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Migraine headaches: Identification and treatment

Migraine headaches: Identification and treatment

Posted: Wednesday, September 28, 2011 8:01 pm
By: Morgan Stone, FNP-BC, Special to The Press

Nothing feels worse or is more distracting than a pounding headache. Next time you reach for pain reliever, you may want to review your headache symptoms. Instead of a simple headache or sinus pain, you may actually be experiencing a migraine.
Nearly 30 million Americans suffer from migraines, according to the National Headache Foundation (NHF), and more than half of all migraines go undiagnosed. Often, migraine headaches are misdiagnosed as a sinus or tension headache.
A 2008 NHF study on sinus headaches and migraines determined that nearly a quarter of respondents who had self-diagnosed a sinus headache might actually have migraines or another form of vascular headache. A large majority of sinus headache sufferers actually experience some form of a vascular headache, a type of headache which can include migraines, researchers said. Furthermore, patients diagnosed as having a migraine also experienced symptoms traditionally attributed to a sinus headache: sinus pressure and pain, nasal congestion, and runny nose.
Another landmark study – the American Migraine Study II – involving nearly 30,000 people, revealed that many people diagnosed with migraine thought they had only a sinus headache. Of those diagnosed during the 1999 study, just half knew prior to the study that they tended to suffer from migraines. A true sinus headache, according to researchers, is typically a viral sinus infection with nasal discharge, decreased sense of smell, and facial pain/pressure. However, the diagnosis may actually be a migraine – with sinus symptoms.
A migraine is an intense, throbbing headache that often involves one side of the head, typically lasting from a few hours up to three days. (See sidebar for typical migraine symptoms.) Usually, a first migraine attack will occur during childhood, adolescence or early adulthood, generally before age 30. About 70 percent of migraine sufferers are women, Women are more likely to suffer from migraines than men, and health care experts believe that the tendency to have migraines can be genetic.
It is thought that migraines may be caused in part by changes in the level of a brain chemical known as serotonin which can cause blood vessels to constrict (shrink) when levels are high – or dilate (enlarge), when serotonin levels fall. The dilation of blood vessels causes the pain felt during a migraine. The level of serotonin in our bodies is impacted by blood sugar, certain foods and, for women, hormonal levels.
However, the exact causes of a migraine are unknown, and migraine triggers are different for everyone. Common triggers include:
• Stress, excessive fatigue or depression
• Hormonal changes (primarily in women)
• Changes in weather or altitude
• Certain foods or medications
• Missing meals or fasting
• Strong odors or fumes, including smoking
• Intense physical activity
• Bright lights or loud noises
• Changes in sleep patterns
One symptom, or trigger, experienced alone may not bring on a migraine. However, the number of triggers occurring around the same time increases the chances for a migraine. Once you’ve had a migraine, the frequency of repeat attacks varies: a migraine can reoccur several times a month – or less than once a year.
Migraines fall into two categories: a migraine with aura (also known as a classic migraine) and migraine without aura (also called a common migraine). An aura is a group of symptoms that develop before or during a migraine and can include visual changes, such as flashes of light or colors in your line of sight, temporary vision loss, muscle weakness, or a burning or prickly sensation. Other unusual symptoms can predict the onset of a migraine – known as “premonitions” – and can include feelings of intense energy, cravings for sweets, excessive thirst, drowsiness and irritability or depression.
Lifestyle remedies for migraine pain include lying down in a quiet, dark room; applying pressure to the temples or massaging the scalp; or putting a cold compress on the forehead. Migraines can also be treated with over-the-counter pain relievers, or with prescription medications for those who suffer more severe migraine pain. Over-the-counter pain relievers should be taken as soon as warning signs of the migraine begin. Other medications can be prescribed to prevent a migraine, rather than only treating symptoms.
Talk with your doctor to discuss your headache or migraine symptoms to determine the right course of treatment.
To learn more, visit; click on “Health Resources” and “Interactive Tools,” to take the Migraine Headaches Quiz, Headache Quiz, or Pain Quiz.
Morgan S. Stone is a board certified family nurse practitioner.  After completing her undergraduate degree at the University of Tennessee at Martin with a bachelor of science in nursing, She received her master of science in nursing with a specialty as a family nurse practitioner from Vanderbilt University.  She now accepts patients at the Martin Specialty Clinic.  
wcp 9/27/11


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