Migraine Classification and external resources
ICD-10	G43.
ICD-9	346
OMIM	157300
DiseasesDB	8207
MedlinePlus	000709
eMedicine	neuro/218  neuro/517 emerg/230 neuro/529
MeSH	D008881

Migraine is a neurological syndrome that can cause headache. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings G00-G99 - Diseases of the Nervous system (G00-G09 Inflammatory diseases of the Central nervous system ( Bacterial meningitis The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books In Medicine and Psychology, the term syndrome refers to the association of several clinically recognizable features signs (observed by a physician A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted It is a common condition that affects women more than men. The typical migraine headache is one-sided and pulsating, lasting four to 72 hours^[1]. Accompanying complaints are nausea and vomiting, and a heightened sensitivity to bright lights (photophobia) and noise (hyperacusis). Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Photophobia is a Symptom of excessive sensitivity to Light and the aversion to Sunlight or well-lit places Hyperacusis is a health condition characterized by an over-sensitivity to certain frequency ranges of sound (a collapsed tolerance to normal environmental sound ^[2][3][4] Approximately one third of people who experience migraine get a preceding aura, in which a patient senses a strange light or unpleasant smell. An aura is the perceptual disturbance experienced by some Migraine sufferers before a migraine headache and the telltale sensation experienced by some people with Epilepsy ^[5] Patients often describe triggers they feel precipitate an episode of migraine, such as certain foods and beverages (like chocolate or alcohol), stress or menstruation. Chocolate ( pronounced or /-ˈələt/ comprises a number of raw and processed foods that are produced from the seed of the tropical Cacao tree In Chemistry, an alcohol is any Organic compound in which a Hydroxyl group ( - O[[hydrogen H]]) is bound to a Carbon See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. In some migraine types there are typical features but the headache remains absent, and in children abdominal pain may be a prominent feature. Abdominal pain can be one of the Symptoms associated with transient disorders or serious disease

Although the exact cause of migraine remains unknown, the most widespread theory is that it is a disorder of the serotonergic control system. Idiopathic is an Adjective used primarily in Medicine meaning arising spontaneously or from an obscure or unknown cause. Serotonergic means "related to the Neurotransmitter Serotonin " Genetic factors may also contribute. ^[6] Studies on twins show that genes have a 60 to 65% influence on the development of migraine . ^[7][8] Fluctuating hormone levels show a relation to migraine in several ways: three quarters of adult migraine patients are female while migraine affects approximately equal numbers of boys and girls before puberty, and migraine is known to disappear during pregnancy in a substantial number of sufferers.

The treatment of migraine begins with simple painkillers for headache and anti-emetics for nausea, and avoidance of triggers if present. An anti-emetic is a drug that is effective against Vomiting and Nausea. Specific anti-migraine drugs can be used to treat migraine. If the condition is severe and frequent enough, preventative drugs might be considered.

The word migraine is French in origin and comes from the Greek hemicrania, as does the Old English term megrim. Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly Literally, hemicrania means "half (the) head".

Contents 1 Classification 1.1 Defining severity of pain 1.2 Migraine without aura 1.3 Migraine with aura 1.4 Basilar type migraine 1.5 Familial hemiplegic migraine 1.6 Abdominal migraine 1.7 Acephalgic migraine 1.8 Menstrual migraine 2 Signs and symptoms 2.1 Prodrome phase 2.2 Aura phase 2.3 Pain phase 2.4 Postdrome phase 3 Diagnosis 4 Pathophysiology 4.1 Depolarization theory 4.2 Vascular theory 4.3 Serotonin theory 4.4 Neural theory 4.5 Unifying theory 5 Epidemiology 6 Triggers 6.1 Food 6.2 Weather 6.3 Head position 7 Treatment 7.1 Abortive treatment 7.1.1 Paracetamol or Non-steroidal anti-inflammatory drug (NSAIDs) 7.1.2 Analgesics combined with antiemetics 7.1.3 Serotonin agonists 7.1.4 Ergot alkaloids 7.1.5 Other agents 7.1.5.1 Status migrainosus 7.1.5.2 Herbal treatment 7.1.6 Comparative studies 7.2 Preventive treatment 7.2.1 Prescription drugs 7.2.2 Trigger avoidance 7.2.3 Herbal and nutritional supplements 7.2.3.1 Butterbur 7.2.3.2 Cannabis 7.2.3.3 Coenzyme Q10 7.2.3.4 Feverfew 7.2.3.5 Magnesium Citrate 7.2.3.6 Riboflavin 7.2.3.7 Vitamin B12 7.2.4 Surgical treatments 7.2.5 Noninvasive medical treatments 7.2.6 Behavioral treatments 7.2.7 Alternative medicine 8 History 9 Economic impact 10 Migraine and cardiovascular risks 11 References 11.1 Migraine triggers 11.2 Treatment 11.2.1 Triptans 11.3 General 11.4 Economic impact 11.5 Clinical picture 12 Footnotes 13 External links 13.1 General information 13.2 Organizations

