How to Diagnose a Migraine (Video)

How to Stop Migraine Headaches (Video)

Migraine Treatment for Kids (Video)

Migraine Homeopathic Treatments (Video)

How Are Migraines Different From Headaches?

Cluster headaches, tension headaches and migraine headaches are the main categories of headaches. Each type of headache is distinguished by pain, duration, symptoms and causes.

1. 
   Image by Flickr.com, courtesy of Nicole Makauskas 
   Migraines produce distinct symptoms that differ from headache pain.

Effects

2. Cluster headaches are identified by intense, stabbing pains above the eye or temple. Tension headaches produce a dull, ache throughout the head, neck and back. Migraines result in chronic throbbing, pulsating pain.

Features

3. Migraines are distinct due to conditions of aura including impaired vision, light and sound sensitivity, hallucinations, mood changes, nausea, vomiting, loss of appetite and temporary paralysis.

Time Frame

4. Cluster headaches occur suddenly with pain escalating within 15 minutes, while tension headaches may intensify in 30 minutes to one week. Migraine pain builds, lasting from one to four days.

Identification

5. Migraines are different from other types of headaches due to neurological causes of hormonal imbalances, blood-vessel expansion and gene mutations. Cluster headaches are not associated with triggers. Tension headaches result from external influences.

Considerations

6. Cluster headaches and migraines are cyclical or episodic. Tension headaches are less of a syndrome. Warning signs of premonition that do not precede other headaches cause erratic behavior and cravings prior to migraines.

Migranal Side Effects

Migranal is a spray medication used to treat acute migraine headaches either with or without aura. The medication is an ergot derivative that works by constricting blood vessels in the brain, which in turn reduces the likelihood of migraine symptoms. As with most medications, there are a number of side effects associated with using Migranal.

Common Side Effects

1. Some of these side effects include diarrhea, drowsiness, dizziness, burning sensation, irritation, dry mouth, nasal congestion, nasal discharge, pain, nausea, runny nose, sinus inflammation, sore nose or throat, stiffness, vomiting, weakness and tiredness. Although these are considered the most common side effects associated with using Migranal, they only affect a small number of users.

Severe Side Effects

2. Some of these include difficulty breathing, tightening of the chest, hives, rash, swelling of the mouth and tongue, chest pain, muscle weakness, loss of color, numbness, swelling, irregular heartbeat and coldness. These side effects are very rare and are not reported in a large number of users.

Important Safety Information

3. This medication can cause drowsiness and dizziness, so it is recommended that users do not operate any type of machinery--including automobiles--while using this drug. Use Migranal with caution in children and adults older than 65 as side effects have been known to affect them more severely. This medication has also been shown to cause damage to an unborn fetus, so do not use it if you are pregnant or are expecting to be soon.

Usage

4. Always use Migranal directly as instructed by your doctor, and never exceed the recommended dosage instructions written on the label. The drug is meant for use in the nose only and should never be injected directly into the bloodstream. To administer the medication, spray once into each nostril without tilting your head or sniffing. This medication is not meant for use on a daily basis.

Warning

5. If you experience any of the aforementioned side effects, contact your local doctor immediately.
   
   If an overdose of Migranal is suspected, contact your local poison center and head directly to the emergency room.
   
   Migranal is meant as a nose spray only and should never be administered into any other bodily orifice.

Homeopathic Migraine Relief

Migraine headaches can be painfully debilitating and can be difficult to treat. There are pharmaceutical medications for migraines that are effective, but many bring with them unwanted and unhealthful side effects, such as dizziness and even seizures (see Resources below). Luckily, there are homeopathic remedies that work to relieve migraine and harbor no side effects.

Belladonna

1. Belladonna can be taken to relieve migraines that start in the morning and begin at the base of the skull. The pain is typically a hammering pain on the right side.

Bryonia

2. Bryonia is helpful when the migraine is accompanied by vomiting and where the pain begins around the left eye.

Cimicifuga

3. Cimicifuga can help migraines that accompany menstruation, muscle aches in the neck and migraines with sharp pains around the eyes.

Cyclamen

4. Cyclamen is helpful for migraines that can happen with earache or a very visual migraine.

Gelsemium

5. Gelsemium can help relieve migraines that start in the back of the head and are accompanied by fatigue.

DHE Treatment for Migraines

DHE stands for dihydroergotamine. It belongs to a class of medications called ergots. Ergots work on migraines by constricting blood vessels. DHE is very effective for treating migraines. However, potentially serious side effects prevent many doctors from using it outside of controlled settings.

Intravenous

1. DHE can be administered by IV in clinics and hospitals. It works rapidly, often reducing or eliminating a headache within one hour. For complex cases, DHE may be administered every six to eight hours.

Injections

2. Doctors can prescribe DHE injections for home use. The standard dose is 1 milliliter per injection. Medical opinions differ on how often DHE injections can be used, so it is best to follow the prescribing doctor's recommendation.

Migranal

3. Migranal is a doctor-prescribed nasal spray version of DHE. One spray of the medication is given in each nostril. After 15 minutes this can be repeated. According to the manufacturer, Migranal should not be used more than twice a week.

Side Effects

4. DHE cannot be used within 24 hours of taking any triptans, which are a class of drugs used to treat migraines. Side effects include changes in heart rate or blood pressure, chest heaviness, nausea, sweating, and numbness or weakness.

Rebound Headaches

5. Rebound headaches occur when someone takes too many triptans or non-steroidal anti-inflammatory drugs in a short period of time. Doctors can use DHE to help break the headache cycle without causing further rebound headaches.

Side Effects of Migraine Medication

If you have migraines, taking medications to reduce the frequency and duration of your symptoms is a necessity in order to go about your normal activities. However, migraine medications may cause significant side effects, some of which may be as disabling as the migraines themselves. According to the Mayo Clinic and Drugs.com, side effects of migraine medications include digestive problems and neurological problems.

Digestive Problems

1. Migraine medications such as triptans and non-steroidal anti-inflammatory drugs (aspirin, ibuprofen) may cause upset stomach, nausea, loss of appetite, vomiting and diarrhea.

Neurological Dysfunction

2. Medications such as triptans and ergots used to treat migraines may cause you to develop neurological dysfunction including dizziness, fainting, vertigo, muscle weakness and confusion, which usually stop after the medication is cleared from your body.

Organ Damage

3. Frequent or long-term use of migraine medications may cause you to develop organ damage in your stomach, liver or intestines, and can lead to organ failure, which is a life threatening condition.

Rebound Headaches

4. Some migraine medications such as butalbitals and opiates may cause you to have rebound headaches, which may occur on their own or as a symptom of withdrawal from the migraine medications.

Sleep Disorders

5. You may experience drowsiness, interrupted sleep or difficulty falling asleep as a result of taking migraine medications such as beta blockers, tricyclic antidepressants and non-steroidal anti-inflammatory preparations that are combined with caffeine.

Cardiac Effects

6. Migraine medications such as triptans may have serious effects on your heart and arteries, such as sudden increases in your blood pressure and an increased chance of having a heart attack or stroke while using the medication.

