Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What causes migraine headaches?

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 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 blood sugar level, certain foods and hormone levels in women.

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 in all people. Possible symptoms of migraines are listed below:

Symptoms of migraines

	Intense throbbing or dull aching pain, usually on one side of your head
	Nausea, vomiting
	Changes in how you see, including blurred vision or blind spots in your vision
	Bothered by light, noise and odours
	Feeling tired
	Confusion
	Stuffy nose
	Feeling cold or sweating
	Still or tender neck
	Light headed
	Tender scalp
	Symptoms worsen with movement

Are there different kinds of migraine headaches?

Yes. The two most common are migraine with aura and migraine without aura.

Migraines with aura or classic migraines start with a set of warning signs are called the aura.
The aura often involves changes in the way you see. You may see flashing lights. You may temporarily lose some of your vision, such as your side vision, in one or both eyes.

You may also feel a strange prickly or burning sensation or muscle weakness on one side of your body. These sensations may seem to march through your body. You may also have trouble communicating. The aura may also involve feelings of depression, irritability and restlessness.
Auras last about 15 to 30 minutes. Head pain usually follows the aura, though sometimes the two overlap or the head pain never occurs. The head pain of migraines with aura may occur on one or both sides of your head.

Migraines without aura or common migraines don't start with an aura. Migraines without aura may start more slowly than migraines with aura, last longer and interfere more with daily activities. The pain of migraines without aura may be on just one side of your head. If you have severe headaches without an aura that don't seem to be caused by muscle tension, they may be migraines without aura.

How long do migraines usually last?

Migraines may last from four to 24 72 hours. They may happen once or twice a year or daily.

What things may set off a migraine?

Certain things can set off migraines in some people. Foods that contain tyramine, sodium nitrite or phenylalanine (see above) can lead to migraines. Other things that may also contribute to migraines include the following:

	Strong odors, perfumes, bright light or loud noises
	Changes in Weather or altitude
	Being really tired, stressed or depressed or the let-down after an intense or stressful event
	Changes in sleeping patterns or sleeping time, especially sleeping late or sleeping less or longer than usual
	Missing meals or fasting
	Menstrual periods, birth control pills or hormones for some women
	Medications including analgesics

Foods that may trigger migraines

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

How are migraines treated?

There are two types of migraine treatments. Some treatments are used to relieve the headache pain. Most of these treatments should be started as soon as you think you're getting a migraine. The other group includes treatments that are used to prevent headaches before they occur.

People with known trigger factors, such as specific foods or stress, may help themselves by changing their diet or their lifestyle, but if this doesn't work, they may need medicine.

To broke an attack, the earlier the treatment is started, the better the chances that it will work. Medications as well as the tips listed seem to be the most effective. Drugs include painkillers such as acetaminophen, aspirin, anti-inflammatory (some examples are: ibuprofen, naproxen, ketorolac) or combining those with other agents such as caffeine or codeine. In several cases, you may need to receive a stronger medication or intravenous treatment (Often in an emergency room) with specific drugs that are aimed to kill the attack.

A new group of drugs called triptans prescribed as a pill, nose spray or injection, look promising as they are fast acting and have less side effects. Your doctor can try to help you find which approach will work best for you or is suitable according to your health.

Can non-prescription medicines help relieve the pain?

Yes. Non-prescription medicines can help migraine pain. They include aspirin, acetaminophen and ibuprofen. If taken as soon as the headache begins, these can work well.

What about prescription medicines?

NSAIDS (Nonsteroidal Antiinflammatory Drugs) can be very good at helping migraine pain and may be an option for you (some examples are: Naproxen and Diclofenac)

People with more severe pain may need prescription medicine. A medicine called ergotamine can be effective alone or combined with other medicines (an example is Cafergot). Dihydroergotamine (some examples are: Migranal, D.H.E. 45) is related to ergotamine and can be helpful.

Other prescription medicines for migraines include sumatriptan (an example is Imitrex), zolmitriptan (an example is Zomig), naratriptan (an example is Amerge), rizatriptan, almotriptan and fravatriptan.

Combinations of medicines are also available.

If the pain won't go away, stronger medicine may be needed, such as a narcotic (an example is Stadol nasal spray) 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 often or if your headaches make it hard for you to work and function. Examples of medicines used to prevent migraines include propranolol (an example is Inderal), anticonvulsants (an example is Valproate), antidepressants such as amitryptyline and SSRI's (serotonin reuptake inhibitors).

An Angrotensin Converting Enzyme Inhibitor (ACEI), lisinopril, may also have a role in preventing migraines. Riboflavin and feverfew are also taken by some people to prevent migraines.

Tips on reducing the pain of an attack

	Lie down in a dark, quiet room
	Put a cold compress on your forehead
	Massage your scalp
	Put pressure on your temples

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Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.