Classification

Migraines have been classified by the International Headache Society which periodically revises their classification. The International Headache Society ( IHS) is a charity organization founded in 1981 for people from all professions that are working to treat Headache ^[9]

Defining severity of pain

In addition to classifying the type of headache, the International Headache Society defines intensity of pain on a verbal 4 point scale:^[10]

• 0 no pain
• 1 mild pain 'does not interfere with usual activities'
• 2 moderate pain 'inhibits, but does not wholly prevent usual activities'
• 3 severe pain 'prevents all activities'

Migraine without aura

This is the most commonly seen form of migraine; patients who primarily suffer from migraine without aura may also have attacks of migraine with aura. The International Headache Society ( IHS) is a charity organization founded in 1981 for people from all professions that are working to treat Headache Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm An aura is the perceptual disturbance experienced by some Migraine sufferers before a migraine headache and the telltale sensation experienced by some people with Epilepsy According to the International Classification of Headache Disorders^[9] it is a recurrent headache disorder manifesting in attacks lasting 4–72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and hyperacusis. Photophobia is a Symptom of excessive sensitivity to Light and the aversion to Sunlight or well-lit places Hyperacusis is a health condition characterized by an over-sensitivity to certain frequency ranges of sound (a collapsed tolerance to normal environmental sound In order to diagnose migraine without aura, there must have been at least five attacks not attributable to another cause that fulfill the following criteria:

1. Headache attacks lasting 4–72 hours when untreated

2. At least two of the following characteristics:

• Unilateral location
• Pulsating quality
• Moderate or severe pain intensity
• Aggravation by or causing avoidance of routine physical activity

3. During the headache there must be at least one of the following associated symptom clusters:

• Nausea and/or vomiting
• Photophobia and hyperacusis

Where these criteria are not fully met, the problem may be classified as "probable migraine without aura" but other diagnoses such as "episodic tension type headache" must also be excluded. Photophobia is a Symptom of excessive sensitivity to Light and the aversion to Sunlight or well-lit places Hyperacusis is a health condition characterized by an over-sensitivity to certain frequency ranges of sound (a collapsed tolerance to normal environmental sound

Migraine with aura

This is the second most commonly seen form of migraine: patients who primarily suffer from migraine with aura may also have attacks of migraine without aura. According to the International Classification of Headache Disorders^[9] it is a recurrent disorder manifesting in attacks of reversible focal neurological symptoms that usually develop gradually over 5–20 minutes and last for less than 60 minutes. Headache with the features of "migraine without aura" usually follows the aura symptoms. Less commonly, the aura may occur without a subsequent headache or the headache may be non-migrainous in type.

In order to diagnose migraine with aura, there must have been at least two attacks not attributable to another cause that fulfill the following criteria:

1. Aura consisting of at least one of the following, but no muscle weakness or paralysis:

• Fully reversible visual symptoms (e. g. flickering lights, spots, lines, loss of vision)
• Fully reversible sensory symptoms (e. g. pins and needles, numbness)
• Fully reversible dysphasia (speech disturbance)

2. Dysphasia should not be confused with the similarly pronounced Dysphagia, which is a difficulty swallowing Aura has at least two of the following characteristics:

• Visual symptoms affecting just one side of the field of vision and/or sensory symptoms affecting just one side of the body
• At least one aura symptom develops gradually over more than 5 minutes and/or different aura symptoms occur one after the other over more than 5 minutes
• Each symptom lasts from 5–60 minutes

Where these criteria are not fully met, a diagnosis of "probable migraine with aura" may be considered, although other neurological causes must also be excluded. If the picture complies with the criteria but includes one-sided muscular weakness or paralysis, a diagnosis of "sporadic hemiplegic migraine" or "familial hemiplegic migraine" should be considered.

