MIGRAINE HEADACHES
W. G. Franklin, M.D.
Symptoms and Prevalence
- Characterized by throbbing, severe, often unilateral head pain
- Migraine without aura (common migraine)
Nausea, vomiting, sensitivity to light, sound, motions - Migraine with aura (classic migraine)
Preceded by neurologic, usually visual symptoms - Prevalence: 6% of men and 18% of women per year have migraines
Cause
- Previous theory pointed to arterial dilatation as the major cause
- Present theory points to neural (nerve) events resulting in dilatation of arteries
Treatment
- Regular sleep, regular meals, regular exercise
- Avoidance of stress, dietary triggers
- Beta blockers counteract adrenalin and decrease headaches by up to 90% in patients with
mitral valve prolapse - Calcium channel blocker are less effective
- Aspirin 900 mg., acetaminophen 1000 mg., ibuprofen 400-800 mg. or naproxen 500-1000
mg. taken immediately are often helpful - Ergot derivatives are erratic and may cause vasoconstriction
- Triptans (serotonin receptor agonists) are consistent
May cause coronary artery constriction, rarely heart attack
Contra-indicated with arteriosclerosis of carotid or coronary arteries or with poorly controlled high BP - Rizatriptan 10 mg. or eletriptan 80 mg. were effective within 2 hours
Literature Cited
Silberstein, S.D., et al. Multispecialty concensus on diagnoses and treatment of headache. Neurology 2000; 54: 1553.
Goadsby, Peter., et al. Migraine: current understanding and treatment. NEJM (Jan 24, 2002) 346(4): 257-270.