By Anthony G. Alessi, MD – Healthy Rounds
Migraine headaches affect more than 28 million Americans each year. They can be severely debilitating with economic and social implications. Unfortunately, it is believed that nearly half of all people with migraine headaches never receive the correct diagnosis. Instead their pain is incorrectly attributed to tension or sinus headaches.
Migraine headaches are best defined as recurrent headaches that last from 4 to 72 hours. The pain is usually pulsatile in nature and occurs on one side of the head. These headaches are often associated with light and noise sensitivity, nausea and vomiting. Physical exertion will intensify the pain and many migraine sufferers retreat to a dark quiet room to attempt sleep.
There is a strong familial component to migraine despite being almost three times more common in women. A history of headaches can often be traced back to childhood. Migraine headaches can be triggered by a variety of events including hormonal changes, head trauma, insomnia and hunger.
The current theory of what causes migraine headaches involves both the vascular and nervous systems. It is believed that migraine headaches begin in the brain stem and spread to involve the trigeminal nerve and its associated blood vessels. The trigeminal nerve is responsible for communicating sensory input from the face and scalp. The pain associated is the result of a cascade of chemical events.
Current treatment of migraine involves interrupting the chemical cascade that produces pain. Over-the-counter medications like aspirin, acetaminophen, caffeine, motrin and naprosyn are very effective. Newer prescription medications known as triptans are designed to bind to specific receptors and block painful dilation of blood vessels.
There is currently a broad spectrum of available medications to alleviate the pain associated with migraine headaches. These medications are best taken early in the onset of discomfort and there is no role for the repeated use of habit-forming narcotics in the treatment of this chronic disorder.
Correct diagnosis and developing a treatment partnership with a physician is the first step to relief from migraine headaches.
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