Basilar type migraine

Basilar type migraine (BTM), formerly known as basilar artery migraine (BAM) or basilar migraine (BM), is an uncommon type of complicated migraine with symptoms that result from brainstem dysfunction. The brain stem (or brainstem) is the lower part of the Brain, adjoining and structurally continuous with the Spinal cord. Serious episodes of BTM can lead to stroke, coma, or even death. The use of triptans and other vasoconstrictors as abortive treatments in BTM is contraindicated. Triptans are a family of Tryptamine based drugs used as Abortive medication in the treatment of Migraine and Cluster headaches They Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels particularly the large Arteries, Arterioles In Medicine, a contraindication (pronounced as contra-indication is a condition or factor that increases the Risks involved in using a particular drug, Abortive treatments for BTM often focus on vasodilation and restoration of normal blood flow to the vertebrobasilar territory and subsequent return of normal brainstem function.

Familial hemiplegic migraine

Main article: Familial hemiplegic migraine

Familial hemiplegic migraine 'FHM' is a type of migraine with a possible polygenetic component. Familial hemiplegic migraine (FHM is an Autosomal dominant classical Migraine subtype that typically includes Hemiparesis (weakness of half the body during These migraine attacks may last 4–72 hours^[9] and are apparently caused by ion channel mutations, three types of which have been identified to date. Patients who experience this syndrome have relatively typical migraine headaches preceded and/or accompanied by reversible limb weakness on one side as well as visual, sensory or speech difficulties. A non-familial form exists as well, "sporadic hemiplegic migraine" (SHM). It is often difficult to make the diagnosis between basilar-type migraine and hemiplegic migraine. When making the differential diagnosis is difficult, the deciding symptom is often the motor weakness or unilateral paralysis which can occur in FHM or SHM. A differential diagnosis (sometimes abbreviated DDx, ddx While basilar-type migraine can present with tingling or numbness, true motor weakness and/or paralysis occur only in hemiplegic migraine.

Abdominal migraine

According to the International Classification of Headache Disorders^[9] abdominal migraine is a recurrent disorder of unknown origin which occurs mainly in children. It is characterised by episodes of moderate to severe central abdominal pain lasting 1–72 hours. There is usually associated nausea and vomiting but the child is entirely well between attacks.

In order to diagnose abdominal migraine, there must be at least five attacks, not attributable to another cause, fulfilling the following criteria:

1. Attacks lasting 1–72 hours when untreated

2. Pain must have ALL of the following characteristics:

• Location in the midline, around the umbilicus or poorly localised
• Dull or 'just sore' quality
• Moderate or severe intensity

3. During an attack there must be at least two of the following:

• Loss of appetite
• Nausea
• Vomiting
• Pallor

Most children with abdominal migraine will develop migraine headache later in life and the two may co-exist during adolescence.

Acephalgic migraine

Acephalgic migraine is a neurological syndrome. It is a variant of migraine in which the patient may experience aura symptoms such as scintillating scotoma, nausea, photophobia, hemiparesis and other migraine symptoms but does not experience headache. An aura is the perceptual disturbance experienced by some Migraine sufferers before a migraine headache and the telltale sensation experienced by some people with Epilepsy Scintillating scotoma is the most common visual aura preceding Migraine and was first described by 19th century physician Hubert Airy (1838–1903 Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Photophobia is a Symptom of excessive sensitivity to Light and the aversion to Sunlight or well-lit places Hemiparesis is the partial Paralysis of one side of the body It is generally caused by lesions of the Corticospinal tract, which runs down from the cortical A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Acephalgic migraine is also referred to as amigrainous migraine, ocular migraine, or optical migraine.

Sufferers of acephalgic migraine are more likely than the general population to develop classical migraine with headache.

The prevention and treatment of acephalgic migraine is broadly the same as for classical migraine. However, because of the absence of "headache", diagnosis of acephalgic migraine is apt to be significantly delayed and the risk of misdiagnosis significantly increased.

Visual snow might be a form of acephalgic migraine. Visual snow is a transitory or persisting visual symptom where people see Snow or television-like static in parts or the whole of their Visual fields

If symptoms are primarily visual, it may be necessary to consult an ophthalmologist to rule out potential eye disease before considering this diagnosis. Ophthalmology is the branch of Medicine which deals with the diseases and surgery of the visual pathways including the Eye, Brain

Menstrual migraine

Menstrual migraine is distinct from other migraines. Approximately 21 million women in the US suffer from migraines,^[11] and about 60% of them suffer from menstrual migraines. ^[12]

• There are two types of menstrual migraine – Menstrually Related Migraine (MRM) and Pure Menstrual Migraine (PMM)

• MRM is a headache of moderate-to-severe pain intensity that happens around the time of a woman’s period and at other times of the month as well.