Symptoms of Complex Migraines

Complex migraines have been known to be mistaken for strokes because they share similar indicators. Stroke symptoms, however, last for about 24 hours, whereas a migraine's duration typically spans 4 to 12 hours.

Cold

1. Your hands or feet can become cold when you have a complex migraine.

Weakness

2. Such migraines drain you of energy and leave you feeling lethargic.

Numbness

3. Your extremities or the side of your face may go numb from the headache.

Blindness

4. Some people are temporarily blinded by complex migraines, or their vision becomes clouded.

Dizziness

5. Feeling lightheaded or dizzy is a common migraine symptom.

Nausea

6. Complex migraines cause nausea or feeling sick to your stomach if you are around strong smells.

Is It a Migraine?

Is It a Migraine?

Unlike less severe types of headaches, migraine pain usually begins on one side of the head and includes extreme sensitivity to light and sound, throbbing pain that worsens with activity, nausea and sometimes vomiting.
Migraines generally fall into two categories: classic and common. Symptoms of "classic" migraine include an "aura" element, which causes the sufferer to see "positive auras," or light around the edges of his field of vision. Alternatively, classic migraine sufferers may experience a "negative aura" effect, characterized by blind spots or tunnel vision. Persons experiencing "common" migraines demonstrate other migraine symptoms without visual aura elements.
Some migraine sufferers report that specific triggers, such as changes in the weather, strong odors, certain foods, changes in sleep patterns or dehydration correlate with the onset of migraine symptoms. For others, the onset of migraine symptoms does not seem to correlate with distinct triggers.

The Prodrome Phase

The first phase of migraine symptoms, known as the "prodrome" phase, is generally marked by a set of vague symptoms that precede the onset of migraine pain by hours or even days. These symptoms may include changes in appetite or food cravings, an increased sensitivity to light and sound, fatigue and mood swings.

The Aura Phase

For those who experience classic migraine, the prodome phase is typically followed by an "aura" phase, during which positive or negative visual auras appear. A sufferer with positive auras may see stars, zigzagging lines or shimmering lights at the edges of her field of vision. Negative auras may present as dark areas or tunnel vision, preventing the sufferer from seeing peripherally. The aura phase may begin 10 to 15 minutes before the onset of migraine pain.

The Migraine Attack Phase

The "migraine attack" phase is marked, most notably, by pain. Common symptoms during the migraine attack phase include continuing visual symptoms, nausea with or without vomiting, throbbing pain on one side of the head, pain that increases with activity, severe light and sound sensitivity, numbness or tingly sensations in the facial area and paleness. A migraine attack may last anywhere from four to 72 hours.

The Postdrome Phase

The final migraine stage, known as the "postdrome" phase, begins when the pain of the migraine subsides or ceases. Sufferers often report symptoms of fatigue and mental dullness during the postdrome phase, which can last from a few hours to several days.

Can Migraines Be Prevented?

Many patients who suffer migraines may obtain relief from or management of symptoms through over-the-counter or prescription medications. Some are able to identify and avoid migraine triggers, thereby preventing the onset of some migraines.
The best course of action for an individual experiencing migraine symptoms is consultation with his or her physician in order to determine which treatment or prevention methods will provide maximum relief.

About the Duration of Migraine Symptoms

up to 17% of women and 6% of men have experienced a migraine. These debilitatingly painful headaches have symptoms that vary from sufferer to sufferer, but many symptoms, and their duration, are common over the four main phases of the migraine.

Alternative medicine

Nontraditional therapies may be helpful if you have chronic headache pain:

• Acupuncture. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points. A number of clinical trials have found that acupuncture may be helpful for headache pain.
• Biofeedback. Biofeedback appears to be especially effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.
• Massage. Massage may help reduce the frequency of migraines. And it can improve the quality of your sleep, which can, in turn, help prevent migraines.
• Herbs, vitamins and minerals. There is some evidence that the herbs feverfew and butterbur may prevent migraines or reduce their severity. A high dose of riboflavin (vitamin B-2) also may prevent migraines by correcting tiny deficiencies in the brain cells. Coenzyme Q10 supplements may be helpful in some individuals. Oral magnesium sulfate supplements may reduce the frequency of headaches in some people, although studies don't all agree on this issue. Magnesium taken intravenously seems to help some people during an acute headache, particularly people with magnesium deficiencies. Ask your doctor if these treatments are right for you. Don't use feverfew or butterbur if you're pregnant.

Prevention

Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you:

• Avoid triggers. If certain foods seem to have triggered your headaches in the past, avoid those foods. If certain scents are a problem, try to avoid them. In general, establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.
• Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches. Obesity is also thought to be a factor in migraines, and regular exercise can help you keep your weight down.
• Reduce the effects of estrogen. If you're a woman with migraines and estrogen seems to trigger or make your headaches worse, you may want to avoid or reduce the amount of medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Talk with your doctor about the best alternatives or dosages for you.

 

Migraines With Neck Pain

Many migraine sufferers report neck pain that seems caused by the excruciating headache or even to be "causing" the headache itself. Stress and tension only aggravate the condition. As the neck becomes increasingly stiff and tight as the result of these episodes, it can trigger continual problems with your range of motion and ability to live a pain-free life. 

The Facts

The National Institute of Neurological Disorders reports that an estimated 45 million Americans suffer from migraine headaches, even if only every few months. The pain from these headaches can not only cause extreme pain, but also be difficult to treat. Research done by David M. Biondi, DO, reports that migraine sufferers commonly have altered neck posture or reduced range of motion, and it is estimated that 64 percent of migraine attacks involve neck pain.

Causes
Headaches with neck pain are sometimes referred to as cervicogenic headaches or muscle contraction headaches. According to research by Dr. Biondi, a cervicogenic headache is characterized by hemicraneal pain and involves the bony structures and soft tissue of the neck. A muscle contraction headache is sometimes less severe, and can be caused by contraction of the neck and head muscles. Stress and tension are both contributors to these types of migraines and neck pain. These headaches may also be brought on by an injury to the head or neck area that was not treated adequately---or at all---with physical therapy. As a result, muscles can become weakened, making them more susceptible to tension and stress. 

Diagnosis

Diagnosis is made by a neurologist, who will ask a series of questions about the types, number and severity of you headaches. When neck pain is reported, diseases such as meningitis need to be ruled out. Laboratory evaluations are necessary to rule out any systemic diseases that may be adversely affecting the muscles and joints. Tests such as a CT (cat scan) or MRI (magnetic resonance imaging) may be used to determine if there may be something more serious involved, such as a brain tumor. Zygapophyseal joint, cervical nerve, or medial branch blockades ---tests done in a clinical setting---are used to confirm the diagnosis of cervicogenic headache, and help the neurologist determine which treatment options are best.

 

Pharmacological Treatment

Many patients use pharmacological treatment to manage these headaches. Muscle relaxants such as cyclobenzaprine may be used to effectively deal with muscle contractions. Medications---including Zomig or Imitrex---are commonly prescribed to treat a migraine once it has begun. Also, other medications may be prescribed as preventives. These medications are taken daily to try to prevent or reduce the number of headaches a patient suffers from. Nortriptyline, Depakote and Propranolol are commonly prescribed to help achieve this preventive action.

