Understanding Migraines -- Diagnosis and Treatment
How Are Migraines Diagnosed?
There is no specific test to diagnose a migraine headache. If you seek help from your health care provider for recurring headaches, you may be asked to keep a headache diary in which you record information about symptoms leading up to a headache, symptoms of the actual headache, and possible triggers that may have provoked the episode.
Your health care provider will want to take a careful history to determine any patterns to your headaches and to learn whether such headaches run in your family. He or she will also perform a careful physical exam to make sure you don't have any other symptoms or signs that point to another problem as the source of your headaches.
Migraines are a type of headache that cause severe, throbbing pain, often accompanied by nausea, vomiting, and sensitivity to light (photophobia) or sound (phonophobia). Migraine headaches generally last between four and 72 hours. Many people experience certain symptoms prior to the onset of the head pain. Symptoms that precede and herald an upcoming headache are referred to as an "aura," and usually last under an hour.
Symptoms of an aura include:
Changes in your vision (even brief blindness)
There are two main approaches to migraine treatment. The first is stopping (aborting) an acute attack, if possible, or at least controlling the pain and nausea. The second approach is preventing future attacks.
Stopping Acute Migraine Pain
In abortive therapy, it's important to take medication at the first sign a migraine is coming. So, if you have an aura or other symptoms before the headache starts, take the medicine then. Many drugs can help, but the leading ones are called triptans. They come in different forms including dissolvable pills, regular pills, skin patches, and nasal spray. They include Imitrex, Zomig, Maxalt, and others. People respond differently, and one of these drugs may work better for you.
Ergot alkaloids are another class of drug that can be used to abort a migraine. The most popular one is dihydroergotamine (DHE). It is available as a nasal spray or an injection. NSAIDs (nonsteroidal anti-inflammatory drugs), such as ketoprophen, Advil, or Motrin, may also stop a migraine attack. Often, doctors recommend taking antinausea drugs such as Reglan or Phenergan as well.
During an acute episode of migraine headache, you'll probably be most comfortable lying down in a darkened, quiet room and trying to sleep. A cold pack on your head may feel comforting. If you are unable to take medications by mouth or your symptoms don't improve, you may need to go to a hospital for treatment.
Preventive Therapies for Migraine
Prophylactic treatment (preventive therapy) is usually recommended if you have more than two or three migraines per month. Medications intended to head off a migraine episode, so that it never fully develops, include:
Antidepressants, such as Elavil and Effexor
Beta-blocking agents (also used to treat high blood pressure), such as Blocadren, Inderal, Innopran XL, Lopressor, and Toprol XL
Calcium-channel blockers (also used to treat high blood pressure), such as Calan, Covera-HS, Verelan, Isoptin and Adalat, Procardia, Nifedical, and Afeditab
Antiseizure medications including Depakote, Neurontin, and Topamax
Vitamin B-2 (riboflavin)
Triptans are commonly used for acute migraine treatment, as mentioned. But one triptan -- Frova -- is also helpful for preventing menstrual-related migraines. It affects serotonin levels and may also relieve pain in other ways. Several other triptans are being studied and may possibly be effective in preventing menstrual-related migraines.