• PMM is similar in every respect but only occurs around the time of a woman’s period. ^[13]

• The exact causes of menstrual migraine are uncertain but evidence suggest there may be a link between menstruation and migraine due to the drop in estrogen levels that normally occurs right before the period starts. ^[14]

• Menstrual migraine has been reported to be more likely to occur during a five-day window, from two days before to two days after menstruation. ^[15]

When compared with migraines that occur at other times of the month, menstrual migraines have been reported to

• Last longer—up to 72 hours^[16]

• Be more severe^[15][17]

• Occur more often with nausea and vomiting^[12]

• Be more difficult to treat—occur more frequently^[18]

Signs and symptoms

The signs and symptoms of migraine vary among patients. Therefore, what a patient experiences before, during and after an attack cannot be defined exactly. The four phases of a migraine attack listed below are common but not necessarily experienced by all migraine sufferers. Additionally, the phases experienced and the symptoms experienced during them can vary from one migraine attack to another in the same migraineur:

1. The prodrome, which occurs hours or days before the headache. In Medicine, a prodrome is an early non-specific Symptom (or set of symptoms indicating the start of a Disease before specific symptoms occur
2. The aura, which immediately precedes the headache. An aura is the perceptual disturbance experienced by some Migraine sufferers before a migraine headache and the telltale sensation experienced by some people with Epilepsy
3. The pain phase, also known as headache phase. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm
4. The postdrome.

Prodrome phase

Prodromal symptoms occur in 40 to 60% of migraineurs (migraine sufferers). This phase may consist of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Euphoria is a medically recognized emotional state related to Pleasure and Happiness. A yawn (from the Middle English yanen, an alteration of yonen or yenen, which in turn comes from the Old English geonian g. chocolate), stiff muscles (especially in the neck), constipation or diarrhea, increased urination, and other vegetative symptoms. Chocolate ( pronounced or /-ˈələt/ comprises a number of raw and processed foods that are produced from the seed of the tropical Cacao tree These symptoms usually precede the headache phase of the migraine attack by several hours or days, and experience teaches the patient or observant family how to detect that a migraine attack is near.

Aura phase

For the 20–30%^[19][20] of individuals who suffer migraine with aura, this aura comprises focal neurological phenomena that precede or accompany the attack. They appear gradually over 5 to 20 minutes and generally last fewer than 60 minutes. The headache phase of the migraine attack usually begins within 60 minutes of the end of the aura phase, but it is sometimes delayed up to several hours, and it can be missing entirely. Symptoms of migraine aura can be visual, sensory, or motor in nature. ^[21]

Visual aura is the most common of the neurological events. An aura is the perceptual disturbance experienced by some Migraine sufferers before a migraine headache and the telltale sensation experienced by some people with Epilepsy There is a disturbance of vision consisting usually of unformed flashes of white and/or black or rarely of multicolored lights (photopsia) or forma­tions of dazzling zigzag lines (scintillating scotoma; often arranged like the battlements of a castle, hence the alternative terms "fortification spectra" or "teichopsia"). Photopsia is the presence of perceived flashes of light It is most commonly associated with Posterior vitreous detachment, Migraine with Aura, migraine Scintillating scotoma is the most common visual aura preceding Migraine and was first described by 19th century physician Hubert Airy (1838–1903 Some patients complain of blurred or shimmering or cloudy vision, as though they were look­ing through thick or smoked glass, or, in some cases, tunnel vision and hemianopsia. This article refers to the medical condition For the novel see Tunnel Vision; for the film see Tunnel Vision (film; for the mural "Tunnelvision" The somatosensory aura of migraine consists of digitolingual or cheiro-oral paresthesias, a feeling of pins-and-needles experienced in the hand and arm as well as in the ipsilateral nose-mouth area. Paresthesia (pron /ˌpɛɹɪsˈθiʒə/ paraesthesia in British English, pron Paresthesia migrate up the arm and then extend to involve the face, lips and tongue.

