Brain pain: understanding migraine headaches

What does a migraine feel like?

The hallmark of a migraine headache is pulsating head pain. The pain is often localized to one side of the head and often occurs behind the eye or near the temple. You may also vomit or feel nauseated; become hypersensitive to light, sound, or smells; feel dizzy; or experience visual disturbances. Symptoms are aggravated by movement. Migraine intensity ranges from uncomfortable to completely disabling and can last anywhere from an hour to several days.

Some people experience an "aura" before a migraine strikes. An aura is an unexplained sensation that affects sight, taste, touch, hearing, or smell. Visual auras are the most common, characterized by flashing lights, jagged lines, blurred vision, or blind spots. Auras can affect other senses as well, causing temporary numbness of a body part, odd smells, ringing in the ears, or difficulty talking. Only 15%-20% of migraine sufferers experience warning auras.

Other medical conditions can also cause these symptoms. Therefore, it's important to see your health care professional to determine whether your head pain is in fact, due to a migraine.

What causes migraines?

No one knows for sure. However, most doctors believe that migraines are caused by swelling and expansion of the blood vessels surrounding the head and neck. As the vessels expand, they cause the nearby brain tissues to become inflamed. This is thought to cause the pain and the aura.

But what causes the swelling? Although it varies from one person to another, certain trigger factors have been generally linked with the onset of migraines. The list of identified triggers includes hunger, menstruation, hormone therapy, foods containing tyramine or alcohol, strong odors such as perfumes or cigarettes, excessive noise or bright lights, stress, and insomnia. Researchers report that the genes you inherited from your parents play a significant role too; a hereditary influence can be found in 70%-80% of migraine sufferers.

There seems to be a strong correlation between hormonal fluctuation and migraines in women. According to the National Headache Foundation, approximately 65% of females experience migraine-like headaches immediately before, during, or immediately, after menstruation. "Both rising and falling estrogen levels can cause headache," says Stephen D. Silberstein, M.D, co-director of the Comprehensive Headache Center of the Germantown Hospital and Medical Center in Philadelphia. "Falling estrogen levels tend to bring on migraines with no aura, while rising estrogen levels usually induce migraine with aura," says Silberstein.

Birth control pills or hormone replacement therapy can trigger an increase in migraines. Post-menopausal women who take estrogen may be able to get by with a lower daily dose to keep hormone levels as balanced as possible.

Eating foods that contain tyramine, monosodium glutamate (MSG), or nitrites may also bring on an attack. Wine, aged cheeses, soy sauce, liver, and sadly, chocolate, all contain tyramine. MSG is a flavor enhancer often used in canned soups, Mexican and Chinese foods, corn chips, and meat tenderizer and seasonings. Nitrites are found in processed or cured meats, including hot dogs, bologna, and beef jerky.

But don't scrutinize your eating habits too much when it comes to the connection between food and migraines. "The role of diet is overstated," says Silberstein. "Don't starve, don't go overboard with MSG or nitrates, and drink less wine. If a certain food or beverage gives you a headache, avoid it, but don't ruin your life by not eating," he says.

What can I do to prevent migraines?

Keep a journal of your headaches. Note when a migraine occurred, what you were doing at that time and shortly before, and what foods you ate in the 24 hours prior to the headache. Reviewing your entries may reveal a pattern linking migraine onset to certain foods or activities that you can then avoid.

Investigate biofeedback therapy. Biofeedback is a relaxation technique that can correct emotional triggers such as stress and anger. Electrodes that track changes in pulse or skin temperature are used to help you relax. The goal of biofeedback is to teach you how to release tension and increase blood flow on your own without using the machine.

You can obtain information about biofeedback at your local library or bookstore. Many clinics also offer training in biofeedback techniques. Daily practice is important in achieving success with biofeedback.

If you sense a migraine coming on, you may be able to head it off. "Get out of any noisy, smelly environment, lay down, take a couple of single or combination analgesics, and put a cold, damp cloth on your head," advises Silberstein.

What about medications?

The medicines currently used to treat migraines fall into three categories: preventive agents (prophylactics), abortive agents, and pain relievers.

If you find that your life is becoming unmanageable because of migraines, your doctor may prescribe a prophylactic medication. Their purpose is to ward off a migraine, or at least reduce the frequency and severity. They are taken regularly, whether or not you are experiencing symptoms.

Prophylactic medications include beta blockers (Inderal and Inderal LA), calcium-channel blockers (Cardizem and Procardia), certain antidepressants (Elavil, Zoloft), and some seizure medicines (Tegretol and Dilantin).

Standard pain relievers are the first line of abortive treatment for migraines. These include medicines that are available over-the-counter (aspirin, Tylenol, ibuprofen) or by prescription (Toradol, Anaprox, Ponstel).

To halt an acute migraine in progress that has not responded to standard pain relievers, health care providers often prescribe ergotamine (Cafergot, Wigraine). Ergotamines can be administered either orally or by injection. Excessive amounts of ergotamines can actually induce headaches, so monitor your usage.

Sumatriptan (Imitrex) is a fairly new abortive-type medication. It can be taken orally or given by injection. If you have frequent migraines, you can learn to do the injections yourself. Imitrex reportedly helps 70%-80% percent of the people who use it. For updated information about sumatriptan and advances in other migraine drugs of the "triptan" class, see our article: Rescue from migraine pain: the very latest treatments.

A recent study describes a new form of treatment to be used for acute migraines in progress: intranasal lidocaine. A solution containing lidocaine is dripped into the nostril(s) as the head is tilted back toward the headache side. The study reported that one-third of the patients receiving this treatment experienced rapid and lasting relief.

Although there is currently no "cure" for migraines, there are ways to obtain significant relief. Both medications and lifestyle changes can significantly reduce the number and severity of your headaches. To initiate this relief, however, you need to visit your health care provider or a headache clinic to work out a treatment plan. You won't be alone; according to one Philadelphia headache center, head pain is one of the leading reasons people visit their doctor.