Migraine Headache - Causes, Symptoms And Treatment

The most common patient complaint, headache usually occurs as a symptom of an underlying disorder. Ninety percent of all headaches are vascular result from muscle contraction or a combination; 10% are due to underlying intracranial, systemic or psychological disorders. Migraine headaches, probably the most intensely studied are throbbing, vascular headaches that usually begin to appear in childhood or adolescence and recur throughout adulthood. Affecting up to 10% of the United States population, they're more common in females and have a strong familial incidence.

Migraine headaches seem to be caused in part by changes in the level of a body chemical called serotonin. Serotonin plays many roles in the body, and it can have an effect on the 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 causes Migraine Headache?

Headaches are believed to be associated with constriction and dilation of intracranial and extracranial arteries. During a migraine attack, certain biochemical abnormalities are thought to occur. These abnormalities include local leakage of a vasodilat of Polypeptide called neurokinin through the dilated arteries and a decrease in the plasma level of serotonin.

Most chronic headaches result from tension (muscle contraction). which may be caused by:

• emotional stress or fatigue
• menstruation
• environmental stimuli (noise, crowds, or bright lights)
• vitamin A intake.

Other possible causes include:

• glaucoma
• inflammation of the eyes or mucosa of the nasal or paranasal sinuses
• diseases of the scalp, teeth, extracranial arteries, external or middle ear or throat
• vasodilators (nitrates, alcohol and histamines)
• systemic disease
• hypertension
• increased intracranial pressure (ICP)
• head trauma or tumor
• intracranial bleeding, abscess or aneurysm
• hormone replacement therapy.

The evolution of a migraine headache has four distinct phases:

• Normal- Cerebral and temporal arteries are innervated extracranially; parenchymal arteries are noninnervated.
• Vasoconstriction (aura) - Stressrelated neurogenic local vasoconstriction of innervated cerebral arteries reduces cerebral blood flow (localized ischemia). Systematically. the prostaglandin thromboxane causes increased platelet aggregation and release of serotonin. a potent vasoconstrictor and possibly, other vasoactive substances.
• Parenchymal artery dilation- Noninnervated parenchymal vessels dilate in response to local acidosis and anoxia (ischemia). Neurogenic or biological factors may cause preformed arteriovenous shunts to open. Increased blood flow. increased internal pressure. and enhanced pulsations shortcircuit the normal nutritive capillaries and cause pain.
• Vasodilation (headache) - Compensatory mechanisms cause marked vasodilation of the innervated arteries. resulting in headache. Systemic platelet aggregation decreases. and falling serotonin levels result in vasodilation. A painful. sterile perivascular inflammation develops and persists into the postheadache phase.

Signs and symptoms of Migraine Headache

Both muscle contraction and traction-inflammatory vascular headaches produce a dull, persistent ache. tender spots on the head and neck. and a feeling of tightness around the head. with a characteristic "hat-band" distribution. The pain is commonly severe and unrelenting. If caused by intracranial bleeding. headache may result in neurologic deficits, such as paresthesia and muscle weakness; narcotics may fail to relieve pain in these cases. If caused by a tumor. pain is most severe when the patient awakens.

Complications may include:

• misdiagnosis of a more serious condition such as stroke
• status migraines
• drug dependency
• disruption of lifestyle.

Diagnosis information

Diagnosis requires a history of recurrent headaches and physical examination of the head and neck. Such examination includes percussion. auscultation for bruits, inspection for signs of infection, and palpation for defects, crepitus, or tender spots (especially after trauma). Definitive diagnosis also requires a complete neurologic examination. assessment for other systemic diseases, and a psychosocial evaluation when such factors are suspected.

Diagnostic tests include cervical spine and sinus X-rays. EEG, computed tomography scan (performed before lumbar puncture to rule out increased ICP) or magnetic resonance imaging. A lumbar puncture isn't done if there's evidence of increased ICP or if a brain tumor is suspected because rapidly reducing pressure, by removing spinal fluid, can cause brain herniation.

Treatment of Migraine Headache

Depending on the type of headache, analgesics - ranging from aspirin (Bayer) to codeine or meperidine (Demerol) - may provide symptomatic relief. Other measures include identification and elimination of causative factors and, possibly. psychotherapy for headaches caused by emotional stress. Chronic tension headaches may also require muscle relaxants.

For migraine headaches, ergotamine (Migranal) alone or with caffeine may be an effective treatment. Remember that pregnant women can't take these medications because they stimulate uterine contractions. These drugs and others, such as etoclopramide (Reglan) or naproxen (Naprosyn). work best when taken early in the course of an attack. If nausea and vomiting make oral administration impossible, drugs may be given as rectal suppositories.

Drugs in the class of sumatriptan Umitrex) are considered by many physicians to be the drug of choice for acute migraine attacks or cluster headaches. Drugs that can help prevent migraine headaches include propranolol (Inderal), atenolol (Tenormin), clonidine (Catapres). and amitriptyline.

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Home Remedies For Migraine Headache

• Apples are valuable in treating all types of headaches. A ripe apple, after removing the upper rind the inner hard portion, should be taken with little salt every morning for about a week.
• Aloe grows wild in most places with sandy soil in India . Its leaves have many medicinal properties. Dried leaves can be powdered and stored. Take two pinches or one-fourth of a teaspoon of this powder, mixed with an equal amount of turmeric, dissolved in half a cup of water, and drink it. It is especially good for headache complaints associated with menstruation.
• Take 2-3 400MG Magnesium tablets and drink at least 1/2 Gallon of water per day. Drink more water if you drink large amounts of Coffee, Tea or Alcohol. This will prevent the onset of Migraines.

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Special considerations and Prevention

• Headaches seldom require hospitalization unless caused by a serious disorder. If that's the case, direct your care to the underlying problem. Otherwise, consider these patient care measures:
• Obtain a complete patient history, including duration and location of the headache, time of day it usually begins, nature of the pain, concurrence with other symptoms such as blurred vision, medications taken such as hormonal contraceptives, prolonged fasting, and precipitating factors, such as tension, menstruation, loud noises, menopause, or alcohol. Exacerbating factors can also be assessed through ongoing observation of the patient's personality, habits, activities of daily living. family relationships, coping mechanisms. and relaxation activities.
• Using the patient history as a guide, help the patient avoid exacerbating factors. Advise her to lie down in a dark. quiet room during an attack and to place ice packs on her forehead or a cold cloth over her eyes.
• Instruct the patient to take the prescribed medication at the onset of migraine symptoms. prevent dehydration by drinking plenty of fluids after nausea and vomiting subside, and use other headache relief measures.
• Get plenty of sleep.
• The patient with a migraine headache usually needs to be hospitalized only if nausea and vomiting are severe enough to induce dehydration and possible shock.