Other symptoms of the aura phase can include auditory or olfactory hallucinations, temporary dysphasia, vertigo, tingling or numbness of the face and extremities, and hypersensitivity to touch. Dysphasia should not be confused with the similarly pronounced Dysphagia, which is a difficulty swallowing Vertigo (from the Latin vertere, to turn and the suffix -igo, a condition i

Pain phase

The typical migraine headache is unilateral, throbbing, moderate to severe and can be aggravated by physical activity. Not all of these features are necessary. The pain may be bilateral at the onset or start on one side and become generalized, and usually alternates sides from one attack to the next. The onset is usually gradual. The pain peaks and then subsides, and usually lasts between 4 and 72 hours in adults and 1 and 48 hours in children. The frequency of attacks is extremely variable, from a few in a lifetime to several times a week, and the average migraineur experiences from one to three headaches a month. The head pain varies greatly in intensity. The pain of migraine is invariably accompanied by other features. Nausea occurs in almost 90 percent of patients, while vomiting occurs in about one third of patients. Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Many patients experience sensory hyperexcitability manifested by photophobia, phonophobia, osmophobia and seek a dark and quiet room. Photophobia is a Symptom of excessive sensitivity to Light and the aversion to Sunlight or well-lit places Phonophobia (also called ligyrophobia) is a fear of loud sounds Osmophobia or olfactophobia refers to a fear aversion or psychological Hypersensitivity to Smells or Odors The Phobia generally Blurred vision, nasal stuffiness, diarrhea, polyuria, pallor or sweating may be noted during the headache phase. In Medicine, polyuria is a condition characterized by the passage of large volumes of urine (at least 2 Pallor (also called pastiness or wanness) is a reduced amount of oxy Hemoglobin in Skin or Mucous membrane, a pale color which can There may be localized edema of the scalp or face, scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness of the neck. Oedema (or Edema in American English formerly known as dropsy or hydropsy, is the increase of Interstitial fluid in any organ &mdash swelling Impairment of concentration and mood are common. Lightheadedness, rather than true vertigo and a feeling of faintness may occur. Vertigo (from the Latin vertere, to turn and the suffix -igo, a condition i The extremities tend to be cold and moist.

Postdrome phase

The patient may feel tired, "washed out", irritable, or listless and may have impaired concentration, scalp tenderness or mood changes. Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise. Malaise is a feeling of general discomfort or uneasiness an "out of sorts" feeling often the first indication of an infection or other disease Often, some of the minor headache phase symptoms may continue, such as loss of appetite, photophobia, and lightheadedness. On some patients, a 5 to 6 hour nap may reduce the pain, but slight headaches may still occur when standing or sitting quickly. Normally these symptoms go away after a good night's rest.

Diagnosis

Migraines are underdiagnosed^[22] and misdiagnosed. ^[23] The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":

• 5 or more attacks
• 4 hours to 3 days in duration
• 2 or more of - unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
• 1 or more accompanying symptoms - nausea and/or vomiting, photophobia, phonophobia

For migraine with aura, only two attacks are required to justify the diagnosis. The International Headache Society ( IHS) is a charity organization founded in 1981 for people from all professions that are working to treat Headache Photophobia is a Symptom of excessive sensitivity to Light and the aversion to Sunlight or well-lit places Phonophobia (also called ligyrophobia) is a fear of loud sounds

The mnemonic POUNDing (Pulsating, duration of 4–72 hOurs, Unilateral, Nausea, Disabling) can help diagnose migraine. Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort If 4 of the 5 criteria are met, then the positive likelihood ratio for diagnosing migraine is 24. The likelihood ratio often denoted by \Lambda (the capital Greek letter Lambda) is the ratio of the maximum Probability of a Result ^[24]

The presence of either disability, nausea or sensitivity, can diagnose migraine with:^[25]

• sensitivity of 81%
• specificity of 75%

Pathophysiology

Migraines were once thought to be initiated exclusively by problems with blood vessels. The blood vessels are part of the Circulatory system and function to transport Blood throughout the body The vascular theory of migraines is now considered secondary to brain dysfunction^[26] and claimed to have been discredited by others. ^[27]

The effects of migraine may persist for some days after the main headache has ended. Many sufferers report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed.

Migraine headaches can be a symptom of hypothyroidism. Hypothyroidism is the disease state in humans and animals caused by insufficient production of Thyroid hormone by the Thyroid gland.