 

Physical Treatments

Physical treatment like massage therapy or physical therapy is helpful to some people. Others may choose to see a chiropractor to help loosen muscles and realign the body. In addition, acupuncture and acupressure are alternative treatments that many people use, and some migraine sufferers find these techniques helpful in dealing with migraine pain.

 

Prevention

The National Institute of Neurological Disorders and Stroke reports that regular exercise can reduce the frequency and severity of migraine headaches. Performing exercises that strengthen your neck and shoulder muscles can be especially beneficial. This strengthening can be achieved through such activities as yoga, swimming or weightlifting.

10 Ways To Get Rid Of A Headache

Headaches are common pains that anyone can suffer. They can be caused by many factors such as stress, working for extended hours in front of the computer to injury and migraines which may be triggered by allergies such as food. Whatever the cause may be, the fact remains that having a headache is very uncomfortable and may keep you from performing to your full potentials. One need not suffer so much because of it, especially if the problem is constant and may keep you from being productive. Headaches may come in different forms usually depending on the cause. So most definitely, before you could opt for any ways to get rid of your headache, you must know first what is causing it. The following are simple ways to get rid of headaches:

1. Maintain good posture and do some stretching. Poor posture while working can cause what are known as tension headaches. Staying in such a position for a very long time may cause the muscles of the neck and shoulders to tighten up. One way to get rid of this headache is to maintain a good posture while working. Every now and then or if you feel tension pains setting in, do some stretching to get rid of the headache before it gets worse.

2. Application of moist heat through a hot compress is also a good way to get rid of headaches. Get a towel and soak it in warm water and apply it on areas where you find pain and tension to rid your body of the discomfort.

3. In women, a common problem is headache that comes days before their period. This is usually felt as a pain directly behind the eyes. To get rid of this headache, women must eat foods that are rich in zinc, especially those that come from lean proteins such as lean meats.

4. Relax. The most common cause of headache is stress. Develop a healthy lifestyle which allows you to get enough sleep and rest. If you feel a huge headache coming in because of stress, get rid of this headache by taking a break from work and catching on some sleep.

5. Get a massage. Tension headaches, especially ones that come with pain that radiates through the neck and shoulders are extremely uncomfortable. A way to get of this headache is by getting some massage, especially on the scalp, neck and shoulder areas to release all the tension that have build up there.

6. Eat regularly. Do not skip meals because hunger and meal- skipping can also cause headaches. If you feel a headache about to start and you haven’t had anything to eat, take a break and grab a bite to prevent that headache from progressing further.

7. Drink lots of water. As much as possible, stick to the eight-glasses a day recommended amount of daily water intake. Water cools down the body and so when you feel a major headache, drink up to get rid of it.

8. Ice. Ice is known to be effective in relieving different types of pains, headaches included. So another option to get rid of your headache if to use ice. Lie down and have an ice pack placed on the areas where you feel pain and tension such as behind your neck, temples or forehead.

9. Kill the pain with pain killers. There are many over-the counter analgesics that are known to work for many forms of headaches. However, it is still best to consult a doctor first before choosing a pain reliever to get rid of your headache most especially if the problem persists for a very long time. It is best to work out with your doctor first what is truly causing the pain.

10. Watch what you eat. Some headaches are triggered by food. This is most especially true for migraine sufferers. So if you feel that your headache was prompted by something that you ate, stop eating that food and consult your doctor to determine whether this is truly the source of your headache.

Having a headache is an uncomfortable experience. It keeps you from performing your task and is counter-productive. Headaches have many causes and so to successfully get rid of that headache, it is best to try to figure out first what is causing it in the first place. Lifestyle still plays a major role in determining whether you headache problem is just temporary or will pester you for a very long time.

Migraine Headaches: Ways to Deal With the Pain

What causes migraine headaches?

Migraine headaches seem to be caused in part by changes in the level of a chemical made in the brain called serotonin. Serotonin plays many roles in the body, and it can have an effect on blood vessels. When serotonin levels are high, blood vessels constrict (shrink). When serotonin levels fall, the blood vessels dilate (swell). This swelling can cause pain or other problems.

Many things can affect the level of serotonin in your body, including your level of blood sugar, certain foods and changes in your estrogen level if you're a woman.

  

What does a migraine feel like?

The pain of a migraine headache can be intense. It can get in the way of your daily activities. Migraines aren't the same for all people. Possible symptoms of migraines are listed in the box below.

You may have a "premonition" several hours to a day before your headache starts. Premonitions are feelings you get that can signal a migraine is coming. These feelings can include intense energy, fatigue, food cravings, thirst and mood changes. 

Possible symptoms of migraines

• Intense throbbing or dull aching pain on one side of your head or both sides
• Pain that worsens with physical activity
• Nausea or vomiting
• Changes in how you see, including blurred vision or blind spots
• Being bothered by light, noise or odors
• Feeling tired and/or confused
• Stopped-up nose
• Feeling cold or sweaty
• Stiff or tender neck
• Light-headedness
• Tender scalp

Are there different kinds of migraine headaches?

Yes. The most common are classic migraine and common migraine.

Classic migraines start with a warning sign, called an aura. The aura often involves changes in the way you see. You may see flashing lights and colors. You may temporarily lose some of your vision, such as your side vision.

You may also feel a strange prickly or burning sensation, or have muscle weakness on one side of your body. You may have trouble communicating. You may also feel depressed, irritable and restless.

Auras last about 15 to 30 minutes. Auras may occur before or after your head pain, and sometimes the pain and aura overlap, or the pain never occurs. The head pain of classic migraines may occur on one side of your head or on both sides.

Common migraines don't start with an aura. Common migraines may start more slowly than classic migraines, last longer and interfere more with daily activities. The pain of common migraines may be on only one side of your head.

How long do migraines usually last?

Migraines can last from 4 to 72 hours. They may happen only once or twice a year, or as often as daily. Women are more likely to have migraines than men.

 

What can set off a migraine?

Things that can set off migraines include the following:

• Strong or unusual odors, bright lights or loud noises
• Changes in weather or altitude
• Feeling tired, stressed or depressed
• Changes in sleeping patterns
• Certain foods (see the list below), especially those that contain tyramine, sodium nitrate or phenylalanine
• Missing meals or fasting
• Menstrual periods, birth control pills or hormonal changes (in women)
• Intense physical activity, including sexual activity
• Smoking
• Fumes

Foods that may trigger migraines:

• Aged, canned, cured or processed meat, including bologna, game, ham, herring, hot dogs, pepperoni and sausage
• Aged cheese
• Alcoholic beverages, especially red wine
• Aspartame
• Avocados
• Beans, including pole, broad, lima, Italian, navy, pinto and garbanzo
• Brewer's yeast, including fresh yeast coffee cake, donuts and sourdough bread
• Caffeine (in excess)
• Canned soup or bouillon cubes
• Chocolate, cocoa and carob
• Cultured dairy products, such as buttermilk and sour cream
• Figs
• Lentils
• Meat tenderizer
• Monosodium glutamate (MSG)
• Nuts and peanut butter
• Onions, except small amounts for flavoring
• Papaya
• Passion fruit
• Pea pods
• Pickled, preserved or marinated foods, such as olives and pickles, and some snack foods
• Raisins
• Red plums
• Sauerkraut
• Seasoned salt
• Snow peas
• Soy sauce

How are migraines treated?

