When to see a doctor?
Migraines are not life–threatening. However, brain infections and brain tumors can also cause bad headaches. You should see a doctor when there is:
- A sudden, severe headache, or the “Worst–ever” headache.
- A headache that gradually gets worse instead of getting better with time.
- A headache with memory loss or thinking difficulty, disturbed vision or speech changes, loss of strength, tingling or numb feelings in one part of the body, such as arms or legs, or a change in balance.
- A headache with fever, stiff neck, clumsiness, change in awareness, change in personality, vision problems that last more than an hour.
- A headache that lasts for more than a week after you have had a head injury.
- Smells and fumes, tobacco smoke, strong, colorful light, weather changes.
- Too much, too little or interrupted sleep.
- Hunger or fasting (not eating), and specific foods and beverages.
- Excessive activity (especially if you’re not in good shape).
- Stress and pressure, major hassles, major losses, anger and depression.
- Monthly period, birth control pills, estrogen therapy.
- Beer, wine and hard liquor.
- Caffeine in coffee, tea and cola, as well as caffeine withdrawal (if you try to give up caffeinated sodas, for example), chocolate in sweets, foods and drinks.
- Dairy products such as ice cream, milk, yogurt, cheese, whipped cream and sour cream.
- Fermented and pickled foods.
- Most citrus fruits like oranges, grapefruit and lemons.
- Monosodium glutamate (MSG), which is found in Chinese food, canned soups, processed meats, and some processed nuts and snack chips.
- Pea pods, bananas, figs and raisins.
- Yeast–containing products, such as fresh breads and donuts.
- Nuts and peanuts.
Neurological symptoms 15 to 30 minutes before a classic migraine attack may appear, these symptoms are called an aura. The person may see flashing lights or zigzag lines, some temporarily lose vision. Other classic symptoms include speech difficulty, weakness of an arm or leg, tingling of the face or hands, and confusion. The pain of a classic migraine headache is described as intense, throbbing, or pounding and is felt in the forehead, temple, ear, jaw, or around the eye. Classic migraine starts on one side of the head but may eventually spread to the other side. An attack lasts 1 to 2 days.
In a common migraine, some people experience a variety of vague symptoms beforehand, including mental fuzziness, mood changes, fatigue, and unusual retention of fluids. During the headache phase of a common migraine, a person may have diarrhea and increased urination, as well as nausea and vomiting. Common migraine pain can last 3 or 4 days.
Both classic and common migraine can occur as often as several times a week, or as rarely as once every few years. Some people, however, experience migraines at predictable times –near the days of menstruation or every Saturday morning after a stressful week of work.
The Migraine Process
People who get migraine headaches appear to have blood vessels that overreact to various triggers.
Research scientists are unclear about the precise cause of migraine headaches. There seems to be general agreement, however, that a key element is blood flow changes in the brain.
According to some, the nervous system responds to a trigger such as stress by creating a spasm in the nerve–rich arteries at the base of the brain. The spasm closes down or constricts several arteries supplying blood to the brain, including the scalp artery and the carotid or neck arteries. As these arteries constrict, the flow of blood to the brain is reduced. At the same time, blood–clotting particles called platelets clump together–a process which is believed to release a chemical called serotonin. Serotonin acts as a powerful constrictor of arteries, further reducing the blood supply to the brain.
Reduced blood flow decreases the brain’s supply of oxygen. Symptoms signaling a headache, such as distorted vision or speech, may then result, similar to symptoms of stroke.
Reacting to the reduced oxygen supply, certain arteries within the brain open wider to meet the brain’s energy needs. This widening or dilation spreads, finally affecting the neck and scalp arteries. The dilation of these arteries triggers the release of pain–producing substances called prostaglandins from various tissues and blood cells. Chemicals which cause inflammation and swelling, and substances which increase sensitivity to pain are also released. The circulation of these chemicals and the dilation of the scalp arteries stimulate the pain–sensitive nociceptors. The result, according to this theory: a throbbing pain in the head.
Women and Migraine
Although both males and females seem to be affected by migraine, the condition is more common in adult women.
Women may have headaches around the time of their menstrual period–which may disappear during pregnancy. Other women develop migraine for the first time when they are pregnant. Some are first affected after menopause.
Research reports that some women who take birth control pills experience migraine more frequent and severe attacks than others. And normal women who do not suffer from headaches may develop migraines as a side effect when they use oral contraceptives.
Other forms of Migraine
There are several other forms besides the classic and common migraine headaches.
Patients with hemiplegic migraine have temporary paralysis on one side of the body. Some people may experience vision problems and vertigo–a feeling that the world is spinning. These symptoms begin 10 to 90 minutes before the onset of headache pain.
In ophthalmoplegic migraine, the pain is around the eye and is associated with a droopy eyelid, double vision, and other sight problems.
Basilar artery migraine. Pre–headache symptoms include vertigo, double vision, and poor muscular coordination. This type of migraine occurs primarily in adolescent and young adult women and is often associated with the menstrual cycle.
Benign exertional headache is brought on by running, lifting, coughing, sneezing, or bending. The headache begins at the onset of activity, and pain rarely lasts more than several minutes.
Status migrainosus is a rare and severe type of migraine that can last 72 hours or longer. The pain and nausea are so intense that people who have this type of headache must be hospitalized.
The use of certain drugs can trigger status migrainosus. Neurologists report that many of their status migrainosus patients were depressed and anxious before they experienced headache attacks.
Headache–free migraine is characterized by such migraine symptoms as visual problems, nausea, vomiting, constipation, or diarrhea. Patients, however, do not experience head pain. Headache specialists have suggested that unexplained pain in a particular part of the body, fever, and dizziness could also be possible types of headache–free migraine.