Depolarization theory

A phenomenon known as cortical spreading depression can cause migraines. Cortical spreading depression is an expression used by some Neuroscientists to represent at least one of the following Cortical processes The spreading ^[28] In cortical spreading depression, neurological activity is depressed over an area of the cortex of the brain. Cortical spreading depression is an expression used by some Neuroscientists to represent at least one of the following Cortical processes The spreading Neurons (ˈnjuːɹɒn also known as neurones and nerve cells) are responsive cells in the Nervous system that process and transmit information The cerebral cortex is a structure within the Brain that plays a key role in Memory, Attention, perceptual Awareness, Thought, This situation results in the release of inflammatory mediators leading to irritation of cranial nerve roots, most particularly the trigeminal nerve, which conveys the sensory information for the face and much of the head. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Cranial nerves are Nerves that emerge directly from the Brain stem in contrast to Spinal nerves which emerge from segments of the Spinal cord. The trigeminal nerve (the fifth Cranial nerve, also called the fifth nerve or simply V) is responsible for sensation in the face

This view is supported by neuroimaging techniques, which appear to show that migraine is primarily a disorder of the brain (neurological), not of the blood vessels (vascular). Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/ Pharmacology of the Brain A spreading depolarization (electrical change) may begin 24 hours before the attack, with onset of the headache occurring around the time when the largest area of the brain is depolarized. A French study in 2007, using the Positron Emission Tomography (PET) technique identified the hypothalamus as being critically involved in the early stages. Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis ^[29]

Vascular theory

Migraines can begin when blood vessels in the brain contract and expand inappropriately. The blood vessels are part of the Circulatory system and function to transport Blood throughout the body This may start in the occipital lobe, in the back of the brain, as arteries spasm. The reduced flow of blood from the occipital lobe triggers the aura that some individuals who have migraines experience because the visual cortex is in the occipital area. ^[26]

When the constriction stops and the blood vessels dilate, they become too wide. The blood vessels are part of the Circulatory system and function to transport Blood throughout the body The once solid walls of the blood vessels become permeable some fluid leaks out. This leakage is recognized by pain receptors in the blood vessels of surrounding tissue. The blood vessels are part of the Circulatory system and function to transport Blood throughout the body In response, the body supplies the area with chemicals which cause inflammation. With each heart beat, blood passes through this sensative area causing a throb of pain. ^[26]

The vascular theory of migraines is now seen as secondary to brain dysfunction. ^[26]

Serotonin theory

Serotonin is a type of neurotransmitter, or "communication chemical" which passes messages between nerve cells. Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons It helps to control mood, pain sensation, sexual behaviour, sleep, as well as dilation and constriction of the blood vessels among other things. Serotonin levels in the brain may lead to a process of constriction and dilation of the blood vessels which trigger a migraine. Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons ^[26] Triptans activate serotonin receptors to stop a migraine attack. Triptans are a family of Tryptamine based drugs used as Abortive medication in the treatment of Migraine and Cluster headaches They ^[26]

Neural theory

When certain nerves or an area in the brain stem become irritated, a migraine begins. In response to the irritation, the body releases chemicals which cause inflammation of the blood vessels. These chemicals cause further irritation of the nerves and blood vessels and results in pain. Substance P is one of the substances released with first irritation. Pain then increases because substance P aids in sending pain signals to the brain. ^[26]

Unifying theory

Both vascular and neural influences cause migraines.

1. stress triggers changes in the brain
2. these changes cause serotonin to be released
3. blood vessels constrict
4. chemicals including substance P irritate nerves and blood vessels causing pain^[26]

Epidemiology

Migraine is an extremely common condition which will affect 12–28% of people at some point in their lives. ^[30] However this figure — the lifetime prevalence — does not provide a very clear picture of how many patients there are with active migraine at any one time. Typically, therefore, the burden of migraine in a population is assessed by looking at the one-year prevalence — a figure that defines the number of patients who have had one or more attacks in the previous year. The third figure, which helps to clarify the picture, is the incidence — this relates to the number of first attacks occurring at any given age and helps understanding of how the disease grows and shrinks over time.

Based on the results of a number of studies, one year prevalence of migraine ranges from 6–15% in adult men and from 14–35% in adult women. ^[30] These figures vary substantially with age: approximately 4–5% of children aged under 12 suffer from migraine, with little apparent difference between boys and girls. ^[31] There is then a rapid growth in incidence amongst girls occurring after puberty,^[32][33][34] which continues throughout early adult life. ^[35] By early middle age, around 25% of women experience a migraine at least once a year, compared with fewer than 10% of men. ^[30][36] After menopause, attacks in women tend to decline dramatically, so that in the over 70s there are approximately equal numbers of male and female sufferers, with prevalence returning to around 5%. ^[30][36]

At all ages, migraine without aura is more common than migraine with aura, with a ratio of between 1. 5:1 and 2:1. ^[37][38] Incidence figures show that the excess of migraine seen in women of reproductive age is mainly due to migraine without aura. ^[37] Thus in pre-pubertal and post-menopausal populations, migraine with aura is somewhat more common than amongst 15–50 year olds. ^[35][39]