There are 2 types of medicines for migraine treatments. One type focuses on relieving the headache pain. This type of treatment should be started as soon as you think you're getting a migraine. The other type includes medicines that are used to prevent headaches before they occur.

Can nonprescription medicines help relieve the pain?

Yes. Nonprescription medicines that can help relieve migraine pain include aspirin; acetaminophen (one brand name: Tylenol); an acetaminophen, aspirin and caffeine combination (one brand name: Excedrin Migraine); ibuprofen (one brand name: Motrin); naproxen (brand name: Aleve); and ketoprofen (brand name: Orudis KT).

What about prescription medicines?

People who have more severe pain may need prescription medicine. A medicine called ergotamine can be effective alone or combined with other medicines. Dihydroergotamine is related to ergotamine and can be helpful.

Other prescription medicines for migraines include sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan and frovatriptan.

If the pain won't go away, stronger medicine may be needed, such as a narcotic, or medicines that contain a barbiturate. These medicines can be habit-forming and should be used cautiously.

Can medicine help prevent migraines?

Yes. Medicine to prevent migraines may be helpful if your headaches happen more than twice a month or if your headaches make it hard for you to work and function. Examples of medicines used to prevent migraines include propranolol, timolol, divalproex and some antidepressants.

Talk to your doctor about which medicine is best for you. Nonprescription and prescription medicines that are used often or in large doses may cause other problems.

What else can I do to prevent migraines?

Try to avoid foods or other things that seem to cause migraines for you. Keep a journal to help you identify triggers. Get plenty of sleep and drink plenty of fluids. Try to relax and reduce the stress in your life. Also try to get regular exercise. Aerobic exercise can help reduce tension as well as keep your weight in check. Obesity can contribute to migraines.

The Doctor Says Get a CT Scan. Should You?

A new report in tomorrow's issue of the New England Journal of Medicine raises serious concerns about the use, and overuse, of CT scanning. While individual risks of developing cancer from a CT scan, which emits high doses of radiation, are relatively low, the researchers worry that their rapid growth as a highly accurate diagnostic tool is exposing too much of the population—and an increasing amount of vulnerable children—to radiation and might be setting the stage for higher incidence of cancer in years to come. Around 62 million scans are performed per year, compared with only 3 million in 1980. Moreover, the researchers estimate that a third of those CT scans are entirely unnecessary—many of them now performed by cautious doctors on worried people with no symptoms at all.

How can you know if a CT scan is a wise move? U.S.News & World Report spoke with Fred Mettler, chief of radiology and nuclear medicine at New Mexico Veterans Health Care System and an expert on the effects of radiation, to find out.

How is a CT scan different from a traditional X-ray?

With a traditional X-ray—a chest X-ray, for example—radiation goes through you from one side to the other, with 3-D information ultimately projected onto a two-dimensional picture. With a CT scan, an X-ray tube rotates around the patient and presents the results to you as a three-dimensional picture. The advantage is that it's much more sensitive, is high resolution, and offers much more anatomically specific information with great detail.

But a typical chest CT means around a 175-times-greater dose of radiation than a similar chest X-ray—that's like 20 sets of mammograms. That range can be between 20 and 200 times higher depending on which part of the body is being scanned.

When is a CT scan definitely warranted?

If you think something is desperately wrong with you and you require an immediate answer. For example, an incredible abdominal pain or a severe acute headache as opposed to a migraine you have had off and on for years. If the CT scan is medically needed, don't think about radiation. If you have excruciating head or abdominal pain, radiation exposure should not be high on the list of concerns.

But there's no question that it's overused—and I don't think I can quarrel with the number of 30 percent.

How should judgment factor in?

One common problem for adults is renal stones. They have them all the time on and off, typically with horrible pain. It used to be that we gave them water and pain medication and told them to wait for the pain to pass. Now, all urologists want a CT scan done. I've seen people in their early 30s who have had 18 or 20 CT scans. They come in once a month, but there's no evidence in the literature that this sort of thing is justified.

Another good example is if you have significant abdominal pain and go to the emergency room. The physician in the ER is buried with a "bazillion" patients. He can poke on your abdomen and see where the pain is emanating from, thinking it's appendicitis. Then he'll get some blood tests and if you have a high count will call a surgeon. Before the use of CT, around 20 percent of the time you got operated on and had a normal appendix.

Nowadays, doctors will immediately get a CT scan, and because it's so sensitive and accurate for diagnosing appendicitis, less than 1 or 2 percent end up taking out normal appendixes. An additional advantage is that CT allows the doctor to see the entire abdomen and pelvis, the aorta, kidneys, and gallbladder. If your doctor wasn't in fact right about the appendicitis, the CT scan will pick up a lot of other things that might be giving you your pain. It's incredibly efficient and, of course, doctors can move you through ER much more quickly.

Is using a CT to determine appendicitis generally justified? Well, if the patient has severe pain in the right lower quadrant, then probably yes. On the other hand, is it justified for a little kid who is crying and doesn't know what's going on? In that case, probably not.

What are the risks involved in CT scanning?

Certainly a CT scan won't make your hair fall out or anything so drastic. But the risk of cancer is there, and it depends on a few things. There's the dose of the radiation, which depends substantially on the age of the patient. We know that kids are more sensitive and their risk of getting cancer is higher [when they are given] an adult dose. But these cancers tend not to occur for years or decades at least. For children, the risk of developing a fatal cancer is somewhere around 1 in 500 or 1 in 1,000—the older you get, the lower the risk becomes. So if someone is 90, for instance, there is virtually no cancer risk. For an adult, the risk is around 1 in 2,000.

At this point, people believe there is [a] linear relationship between the dose and the risk of cancer. So if you cut the dose in half, you also cut the risk in half. The question should be, can you optimize the dose by using a lower amount of radiation or can the scan be done only once instead of three times? For kids especially, doctors should really optimize with the lowest dose possible if a CT scan is warranted.

Is that happening?

I would say that five or so years ago, there's no question they were actually getting adult doses. But after Dave Brenner [of Columbia] started hopping up and down about this problem and it was picked up in the media, pediatricians got very sensitive and manufacturers began putting pediatric dose settings on the CT machines. But, I don't think the sensitivity is there for teenagers or young adults.

What are some alternatives to CT scanning that patients should know about or ask their doctors?

I would ask if there are ways we can find out the answer without using radiation. Using ultrasound, for example, or doing an MRI scan. Those don't use ionizing radiation, so there is virtually no risk. And if the scan is definitely going to be done, ask about the dose you will be getting. If a child is getting a scan, a concerned parent should make sure the radiology technician is using the correct pediatric doses.

How do you prevent redundant CT scans and help patients to keep track of the scans they've already had?

When our patients go to another hospital or doctor, we give them a CD of all their exams on it, and anyone can open them up, throw it on a PC, and have a look at the pics. That's very helpful.

Are CT scans useful for asymptomatic patients?

