Diagnosis & Treatment of Migraine

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No test can objectively tell you or your doctor that you suffer from migraines. Your doctor relies on you for information about the pain you feel. Because the diagnosis of a migraine is based on your own description of the pain, it’s very important that you communicate well with your doctor. It is important to learn how to describe your headaches clearly and, ideally to avoid misdiagnosis. All headaches are categorized according to the nature of the pain they inflict.
  1. The intensity of your headache–the relative degree of your discomfort or pain.
  2. The duration of your headache–how long it lasts.
  3. The frequency of your headaches–how often they occur.
  4. The location of your headache–the specific area of your head that hurts.
  5. The type of pain associated with your headache–for example, dull and constant versus sharp and stabbing.
Evaluating your own Headache
Under each category, choose the listed item that best describes your headache. This should help you describe your headaches more effectively to your doctor.
Intensity of pain Duration of headache Frequency of headaches Location of pain Type of pain Location of Pain
Location of Pain Location of Pain
The location of your pain is another important clue to determine the type of headache you have. For example, tension headache is generally a band–like pressure around the head, and a sinus headache is usually felt on the forehead or face. But nearly 60% of the time, migraine headaches occur on just one side of the head and are centered above or behind one eye. The particular side of the headache often changes from one headache episode to the next. During a migraine attack, the pain can migrate from the original area of pain and even travel down the neck and into the shoulder. Frequently, the pain spreads during the course of the migraine, often until it covers the entire head. Doctors refer to seven specific regions of the head (see the illustration Pain Locations). When you describe your headache to your physician, you should make it clear which of these region(s) your pain is located in: Treatment of Migraine
Drug therapy, stress reduction, and right diet are the most common methods of preventing and controlling migraine and other vascular headaches. Regular exercise, such as swimming or vigorous walking, can also reduce the frequency and severity of migraine headaches. Yoga and whirlpool baths help to relax. During a migraine headache, temporary relief can sometimes be obtained by using cold packs or by pressing on the bulging artery found in front of the ear on the painful side of the head.


Drug therapy
There are two: prevent the attacks or relieve symptoms after the headache occurs. Drugs can be taken at the first sign of a headache in order to stop it or to at least ease the pain. People who get occasional mild migraine may benefit by taking aspirin or acetaminophen at the start of an attack. Dispirin raises a person’s tolerance to pain and also discourages clumping of blood platelets. Small amounts of caffeine may be useful if taken in the early stages of migraine. But for most migraine sufferers who get moderate to severe headaches, and for all cluster patients, stronger drugs may be necessary to control the pain.

One of the most commonly used drugs for the relief of classic and common migraine symptoms is ergotamine tartrate, a vasoconstrictor which helps counteract the painful dilation stage of the headache. For optimal benefit, the drug is taken during the early stages of an attack. If a migraine has been in progress for about an hour and has passed into the final throbbing stage, ergotamine tartrate will probably not help. Because ergotamine tartrate can cause nausea and vomiting, it may be combined with antinausea drugs. Research scientists caution that ergotamine tartrate should not be taken in excess or by people who have angina pectoris, severe hypertension, or vascular, liver, or kidney disease.

Patients who are unable to take ergotamine tartrate may benefit from other drugs that constrict dilated blood vessels or help reduce blood vessel inflammation. For headaches that occur three or more times a month, preventive treatment is usually recommended. Drugs used to prevent classic and common migraine include methysergide maleate, which counteracts blood vessel constriction, propranolol hydrochloride, which stops blood vessel dilation, and amitriptyline, an antidepressants.

Antidepressants called MAO inhibitors also prevent migraine. These drugs block an enzyme called monoamine oxidase which normally helps nerve cells absorb the artery–constricting brain chemical, serotonin. MAO inhibitors can have potentially serious side effects–particularly if taken while ingesting foods or beverages that contain tyramine, a substance that constricts arteries.

Several drugs for the prevention of migraine have been developed in recent years, including drugs which mimic the action of serotonin, including serotonin agonists which mimic the action of this key brain chemical. Prompt administration of these drugs is important. Many antimigraine drugs can have adverse side effects. But like most medicines they are relatively safe when used carefully and under a physician’s supervision. To avoid long–term side effects of preventive medications, headache specialists advise patients to reduce the dosage of these drugs and then to stop taking them as soon as possible.

Biofeedback and relaxation training
Biofeedback refers to a technique that can give people better control over such body function indicators as blood pressure, heart rate, temperature, muscle tension, and brain waves. Drug therapy for migraine is often combined with biofeedback and relaxation training.

“To succeed in biofeedback,” says a headache specialist, “You must be able to concentrate and you must be motivated to get well.” A patient learning thermal biofeedback wears a device which transmits the temperature of an index finger or hand to a monitor. While the patient tries to warm his hands, the monitor provides feedback either on a gauge that shows the temperature reading or by emitting a sound or beep that increases in intensity as the temperature increases. The patient is not told how to raise hand temperature, but is given suggestions such as “Imagine that your hands feel very warm and heavy.” “I have a good imagination,” says one headache sufferer who traded in her medication for thermal biofeedback. The technique decreased the number and severity of headaches she experienced. In another type of biofeedback called electromyographic or EMG training, the patient learns to control muscle tension in the face, neck, and shoulders.

Either kind of biofeedback may be combined with relaxation training, during which patients learn to relax the mind and body. Biofeedback can be practiced at home with a portable monitor. But the ultimate goal of treatment is to wean the patient from the machine. The patient can then use biofeedback anywhere at the first sign of a headache.

The Antimigraine diet
A treatment program focused solely on eliminating headache–provoking foods. Migraine patients may be helped by a diet to prevent low blood sugar. Low blood sugar, or hypoglycemia, can cause dilation of the blood vessels in the head. This condition can occur after a period without food: overnight, for example, or when a meal is skipped. People who wake up in the morning with a headache may be reacting to the low blood sugar caused by the lack of food overnight. For the same reason, many specialists also recommend that migraine patients avoid oversleeping on weekends. Sleeping late can change the body’s normal blood sugar level and lead to a headache.