Migraine Headache (cont.)
How is a migraine headache diagnosed?
Migraine headaches are usually diagnosed when the symptoms described above
are present. Migraine generally begins in childhood to early adulthood. While
migraines can first occur in an individual beyond the age of fifty, advancing
age makes other types of headaches more likely. A family history is usually
present, suggesting a genetic predisposition in migraine sufferers. In addition
to diagnosing migraine from the clinical presentation there is usually an
accompanying normal examination.
Patients with the first headache ever, worst headache ever, or where there is
a significant change in headache or the presence of nervous system symptoms,
like visual or hearing or sensory loss, may require additional tests. The tests
may include blood testing, brain scanning (either CT or
MRI), and a spinal tap.
How are migraine headaches treated?
Treatment is can include non-medication and medication approaches.
Non-medication therapies for migraine
Therapy that does not involve medications can provide symptomatic and
preventative therapy. Using ice, biofeedback, and relaxation techniques may be
helpful at stopping an attack once it has started. If possible, sleep is the
best medicine. Preventing migraine takes motivation for the patient to make some
life changes. Patients are educated as to triggering factors that can be
avoided. These include smoking cessation, avoiding certain foods especially
those high in tyramine (sharp cheeses) or those containing sulphites (wines) or
nitrates (nuts, pressed meats). Generally, leading a healthy life style with
good nutrition, adequate water intake, sufficient sleep and exercise may be
useful. Acupuncture has been suggested to be a useful non-medication therapy.
Medication therapies for migraine
Individuals with occasional mild migraine headaches that
do not interfere with daily activities usually medicate themselves with
over-the-counter (OTC, non-prescription) pain relievers (analgesics). Many OTC
analgesics are available. OTC analgesics have been shown to be safe and
effective for short-term relief of headache (as well as muscle aches, pains, menstrual cramps
, and fever) when used according to the instructions on their
labels.
There are two major classes of OTC analgesics: acetaminophen (Tylenol) and non-steroidal anti-inflammatory
drugs (NSAIDs). The two types of NSAIDs are aspirin and non-aspirin.
Examples of non-aspirin NSAIDs are ibuprofen (Advil, Nuprin, Motrin
IB, and Medipren) and naproxen
(Aleve). Some NSAIDs are available by prescription only. Prescription NSAIDs are
usually prescribed to treat arthritis and other inflammatory
conditions such as bursitis,
tendonitis, etc. The difference between OTC and prescription NSAIDs may only be
the amount of the active ingredient contained in each pill. For example, OTC naproxen (Aleve) contains 220 mg
of naproxen per pill, whereas prescription naproxen (Naprosyn) contains 375 or
500 mg of naproxen per pill.
Acetaminophen reduces pain
and fever by acting on pain centers in the brain. Acetaminophen is well
tolerated and generally is considered easier on the stomach than NSAIDs.
However, acetaminophen can cause severe liver damage in high (toxic) doses or if
used on a regular basis over extended periods of time. In individuals who
regularly consume moderate or large amounts of alcohol, acetaminophen can cause
serious damage to the liver in lower doses that usually are not toxic.
Acetaminophen also can damage the kidneys when taken in large doses. Therefore,
acetaminophen should not be taken more frequently or in larger doses than
recommended on the label. For information, please read the Acetaminophen and
Liver Damage article.
NSAIDs relieve pain by reducing the inflammation that causes the pain (They
are called non-steroidal anti-inflammatory drugs or NSAIDs because they are
different from corticosteroids such as prednisone, prednisolone, and cortisone which
also reduce inflammation). Corticosteroids, though valuable in reducing
inflammation, have predictable and potentially serious side effects, especially
when used long-term. NSAIDs do not have the same side effects that
corticosteroids have.
Aspirin, Aleve, Motrin, and Advil all are NSAIDs and are similarly effective
in relieving pain and fever. The main difference between aspirin and non-aspirin
NSAIDs is their effect on platelets. Platelets are small particles in the blood
that cause blood clots to form. Aspirin prevents the platelets from forming
blood clots. Therefore, aspirin can increase bleeding by preventing blood from
clotting though it also can be used therapeutically to prevent clots from
causing heart attacks and strokes. The non-aspirin NSAIDs also have
anti-platelet effects, but their anti-platelet action does not last as long as
aspirin.
Aspirin, acetaminophen, and caffeine also are available combined in OTC
analgesics for the treatment of headaches. Examples of such combination
analgesics are Pain-aid, Excedrin, Fioricet, and Fiorinal.
Finding an effective analgesic or analgesic combination often is a process of
trial and error because individuals respond differently to different analgesics.
In general, a person should use the analgesic that has worked in the past. This
will increase the likelihood that an analgesic will be effective and decrease
the risk of side effects.
There are several precautions that should be observed with OTC
analgesics:
- Children and teenagers should not use aspirin for the treatment of
headaches, other pain, or fever, because of the risk of developing Reye's
Syndrome, a life-threatening neurological disease that can lead to coma and
even death.
- Patients with balance disorders or hearing difficulties should avoid using
aspirin because aspirin may aggravate these conditions.
- Patients taking blood thinners such as warfarin (Coumadin) should not
take aspirin and non-aspirin NSAIDs without a doctor's supervision because
they add further to the risk of bleeding that is caused by the blood
thinner.
- Patients with active ulcers of the stomach and duodenum should not take
aspirin and non-aspirin NSAIDs because they can increase the risk of bleeding
from the ulcer and impair healing of the ulcer.
- Patients with advanced liver disease should not take aspirin and
non-aspirin NSAIDs because they may impair kidney function. Deterioration of
kidney function in these patients can lead to rapid and life-threatening
deterioration of their liver disease.
- Patients should not overuse OTC or prescription analgesics. Overuse of
analgesics can lead to the development of tolerance (increasing
ineffectiveness of the analgesic) and rebound headaches (return of the
headache as soon as the effect of the analgesic wears off, usually in the
early morning hours). Thus, overuse of analgesics can lead to a vicious cycle
of more and more analgesics for headaches that respond less and less to
treatment and occur more frequently.
Next: What is the treatment for moderate to severe migraine
headaches? »
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