I don't recommend CT scans for asymptomatic patients. Take lung cancer screening for example. One article in the New England Journal of Medicine from last year concluded that CT scanning could prevent 80 percent of lung cancer deaths by catching lung nodules. Then in a 2007 Journal of the American Medical Association study, there was found to be no reduction in mortality by using CT scans for lung cancer. We shouldn't do something with risk until studies determine what the risks and benefits actually are. A lot of scans are not justified, like the business of whole-body CT screening. No one has ever shown that these have more benefit than risk.

Maca Gives Potential Relief for Migraine Sufferers

People who suffer from the debilitating pain of migraine headaches need relief. Could the solution be found in a radish-like root vegetable that grows in an extreme climate where few other plants can survive? Might something the Incas consumed regularly 2,000 years ago be a modern day panacea for migraine sufferers?

Migraines Defined

The word migraine derives from the Greek word hemikrania meaning "half a skull". The disorder was so named because migraines are typically unilateral (affecting one half of the head). Migraines are severe, vascular headaches often accompanied by symptoms such as persistent pain in the temple or behind the ear, nausea, vomiting, and sensitivity to sounds and light. Some migraines are preceded by an aura, which is a type of unusual visual or auditory sensory experience. For some, a migraine will last only a couple of hours. For others, the intense pain and discomfort can last up to 72 hours.

Triggers & Causes

Some of the usual suspects such as stress, lack of exercise, allergies, irregular sleep patterns, caffeine, nicotine, and alcohol (particularly red wine) are implicated as possible causes of migraines headaches. Migraines involve excessive dilation or contraction of the brain's blood vessels. Nicotine is known to constrict blood vessels and red wine can contain sulfites which will cause a reaction in some people. Other potential stressors on blood vessels can be elevated estrogen levels or progesterone levels that are too low.

The Hormonal Connection

Modern-day exposure to chemicals and pollution, along with the standard American diet and its accompanying toxic load, can wreak havoc on the endocrine system, leaving individuals with wild fluctuations and deficiencies in hormone levels. It is interesting to note that women are three times more likely to suffer from migraines than men. Low progesterone levels are often the reason for these terrible headaches in women over the age of 35. Also, when excessive estrogenic burdens (xenoestrogens from plastics, for example) are placed on the body, the endocrine system's homeostasis can be disrupted. This may indicate a relationship between migraines and fluctuating hormone levels.

Maca's Role

Maca is a superfood that grows at 14,000 feet elevation in the Andes Mountains of Peru. It is both adaptogenic and restorative in that it helps the body to adapt to stress and can help to recalibrate the body's hormones. Maca has an incredible nutritional profile of potent phytonutrients that include vitamins, minerals, amino acids, fiber, and fatty acids. This amazing plant can nutritionally fuel the endocrine system so that it is able to produce hormones regularly. Maca does not actually increase levels of any hormones but encourages the body to produce them on its own. This is accomplished through maca's targeted nourishment of the hypothalamus and pituitary glands (master glands of the body). These glands in turn regulate other glands, bringing balance to the adrenal, thyroid, pancreas, ovarian, and testicular glands. This can move the body toward a more optimal balance of estrogen and progesterone levels potentially reducing the severity and occurrence of migraine headaches.

Lavender Alleviates Symptoms of Migraine Headaches

Gentle and soothing, the common herb lavender has strong analgesic effects useful for treatment of migraines and migraine-related depression. Migraine headaches are a neurological condition accompanied by debilitating and excruciating pain. Migraine sufferers often experience "missing time" for hours or days, are unable to function at full capacity and experience blinding pain from which there is little relief. Migraine headache symptoms such as fogginess, cognitive loss, confusion and visual symptoms often linger long after the headache has resolved. Strong, pain killers may be prescribed as migraine cures, including narcotics, which leave the person groggy and befuddled.

Although the National Center for Complementary and Alternative Medicine asserts there has been no scientific evidence attesting to the efficacy of lavender for symptoms of migraine headaches, anecdotal evidence from alternative healthcare practitioners and patients points to its efficacy as a pain reliever, something herbalists have know for centuries. Lavender relieves the pain of migraine headaches and prevents the onset of a new headache.

Inflammation and Anti-spasmodic Effects of Lavender for Symptoms of Migraine Headaches

The scent of lavender is soothing and reduces migraine-related inflammation in the blood vessels according to the University of Maryland Medical Center (UMMC). Lavender flowers contain compounds that have medicinal properties, and their aroma gently sedates migraine headache symptoms. Additionally, they act as an anti-spasmodic on inflamed blood vessels and small muscles of the scalp, neck and around eyes helping them to relax according to Phyllis A. Balch in her book, "Prescription for Nutritional Healing."

Migraine Headache Relief for Depression, Anxiety and Stress

Conditions such as anxiety and stress are two of the many migraine causes reported by patients. Lavender's effects for relieving symptoms of depression and soothing anxiety are well known to herbalists, and its aroma is stimulating to the senses increasing cognitive powers, explains Balch. The University of Maryland Medical Center (UMMC) discusses lavender's ability to help reduce stress, lower anxiety levels and improve the mood of headache patients on exposure to its scent. The soothing medicinal features of this aromatic blue herb are of great benefit in relieving migraine headache symptoms in sufferers for whom depression or anxiety is a concomitant during a headache.

Lavender Relieves Migraine Headache Symptoms of Insomnia and Exhaustion

Lavender helps induce relaxation and sleep in people who suffer from insomnia as well as for those suffering from migraine headache pain, explains UMMC. There is now scientific evidence that suggests that aromatherapy using lavender helps soothe the activity of the nervous system by promoting relaxation and helping people feel more positive. Aromatherapists use lavender as a tonic with inhalation therapy to stimulate the senses and reduce exhaustion, which may be what causes migraines in some patients. Exhaustion and weakness may accompany the migraine headache and lavender's effects work to rejuvenate patients who have to deal with chronic pain and little sleep for days at a time.

Nausea Relief in Migraine Cures from Lavender

Nausea is present in the majority of people who complain of migraine headaches due to inflammation of the Vegas nerve. Lavender flowers are approved for use as a medicinal tea in Germany to relieve migraine headache symptoms and nausea, reports UMMC. The tea can also be used for restlessness, insomnia and nervous stomach irritations accompanying migraine headaches. Steep a teaspoon of dried lavender flowers in a tea ball inserted into a cup of hot water and make a delicious tea. Add a touch of raw honey to sweeten.

Nothing can stop a person in their tracks faster than a migraine headache, and knowing how to treat migraines and depression before the symptoms become overbearing is very self-empowering. Grow a lavender plant in the kitchen window and dry the flowers for fresh, natural and effective migraine cures.

Little-known Herb Butterbur Cures Symptoms of Migraine Headaches

New research into the causes of migraine headaches reveals that a little-known herb called butterbur offers tremendous promise for migraine headache relief. Clinical trials also indicate that butterbur, discovered originally in Germany, can prevent the recurrence of devastating migraine headache pain.

