Migraine Headache (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
How is a migraine headache diagnosed?
Migraine headaches are usually diagnosed when the symptoms described previously 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 usually is present, suggesting a genetic predisposition in migraine sufferers. The examination of individuals with migraine attacks usually is normal.
Patients with the first headache ever, worst headache ever, a significant change in the characteristics of headache, or an association of the headache with nervous system symptoms -- like visual or hearing or sensory loss -- may require additional tests to exclude diseases other than migraine. The tests may include blood testing, brain scanning (either CT or MRI), and a spinal tap.
Formal diagnostic criteria for migraine have been established by the International Headache Society. According to these criteria, migraine is present when an individual has had five or more episodic headaches lasting from 4 to 72 hours with TWO of the following characteristics: unilateral (one-sided), throbbing, moderate or severe, and worsened by movement; plus any ONE of the following: nausea or vomiting, phonophobia (decreased tolerance to sounds), or photophobia (decreased tolerance to light).
How are migraine headaches treated?
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Treatment includes therapies that may or may not involve medications.
Nonmedication therapies for migraine
Therapy that does not involve medications can provide symptomatic and preventative therapy.
Prevention of migraine requires motivation by the patient to make some life changes. Patients are educated as to triggering factors that can be avoided. These triggers include:
Medication for migraine
Individuals with occasional, mild migraine headaches that do not interfere with daily activities usually medicate themselves with over-the-counter (OTC or nonprescription) 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 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 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 liver damage at lower doses that are not usually 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 package label.
The two types of NSAIDs are 1) aspirin and 2) 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 usually is 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.
NSAIDs relieve pain by reducing the inflammation that occurs during the headache (They are called nonsteroidal antiinflammatory drugs or NSAIDs because they are different from steroids such as prednisone, prednisolone, and cortisone which also reduce inflammation). Steroids, though valuable in reducing inflammation, have predictable and potentially serious side effects, especially when used long term. Their full effects also require hours or days. NSAIDs do not have the same side effects that steroids have, and their onset of action is faster.
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, the small particles in 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 antiplatelet effects, but their antiplatelet action does not last as long as aspirin (hours rather than days).
Aspirin, acetaminophen, and caffeine also are available combined in OTC analgesics for the treatment of headaches including migraine. 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:
Reviewed by Jay W. Marks, MD on 12/4/2012
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