There is a strong relationship between age, gender and type of migraine. ^[40]

Geographical differences in migraine prevalence are not marked. Studies in Asia and South America suggest that the rates there are relatively low,^[41][42] but they do not fall outside the range of values seen in European and North American studies. ^[30][36]

The incidence of migraine is related to the incidence of epilepsy in families, with migraine twice as prevalent in family members of epilepsy sufferers, and more common in epilepsy sufferers themselves. Epilepsy is a common chronic Neurological disorder that is characterized by recurrent unprovoked seizures. ^[43]

Triggers

A migraine trigger is any factor that, on exposure or withdrawal, leads to the development of an acute migraine headache. Triggers may be categorized as behavioral, environmental, infectious, dietary, chemical, or hormonal. In the medical literature, these factors are known as 'precipitants. '

Migraine attacks may be triggered by:^[44]

• Allergic reactions
• Bright lights, loud noises, and certain odors or perfumes
• Physical or emotional stress
• Changes in sleep patterns
• Smoking or exposure to smoke
• Skipping meals
• Dehydration
• Alcohol or caffeine
• Menstrual cycle fluctuations, birth control pills
• Tension headaches
• Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate or nitrates (preserved meats)
• Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods. Allergy is a disorder of the Immune system often also referred to as Atopy. Sleep is a Natural state of bodily rest observed throughout the animal kingdom Smoking is a practice where a substance most commonly Tobacco, is burned and the Smoke tasted or inhaled Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object In Chemistry, an alcohol is any Organic compound in which a Hydroxyl group ( - O[[hydrogen H]]) is bound to a Carbon Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the Tension headaches, which were renamed tension-type headaches by the International Headache Society in 1988 are the most common type of primary Headaches In organic Chemistry tyramine (4-hydroxy- Phenethylamine, para-tyramine p-tyramine is a Monoamine compound derived from the Monosodium glutamate, also known as sodium glutamate and MSG, is a Sodium salt of the non-essential Amino acid Glutamic acid In Inorganic chemistry, a nitrate is a salt of Nitric acid with an Ion composed of one Nitrogen and three Oxygen atoms

Sometimes the migraine occurs with no apparent "cause". The trigger theory supposes that exposure to various environmental factors precipitates, or triggers, individual migraine episodes. Migraine patients have long been advised to try to identify personal headache triggers by looking for associations between their headaches and various suspected trigger factors and keeping a "headache diary" recording migraine incidents and diet to look for correlations in order to avoid trigger foods. In Probability theory and Statistics, correlation, (often measured as a correlation coefficient) indicates the strength and direction of a linear It must be mentioned, that some trigger factors are quantitative in nature, i. e. , a small block of dark chocolate may not cause a migraine, but half a slab of dark chocolate almost definitely will, in a susceptible person. In addition, being exposed to more than one trigger factor simultaneously will more likely cause a migraine, than a single trigger factor in isolation, e. g. , drinking and eating various known dietary trigger factors on a hot, humid day, when feeling stressed and having had little sleep will probably result in a migraine in a susceptible person, but consuming a single trigger factor on a cool day, after a good night's rest with minimal environmental stress may mean that the sufferer will not develop a migraine after all. Migraines can be complex to avoid, but by keeping an accurate migraine diary and making suitable lifestyle changes can have a very positive effect on the sufferer's quality of life. Some trigger factors are virtually impossible to avoid, e. g. the weather or emotions, but by limiting the avoidable trigger factors, the unavoidable ones may have less of an impact on the sufferer. ^[45]