Butterbur's Two-pronged Action for Migraine Headache Relief

Butterbur acts on migraine headaches in two ways. It removes painful migraine headache symptoms by lowering the inflammatory effect of chemicals like leukotrienes and prostaglandin E2. The second active benefit found in butterbur is its ability to function as a natural beta blocker whose action results in the normal flow of blood to the brain. This helps control blood pressure and spasmodic capillary action, which can also contribute to the onset of migraine headaches.

Wondering how well butterbur works? In a study of 245 people conducted by the Department of Neurology at Albert Einstein College of Medicine, 68% of participants saw the incidence of migraine headache symptoms reduced by at least 50%. This is a huge breakthrough for people suffering from migraine headaches and the results are better than those of many dangerous over-the-counter and prescription medicines.

The May 2000 issue of the journal, "Headache", states that butterbur is gaining recognition in the US as an effective alternative migraine headache treatment. Additionally, the report confirms its ability to reduce active migraine headache symptoms and prevent future migraine headache attacks. The best part is people taking butterbur reported no significant side effects and only infrequent, mild stomach upset.

Buy Specially Processed Butterbur at Health Food Stores and Online Herbal Pharmacies

When buying butterbur as a migraine cure, be sure to choose a brand labeled PA-Free. This means the product was processed to remove potentially harmful, toxic chemicals found in the butterbur plant. The special butterbur extract is prepared by having all liver-toxic alkaloids removed. Purchase butterbur at most health food stores and online herbal pharmacies.

Clinical Guidelines for the Use of Butterbur for Migraine Headache Relief

Double-check with a healthcare practitioner before using butterbur as a migraine cure. Clinical guidelines for using butterbur for migraine prevention include documenting the frequency of migraine attacks, determining the recurrence of migraine headache symptoms and whether they interfere substantially with daily routines, and charting the patient's use of conventional medications and how well they are tolerated.

The recommended adult dosage is 50-100 mg twice daily to reduce migraine headache symptoms and to prevent future migraine headaches. Take butterbur for an adequate amount of time to observe its efficacy. A three month trial is suggested for this assessment.

If conventional medicines or other herbs are taken for migraine headache treatment, consult a doctor for a timetable to wean the individual off those other preparations to avoid interactions between medicines. Avoid using butterbur if the person is allergic to ragweed, daisies, chrysanthemums or marigolds.

The use of butterbur as a migraine cure and to prevent future attacks of migraine headaches is on the cutting edge of alternative treatment for this debilitating condition. Speak to a holistic doctor to find out how butterbur may be integrated into an individualized treatment plan for migraine headache relief.

Food Culprits Trigger Migraine Headaches and Depression

Migraine headache causes include one or more triggers such as sensitivity to external stimuli, hormone imbalances, stress and a group of offending foods and additives. Prevent migraine headaches caused by food by eliminating those foods that trigger pain. Discover which foods and food additives are responsible for triggering migraine headaches and accompanying migraine-related depression.

Although it may be discouraging at first to eliminate certain favorites, the good news is culprits found in processed foods aggravate migraine headaches and are easy to recognize and avoid. The rest of the good news is migraine sufferers respond well to replacing processed food with whole foods that support their overall well being while reducing or eliminating migraine headache pain.

Processed foods containing food additives such as MSG are some of the worst offenders on the list of migraine headache causes. Other problematic substances are artificial sweeteners, chemicals such as nitrates and nitrites, flavor enhancers, foods containing tyramine, chocolate, alcohol and caffeine.

Common Foods and Food Additives Causing Migraine Headache Symptoms

Research identifies the following food groups as common migraine triggers. Some are obvious and others may be surprising. Eliminating certain foods at least for a short time is the best way to find out which of them may be causing migraine headaches and depression for each individual.

Aged cheeses
Smoked, cured and processed meats
Peanuts and peanut products
Legumes including soy
Alcohol, especially red wine and beer
Caffeine found in coffee, tea, sodas
Refined sugars and white flour products (Gluten allergies may cause migraine headaches)
Monosodium Glutamate (MSG) and chemical additives
Artificial Sweeteners

Chemicals and Food Additives Cause Migraine Headaches and Depression

There is plenty of evidence pointing to food-additives as the source of multiple health problems including migraine headaches and depression. Most symptoms are common and easy to recognize appearing within 25 minutes after eating foods containing additives.

Headache
Dizziness
Flushing of face and neck
Pressure and tightness in chest and face
Disorientation
Tingling and numbness
Burning pains
Depression
Weakness

Check packaged foods for MSG. MSG is a flavor enhancer and preservative used in most packaged and processed foods. It is a major perpetrator of migraine headaches.

Natural Products Replace Offending Additives for Migraine Cures

Avoid products containing artificial sweeteners, saccharine and aspartame. Use stevia, a no-calorie, natural sweetener, to sweeten foods and eliminate migraine headache symptoms. Include lots of fresh fruits, vegetables, meat, poultry, and whole grains.

Depression and Migraine Headache Symptoms are the Result of Tyramine

Aged cheeses contain high amounts of tyramine, a substance formed during protein breakdown. Studies report tyramine as the cause of migraine headaches for some. The older the cheese, the higher the tyramine content. People taking MAO inhibitors for migraines should avoid all foods containing tyramine. Tyramine also contributes to high blood pressure.

Foods containing tyramine are all aged cheeses including blue cheeses, Brie, Muenster, Cheddar, Parmesan, Mozzarella, Swiss, and Feta. Other foods containing tyramine are red wine, alcoholic drinks, aged, canned or cured meats, onions, pickles, garbanzo and lima beans, raisins and avocados.

Find Migraine Headache Relief by Avoiding Cold Foods

Some migraine sufferers report that cold foods cause migraine headaches. Consume foods and drinks at room temperature to prevent migraine headaches. Cold foods and drinks will aggravate a migraine condition if a person is overheated before eating. More than 90% of headache sufferers claim that icy cold foods are a problem.

Decrease offending foods slowly to avoid rebound reactions creating additional migraine headache symptoms.

Migraines, why do doctors get them more than other people? The answer may be simple

Ask a bunch of neurologists how many of them had a migraine over the last twelve months and over half of them will put their hands up. If you ask family physicians the same question you will find that about 32% of them had a migraine (or more than one) over the last twelve months. The figure for the general population is about 12%.

Why do health professionals say they have more migraines than the general population? Is there something about their jobs that gives them splitting headaches? Apparently, the reason is more straightforward. Health professionals are able to self-diagnose more quickly and do something about it.

If this is true, wouldn't it also be true that perhaps 50% of the general population gets migraines, it is just that many people do not know it when they have one. Experts throughout the world are beginning to wonder whether migraines are much more common that previously thought.

So, maybe we should learn to diagnose ourselves better. How do we know whether it is a migraine or just a tension headache or something else?

WHAT IS A MIGRAINE HEADACHE?

A migraine is a very bad headache that tends to recur. With a migraine, you may feel nauseated and might vomit. The pain is usually on one side of your head and you may be very sensitive to bright lights and noises. Moving around can make the headache feel worse. There are many forms of migraine headaches. Classic and common are the two major varieties.

SYMPTOMS OF A MIGRAINE

The basic difference between the two types of migraine is the appearance of an "aura." The aura is the occurrence of neurological symptoms 10-30 minutes before the classic migraine attack. You may see flashing lights, zigzag lines or may temporarily lose vision. Other symptoms of classic migraine include speech difficulty, confusion, weakness of an arm or leg and tingling of face or hands.

