Migraine Headache
Medical Author: Dennis Lee, MD
Medical Editors: Harley I. Kornblum, MD, PhD,
Jay W. Marks, MD
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Migraine Symptoms
Medical Author: Melissa Stoppler, M.D.
Medical Editor: William C. Shiel,
Jr, MD, FACP, FACR
 How can you tell if that throbbing headache is really a migraine
? Only about 15-20% of migraine sufferers experience the classic “auras” - the visual,
auditory, or olfactory perceptions or other neurological symptoms known to
occur 15 to 30 minutes prior to an attack. While severe head pain is the
hallmark of the condition, the manifestations of migraine may vary widely from individual to
individual.
In general, symptoms of a migraine attack include:
- moderate to severe, throbbing head pain
- most commonly one-sided pain; less frequently both
sides of the head are affected
- pain located near the eye on affected side
- pain that worsens with physical activity
- sensitivity to light and/or sound
- nausea or vomiting
- debilitating pain that hinders daily activities
- untreated attacks most commonly last from four to 72 hours, but may
persist for weeks
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What is a migraine headache?
A migraine headache is a form of
vascular headache. Migraine headache is caused by a combination of
vasodilatation (enlargement of blood vessels) and the release of chemicals from
nerve fibers that coil around the blood vessels. During a migraine attack, the
temporal artery enlarges. (The temporal artery is an artery that lies on the outside of
the skull just under the skin of the temple.) Enlargement of the temporal
artery stretches the nerves that coil around the artery and causes the nerves
to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The
increasing enlargement of the artery magnifies the pain.
Migraine attacks commonly activate the sympathetic nervous system in the
body. The sympathetic nervous system is often thought of as the part of the
nervous system that controls primitive responses to stress and pain, the so-called
"fight or flight" response. The increased sympathetic nervous activity in the
intestine causes nausea, vomiting, and diarrhea. Sympathetic activity
also delays emptying of the stomach into the small intestine and thereby
prevents oral medications from entering the intestine and being absorbed. The
impaired absorption of oral medications is a common reason for the
ineffectiveness of medications taken to treat migraine headaches. The increased
sympathetic activity also decreases the circulation of blood, and this leads to
pallor of the skin as well as cold hands and feet. The increased sympathetic
activity also contributes to the sensitivity to light and sound sensitivity as
well as blurred vision.
Migraine
afflicts 28 million Americans, with females suffering more
frequently (17%) than males (6%). Missed work and lost productivity from migraine
create a significant public burden. Nevertheless, migraine still remains largely
undertreated and underdiagnosed. Less than half the sufferers are diagnosed by
their doctors.
Next: What are the symptoms of migraine headaches? »
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