDS) like ibuprofen (Advil, Las-Ibuprofen) or aspirin relieve mild migraines. Combinations of ingredients like paracetamol, aspirin and caffeine (Excedrin Migraine) are useful for moderate migraine pain. However, preparations with caffeine should be used with caution for migraine, as caffeine is itself a trigger for migraines.
When the above products are not sufficient to relieve migraine pain, we step up to the Triptans. Serotonin Receptor Agonists also called Triptans act specifically to reduce the widening of blood vessels in the brain which causes the migraine pain.
Eletriptan (Relpax) - no more than 80mg over 24 hours should be consumed.
Sumatriptan (Imigran) - maximum 300mg to be taken over 24 hours.
Zolmitriptan (Zomig) - no more than 10mg, should be taken in 24 hours.
The versatile ergots
Combinations of ergot drugs and caffeine (Cafergot, Tonopan) are useful in preventing migraines and treating them after they have started. However, the newer drugs (above) are more effective and may carry fewer side effects.
Dahlia McDaniel is a pharmacist and final year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.