The pain of a classic migraine headache is described as an intense throbbing or pounding felt in the forehead/temple, ear/jaw or around the eyes. Classic migraine starts on one side of the head but may eventually spread to the other side. An attack may last one to two pain-racked days.

The common migraine - a term that reflects the disorder's more frequent occurrence in the general population - is not preceded by an aura. Some people do experience a variety of vague symptoms before common migraines - mental fuzziness, mood changes, fatigue, and unusual retention of fluid. During the headache phase of a common migraine, you may have abdominal pain and diarrhea, increased urination, nausea and vomiting. Both classic and common migraines can strike as often as several times a week or rarely as once every few years.

WHAT CAUSES MIGRAINE?

Doctors think migraines may be caused by a chemical or electrical problem in certain parts of the brain. A key element of a migraine headache is blood flow change in the brain. According to theory, the nervous system responds to a trigger such as stress by creating spasms in the nerve-rich arteries at the base of the brain.

The spasms constrict several arteries supplying blood to the brain, including arteries from the scalp and neck. As these arteries constrict, the flow of blood to the brain is reduced. At the same time, platelets clump together and release a chemical called serotonin.

Serotonin acts as a powerful constrictor of arteries further reducing blood and oxygen supply to the brain. In reaction to the reduced oxygen supply, certain arteries within the brain dilate to meet the brain's energy needs. This dilation spreads, finally affecting neck and scalp arteries. Doctors believe this dilation causes the pain of migraine.

what doctor says about migraine?

Migraine is hereditary say doctors

Over the years migraine sufferers have often suspected the debilitating condition runs in the family.
Now scientists say they have found the first hard evidence that the blinding headaches which can cause disturbed vision and nausea are indeed hereditary.
Researchers claim to be close to identifying a specific gene predisposing people to the disorder.
Children whose mothers suffered from headaches had double the risk of migraines when they grew up.
Dr Aarno Palotie, a geneticist at the University of California, in Los Angeles, said: 'For the first time we have proof of an isolated genetic link to migraine.'
He and his researchers focused on classical migraine - or migraine with aura - when the headache is preceded by visual disturbances, including flashing lights, shimmering lines and blind spots.
The visual disturbance usually disappears after about 30 minutes and is followed by a piercing headache, and a sensitivity to light.
Dr Palotie's team analysed genetic markers in blood samples from 50 families with three or more members from different generations who had the disorder.
In a third of the 430 people studied, researchers discovered three common markers on a crucial section of 'chromosome four' - there are 23 pairs of chromosomes in every cell in our bodies made up of DNA.
Dr Palotie, whose breakthrough is reported in the American Journal of Human Genetics, explained: 'This finding moves us a step closer to isolating the gene that predisposes people to migraines with auras.' Now that they had 'narrowed the hunting ground' they could concentrate on identifying the gene.
'The findings also pave the way for clinical trials of more effective prophylactic drugs,' added Dr Palotie.
The discovery may help doctors treat the six million British sufferers. Migraines affect almost 20 per cent of women and 6 per cent of men.
Dr Anne Turner, of the charity Migraine Action Association, said: 'It has long been suspected that there is a genetic component to migraine, because people say it does tend to run in families.'
She added that a gene had also recently been identified for a rare form of the condition called familial hemoplegic migraine.
Though this affected only a handful of people, it had already led to more effective drug treatments.
'The hope is that discoveries about the genetics of other forms of migraine will do the same,' said Dr Turner.

What is a migraine headache?

A migraine headache is a form of vascular headache. Migraine headache is caused by vasodilatation (enlargement of blood vessels) that causes the release of chemicals from nerve fibers that coil around the large arteries of the brain. Enlargement of these blood vessels stretches the nerves that coil around them and causes the nerves to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the arteries 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, and this activation causes many of the symptoms associated with migraine attacks; for example, 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 underdiagnosed and undertreated. Less than half of individuals with migraine are diagnosed by their doctors.

What are the symptoms of migraine headaches?

Migraine is a chronic condition with recurrent attacks. Most (but not all) migraine attacks are associated with headaches.

• Migraine headaches usually are described as an intense, throbbing or pounding pain that involves one temple. (Sometimes the pain is located in the forehead, around the eye, or at the back of the head).
• The pain usually is unilateral (on one side of the head), although about a third of the time the pain is bilateral (on both sides of the head).
• The unilateral headaches typically change sides from one attack to the next. (In fact, unilateral headaches that always occur on the same side should alert the doctor to consider a secondary headache, for example, one caused by a brain tumor).
• A migraine headache usually is aggravated by daily activities such as walking upstairs.
• Nausea, vomiting, diarrhea, facial pallor, cold hands, cold feet, and sensitivity to light and sound commonly accompany migraine headaches. As a result of this sensitivity to light and sound, migraine sufferers usually prefer to lie in a quiet, dark room during an attack. A typical attack lasts between 4 and 72 hours.

An estimated 40%-60% of migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days. The symptoms may include:

• sleepiness,
• irritability,
• fatigue,
• depression or euphoria,
• yawning, and
• cravings for sweet or salty foods.

Patients and their family members usually know that when they observe these warning symptoms that a migraine attack is beginning.

Migraine aura

An estimated 20% of migraine headaches are associated with an aura. Usually, the aura precedes the headache, although occasionally it may occur simultaneously with the headache. The most common auras are:

1. flashing, brightly colored lights in a zigzag pattern (referred to as fortification spectra), usually starting in the middle of the visual field and progressing outward; and
2. a hole (scotoma) in the visual field, also known as a blind spot.

Some elderly migraine sufferers may experience only the visual aura without the headache. A less common aura consists of pins-and-needles sensations in the hand and the arm on one side of the body or pins-and-needles sensations around the mouth and the nose on the same side. Other auras include auditory (hearing) hallucinations and abnormal tastes and smells.

For approximately 24 hours after a migraine attack, the migraine sufferer may feel drained of energy and may experience a low-grade headache along with sensitivity to light and sound. Unfortunately, some sufferers may have recurrences of the headache during this period.

What are some variants of migraine headaches?

Complicated migraines are migraines that are accompanied by neurological dysfunction. The part of the body that is affected by the dysfunction is determined by the part of the brain that is responsible for the headache.

Vertebrobasilar migraines are characterized by dysfunction of the brainstem (the lower part of the brain that is responsible for automatic activities like consciousness and balance).

The symptoms of vertebrobasilar migraines include:

• fainting as an aura,
• vertigo (dizziness in which the environment seems to be spinning), and
• double vision.

Hemiplegic migraines are characterized by:

• paralysis or weakness of one side of the body,
• mimicking a stroke.

The paralysis or weakness is usually temporary, but sometimes it can last for days.

Retinal, or ocular, migraines are rare attacks characterized by repeated instances of scotomata (blind spots) or blindness on one side, lasting less than an hour, that can be associated with

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.

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How are migraine headaches treated?

Treatment includes therapies that may or may not involve medications.

