American Medical Association Family Medical Guide - American Medical Association [427]
Some people experience a warning sign called an aura just before the onset of a migraine, during which they feel uncomfortable and fatigued and may experience some sort of visual disturbance, such as a zigzag distortion. An aura can last from several minutes to several hours, but once the headache begins, the warning symptoms usually fade.
The duration of a migraine and its timing can vary, but you may be able to learn from experience to predict the nature and duration of your headaches. Migraines usually last several hours—severe migraines can last a few days. Episodes may occur several times over the course of a week or once every few years. If you have recurring, severe headaches that you cannot control with over-the-counter pain relievers, see your doctor as soon as possible.
Diagnosis
A migraine is diagnosed by the symptoms and by a neurological examination that rules out more serious possible causes. In some cases, doctors perform specific diagnostic tests to rule out other possible underlying causes of the headaches.
Treatment
Your doctor will probably recommend that you keep a headache diary (see previous page) to help identify symptoms, triggers, and patterns associated with your migraines. This detailed record will help you and your doctor plan an effective course of treatment. Although there is no cure for migraines, their symptoms can be relieved, often dramatically.
The doctor may recommend taking over-the-counter pain relievers such as aspirin, acetaminophen, ibuprofen, or naproxen. If these drugs are not effective, he or she may prescribe vasoconstrictors (drugs that narrow the blood vessels) such as sumatriptan, ergot alkaloids, or serotonin agonists. For severe migraines, these drugs may be injected into a vein or muscle as soon as the symptoms start. To control nausea and vomiting, the doctor may prescribe antihistamines or phenothiazines.
It may take several months of trying different medications—such as beta blockers, calcium channel blockers, antiseizure medications, or antidepressants used in combination with nonsteroidal anti-inflammatory drugs—before you and your doctor find the drug or drug combination that works best for you. Taking medication at the onset of your symptoms can help reduce the severity and duration of a migraine. To avoid side effects, take your medication exactly as prescribed.
Because oral contraceptives (see page 470) can trigger migraines in some women, a doctor may prescribe a different contraceptive or recommend changing birth-control methods to eliminate the headaches. Because tobacco smoke can irritate blood vessels, your doctor may recommend that you stop smoking if you smoke. For some people, relaxation techniques such as meditation, yoga, or biofeedback help prevent migraines.
Cluster Headaches
Cluster headaches are severe, recurring headaches that affect one side of the head. The headaches often occur during the night or early in the morning and can last from 15 minutes to several hours. Cluster headaches go away but often return within a few hours or at the same time the next day. After several days or weeks of recurring headaches (referred to as the cluster), the headaches disappear and may not return for several months or years. Cluster headaches are more common in men than in women.
Symptoms
The symptoms of cluster headaches include sudden, intense pain that is usually centered in and around one eye or on one side of the face. The eye on the affected side is watery and red, and the eyelid may droop. The person’s nose may be either runny or stuffy.
Diagnosis
Cluster headaches are diagnosed by the person’s symptoms and by a neurological examination that rules out more serious possible causes. In some cases, doctors perform specific diagnostic tests to rule out other possible underlying causes of the headaches.
Treatment
Cluster headaches are usually treated with over-the-counter pain relievers such as aspirin, acetaminophen, ibuprofen, or naproxen. Doctors may also prescribe antihistamines or corticosteroid