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USA Today (Society for the Advancement of Education), Oct, 2004 If headaches consistently stop you from working or enjoying life, you may suffer from migraine--the most common neurological disorder in the developed world. Migraine affects an estimated 28,000,000 Americans--more than diabetes, asthma, and epilepsy combined--and it is believed that over half of them remain undiagnosed. "If you are having more than two or three headaches a week, or if your headaches cause disability more than three days in a month, those are chronically recurring headaches," says Dion Graybeal, assistant professor of neurology, University of Texas Southwestern Medical Center at Dallas. "Regardless of how those headaches have been diagnosed in the past, 75% to 85% of them are actually migraine, and not tension or sinus headaches." Migraine is a debilitating condition marked by intense, throbbing pain on one side of the head that becomes worse with movement and often involves nausea, vomiting, and extreme sensitivity to light and sound. One attack can last several hours to several days. Fifteen percent of migraine sufferers experience neurological disturbances called auras before the pain begins. Symptoms include vision problems, ringing in the ears, difficulty speaking, disorientation, and numbness or tingling. There is no cure for migraine, but there are prescription drugs that significantly can reduce the frequency and severity of attacks. Migraine Headache Encyclopedia of Alternative Medicine by Belinda Rowland Definition Migraine is a type of headache marked by severe head pain lasting several hours or more. Description Migraine is an intense, often debilitating type of headache. The term migraine is derived from the Greek work hemikrania, meaning "half a head." Migraines affect as many as 24 million people in the United States, and are responsible for billions of dollars in lost work, poor job performance, and direct medical costs. Approximately 18% of women and 6% of men experience at least one migraine attack per year. Currently, one American in 11 now suffers from migraines, more than three times as many are women, with most of them being premenopausal. Migraines often begin in adolescence, and are rare after age 60. Two types of migraine are recognized. Eighty percent of migraine sufferers experience "migraine without aura" (common migraine). In "migraine with aura," (classic migraine), pain is preceded or accompanied by visual or other sensory disturbances, including hallucinations, partial obstruction of the visual field, numbness or tingling, or a feeling of heaviness. Symptoms are often most prominent on one side of the body, and may begin as early as 72 hours before the onset of pain. Causes & symptoms Causes The physiological basis of migraine has proved difficult to uncover. There are a multitude of potential triggers for a migraine attack, and recognizing one's own set of triggers is the key to prevention. Physiology The most widely accepted hypothesis of migraine suggests that a migraine attack is precipitated when pain-sensing nerve cells in the brain (called nociceptors) release chemicals called neuropeptides. At least one of the neurotransmitters, substance P, increases the pain sensitivity of nearby nociceptors. Other neuropeptides act on the smooth muscle surrounding cranial blood vessels. This smooth muscle regulates blood flow in the brain by relaxing or contracting, thus dilating (enlarging) or constricting the enclosed blood vessels. At the onset of a migraine headache, neuropeptides are thought to cause muscle relaxation, allowing vessel dilation and increased blood flow. Other neuropeptides increase the leakiness of cranial vessels, allowing fluid leak, and promote inflammation and tissue swelling. The pain of migraine is thought to result from this combination of increased pain sensitivity, tissue and vessel swelling, and inflammation. The aura seen during a migraine may be related to constriction in the blood vessels that dilate in the headache phase. Genetics Susceptibility to migraine may be inherited. A child of a migraine sufferer has as much as a 50% chance of developing migraines. If both parents are affected, the chance rises to 70%. However, the gene or genes responsible have not been identified, and many cases of migraine have no obvious familial basis. It is likely that whatever genes are involved set the stage for migraine, and that full development requires environmental influences, as well. Triggers A wide variety of foods, drugs, environmental cues, and personal events are known to trigger migraines. It is not known how most triggers set off the events of migraine, nor why individual migraine sufferers are affected by particular triggers but not others. Common food triggers include:
environmental and event-related triggers include:
Drugs which may trigger migraine include:
Symptoms Migraine without aura may be preceded by elevations in mood or energy level for up to 24 hours before the attack. Other pre-migraine symptoms may include fatigue, depression, and excessive yawning. Aura most often begins with shimmering, jagged arcs of #016EBB or colored light progressing over the visual field in the course of 10-20 minutes. This may be preceded or replaced by dark areas or other visual disturbances. Numbness and tingling is common, especially of the face and hands. These sensations may spread, and may be accompanied by a sensation of weakness or heaviness in the affected limb. Migraine pain is often present only on one side of the head, although it may involve both, or switch sides during attacks. The pain is usually throbbing, and may range from mild to incapacitating. It is often accompanied by nausea or vomiting, painful sensitivity to light and sound, and intolerance of food or odors. Blurred vision is also common. The pain tends to intensify over the first 30 minutes to several hours, and may last from several hours to a day, or longer. Afterward, the affected person is usually weary, and sensitive to sudden head movements. Diagnosis Migraine is diagnosed by a careful medical history. So far, lab tests and imaging studies such as computed tomography (CT scan) or magnetic resonance imaging (MRI) scans have not been useful for identifying migraine. However, for some patients, these tests may be needed to rule out a brain tumor or other structural causes of migraine headache. Prevention The frequency of migraine headaches may be lessened by avoiding triggers. It is useful to track these triggers by keeping a headache journal. Certain drugs can be used for migraine prevention, but this is not an appropriate option for most patients. However, for women whose migraines coincide with the menstrual period, limited preventive treatment may be effective. Possible preventive measures include: eating at regular times, not skipping meals, reducing the use of caffeine and pain-relievers, restricting physical exertion (especially on hot days), and keeping regular sleep hours, but not oversleeping. Other measures include:
ThinkHealthy News Shape, Dec, 2003 Don't put off taking your migraine medication, especially if your symptoms include skin hyper-sensitivity. Treating yourself early can give you a better chance of stopping a headache, says Rami Burstein, Ph.D., an associate professor of neurology at Harvard Medical School, who evaluated 51 migraine attacks in 28 people. Half were given migraine medicine at the first sign of hypersensitive skin (80 percent of sufferers experienced this), half after the skin symptoms were in progress. Ninety-one percent of those who took medication early got relief, compared to only 3 percent who waited.--K.D. Quick test: is it a migraine? - Headache Update Shape, Dec, 2003 by Maryann Hammers Around 18 percent of women suffer from migraines, but only half have been diagnosed. "Knowing your headaches are migraines is the first step toward managing them," says Richard Lipton, M.D., a professor of neurology at the Albert Einstein College of Medicine in New York City, who helped develop this quick self-test to determine what's causing that crushing pain in your cranium: 1. Has a headache limited your activities for a day or more in the last three months? 2. Are you nauseated or sick to your stomach when you have a headache? 3. Does light bother you when you have a headache? If you answer yes to at least two of these three questions, you probably have migraines. Lipton says you may be able to prevent attacks by avoiding dietary triggers, such as alcohol (especially red wine), chocolate and cheese. And a number of medications can relieve pain.
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