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 in stopping an attack once it has started.
• Sleep may be the best medicine if it is possible.

Preventing migraine takes motivation for the patient to make some life changes. Patients are educated as to triggering factors that can be avoided. These triggers include:

• smoking, and
• avoiding certain foods especially those high in tyramine such as sharp cheeses or those containing sulphites (wines) or nitrates (nuts, pressed meats).

Generally, leading a healthy life-style with good nutrition, an adequate intake of fluids, sufficient sleep and exercise may be useful. Acupuncture has been suggested to be a useful therapy.

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 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).

Acetaminophen

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 package label.

NSAIDS

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 causes the pain (they are called nonsteroidal antiinflammatory 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. Their full effects also require hours or days. NSAIDs do not have the same side effects that corticosteroids 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, i.e. 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:

• 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.

• People with balance disorders or hearing difficulties should avoid using aspirin because aspirin may aggravate these conditions.

• People 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.

• People 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.

• People 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 failure of the kidneys.

• OTC or prescription analgesics should not be overused. 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.

What is the treatment for moderate to severe migraine headaches?

Migraine-specific abortive medications usually are necessary for moderate to severe migraine headaches. The abortive medications for moderate or severe migraine headaches are different than OTC analgesics. Instead of relieving pain, they abort headaches by counteracting the cause of the headache, dilation of the temporal arteries. In fact, they cause narrowing of the arteries. Examples of migraine-specific abortive medications are the triptans and ergot preparations.

Triptans

The triptans attach to serotonin receptors on the blood vessels and nerves that surround them, constrict the blood vessels, and reduce the inflammation. This stops the headache. The triptan with the longest history of use is sumatriptan (Imitrex). Sumatriptan is available in the US as an injection, oral tablet, and nasal inhaler. Zolmitriptan (Zomig) and rizatriptan (Maxalt) are newer triptans that are available as oral tablets and as tablets that melt in the mouth. Naratriptan (Amerge), almotriptan (Axert) and frovatriptan (Frovalan) are available only as oral tablets.

Traditionally, triptans were prescribed for moderate or severe migraines after OTC analgesics and other simple measures failed. Newer studies suggest that triptans can be used as the first treatment for patients with migraines that are causing disability. (Significant disability is defined as more than 10 days of at least 50% disability during a three-month period.). Triptans should be used early after the migraine begins, before the onset of pain or when the pain is mild. Using a triptan early in an attack increases its effectiveness, reduces side effects, and decreases the chance of recurrence of another headache during the following 24 hours. Used early, triptans can be expected to abort more than 80% of migraine headaches within two hours.

The U.S. Food and Drug Administration (FDA) has issued a warning about taking triptans together with medications of the SSRI (selective serotonin reuptake inhibitor) or SNRI (selective serotonin/norepinephrine reuptake inhibitor) classes. Taking these medicines together can cause a serious condition called serotonin syndrome.

Side effects of triptans

The most common side effects of triptans are facial flushing, tingling of the skin, and a sense of tightness around the chest and throat. Other less common side effects include drowsiness, fatigue, and dizziness. These side effects are short-lived and are not considered serious.

The most serious side effects of triptans are heart attacks and strokes. Triptans are effective in migraine headaches because they narrow arteries in the head; however, they also can narrow arteries in the heart. In individuals without existing carotid or coronary artery disease, the narrowing caused by triptans usually does not cause problems. However, persons whose carotid and coronary arteries are narrowed by atherosclerosis or who suffer from intermittent spasm of the coronary arteries (a condition called Prinzmetal's or variant angina), the narrowing caused by triptans can further reduce the flow of blood through the arteries and have been reported to cause heart attacks and strokes. Therefore, triptans should not be used by those who have had heart attacks and strokes, or those who have symptoms of atherosclerosis such as angina, transient ischemic attack (TIAs), and intermittent claudication.

Healthy adults may have atherosclerosis and narrowing of the coronary arteries that are "silent", that is, without past strokes, transient ischemic attacks, heart attacks, or angina. Therefore, before prescribing a triptan, a doctor should evaluate patients for possible atherosclerosis if they have one or more risk factors for developing atherosclerosis. These risk factors include cigarette smoking, diabetes mellitus, high blood pressure, high levels of LDL ("bad") cholesterol in the blood, obesity, male and over 40 years of age, female and postmenopausal, or a family member(s) who has had heart attacks at an early age. Some patients who are at risk should receive their first dose of a triptan in the doctor's office while being monitored with an electrocardiogram (EKG).

Triptans can interact with other drugs. For example, there have been rare reports of triptans causing a "serotonin syndrome" when given together with a selective serotonin reuptake inhibitor. Selective serotonin reuptake inhibitors (SSRIs) are a class of medications widely used to treat depression. The symptoms of serotonin syndrome include confusion, fever, tremor, high blood pressure, diarrhea, and sweating. Certain triptans such as sumatriptan, zolmitriptan, and rizatriptan can interact with monoamine oxidase inhibitors. Propranolol (Inderal) can raise rizatriptan blood levels. Cimetidine (Tagamet) can increase zolmitriptan blood levels.

Triptans should not be used in pregnant women and are not generally used in young children.

Ergots

Ergots, like triptans, are medications that abort migraine headaches. These may be combined with caffeine and/or other pain relief medications in combination products. Examples of ergots include ergotamine preparations (Ergomar, Wigraine, and Cafergot) and dihydroergotamine preparations (Migranal, DHE-45). Ergots, like triptans, cause constriction of blood vessels, but ergots tend to cause more constriction of vessels in the heart and other parts of the body than the triptans, and their effects on the heart are more prolonged than those of the triptans. Therefore, they are not as safe as the triptans. The ergots also are more prone to cause nausea and vomiting than the triptans. The ergots can cause prolonged contraction of the uterus and miscarriages in pregnant women.

Midrin

Midrin is used to abort migraine and tension headaches. It is a combination of isometheptene (a blood vessel constrictor), acetaminophen (a pain reliever), and dichloralphenazone (a mild sedative). It is most effective if used early during a headache; however, because of its potent blood vessel constricting effect, it should not be used in persons with high blood pressure, kidney disease, glaucoma, atherosclerosis, liver disease, or taking monoamine oxidase inhibitors.

What other medications are used for treating migraine headaches?

Narcotics and butalbital-containing medications sometimes are used to treat migraine headaches; however, these medications are potentially addicting and are not used as initial treatment. They are sometimes used for individuals whose headaches fail to respond to OTC medications but who are not candidates for triptans either due to pregnancy or the risk of heart attack and stroke.

In migraine sufferers with severe nausea, a combination of a triptan and an antinausea medication, for example, prochlorperazine (Compazine) or metoclopramide (Reglan) may be used. When nausea is severe enough that oral medications are impractical, intravenous medications such as DHE-45 (dihydroergotamine), prochlorperazine (Compazine), and valproate (Depacon) are useful.

How are migraine headaches prevented?

There are two ways to prevent migraine headaches: 1) by avoiding factors ("triggers") that cause the headaches, and 2) by preventing headaches with medications (prophylactic medications). Neither of these preventive strategies is 100% effective. The best one can hope for is to reduce the frequency of headaches.