Food

A 2005 literature review found that the available information about dietary trigger factors relies mostly on the subjective assessments of patients. A literature review is a body of text that aims to review the critical points of current Knowledge on a particular topic ^[46] Some suspected dietary trigger factors appear to genuinely promote or precipitate migraine episodes, but many other suspected dietary triggers have never been demonstrated to trigger migraines. The review authors found that alcohol, caffeine withdrawal, and missing meals are the most important dietary migraine precipitants, that dehydration deserved more attention, and that some patients report sensitivity to red wine. Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic Little or no evidence associated notorious suspected triggers like chocolate, cheese, histamine, tyramine, nitrates, or nitrites with migraines. Histamine is a Biogenic amine involved in local immune responses as well as regulating physiological function in the gut and acting as a Neurotransmitter In organic Chemistry tyramine (4-hydroxy- Phenethylamine, para-tyramine p-tyramine is a Monoamine compound derived from the The artificial sweetener aspartame has not been shown to trigger headache, but in a large and definitive study monosodium glutamate (MSG) in large doses (2. Aspartame (or APM) (ˈæspɚteɪm or /əˈspɑrteɪm/ is the name for an artificial non- Saccharide Sweetener, aspartyl-phenylalanine-1-methyl Monosodium glutamate, also known as sodium glutamate and MSG, is a Sodium salt of the non-essential Amino acid Glutamic acid 5 grams) was associated with adverse symptoms including headache more often than was placebo. Placebo is a substance or procedure a patient accepts as medicine or therapy but which has no specific therapeutic activity The review authors also note that while general dietary restriction has not been demonstrated to be an effective migraine therapy, it is beneficial for the individual to avoid what has been a definite cause of the migraine.

The National Headache Foundation has a specific list of triggers based on the tyramine theory, detailing allowed, with caution and avoid triggers. ^[47]

Weather

Several studies have found some migraines are triggered by changes in weather. One study noted 62% of the subjects thought weather was a factor but only 51% were sensitive to weather changes. ^[48] Among those whose migraines did occur during a change in weather, the subjects often picked a weather change other than the actual weather data recorded. Most likely to trigger a migraine were, in order:

1. Temperature mixed with humidity. High humidity plus high or low temperature was the biggest cause.
2. Significant changes in weather
3. Changes in barometric pressure

Another study examined the effects of warm chinook winds on migraines, with many patients reporting increased incidence of migraines immediately before and/or during the chinook winds. Chinook winds, often just called chinooks commonly refers to Foehn winds ref> in the interior West of North America, where the Canadian Prairies and The number of people reporting migrainous episodes during the chinook winds was higher on high-wind chinook days. The probable cause was thought to be an increase in positive ions in the air. An ion is an Atom or Molecule which has lost or gained one or more Valence electrons giving it a positive or negative electrical charge ^[49]

Head position

One study suggests that migraines can be triggered by the head being held downwards for an extended period, as when washing hair in a basin. ^[50]

Treatment

Conventional treatment focuses on three areas: trigger avoidance, symptomatic control, and preventive drugs. Patients who experience migraines often find that the recommended treatments are not 100% effective at preventing migraines, and sometimes may not be effective at all.

Children and adolescents, are often first given drug treatment, but the value of diet modification should not be overlooked. The simple task of starting a diet journal to help modify the intake of trigger foods like hot dogs, chocolate, cheese and ice cream could help alleviate symptoms^[51]

Abortive treatment

Migraine sufferers usually develop their own coping mechanisms for the pain of a migraine attack. Hot or cold water applied to the head, resting in a dark and silent room or ingesting caffeine at an appropriate time may be as helpful as medication for some patients.

For patients who have been diagnosed with recurring migraines, migraine abortive medications can be used to treat the attack, and may be more effective if taken early, losing effectiveness once the attack has begun. Abortive medication (such as the Triptans) is used to interrupt an attack or episode of severe Headache. Treating the attack at the onset can often abort it before it becomes serious, and can reduce the near-term frequency of subsequent attacks.

Paracetamol or Non-steroidal anti-inflammatory drug (NSAIDs)

The first line of treatment is over-the-counter abortive medication. Abortive medication (such as the Triptans) is used to interrupt an attack or episode of severe Headache.

• Regarding non-steroidal anti-inflammatory drugs, a randomized controlled trial found that naproxen can abort about one third of migraine attacks, which was 5% less than the benefit of sumatriptan. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Naproxen ( INN) (nəˈprɒksən is a Non-steroidal anti-inflammatory drug (NSAID commonly used for the reduction of moderate to severe Pain, Fever Sumatriptan ( Imitrex, Imigran, Imigran Recovery) is a Triptan drug including a Sulfonamide group which was marketed ^[52]
• Paracetamol, at a dose of 1000 mg, benefited over half of patients with mild or moderate migraines in a randomized controlled trial. Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare ^[53]
• Simple analgesics combined with caffeine may help. Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic ^[54] During a migraine attack, emptying of the stomach is slowed, resulting in nausea and a delay in absorbing medication. Caffeine has been shown to partially reverse this effect, and probably accounts for its benefit. Excedrin is an example of an aspirin with caffeine product. Excedrin is an over-the-counter Headache Pain reliever, typically in the form of tablets or caplets. Caffeine is recognized by the U. S. FDA as an Over The Counter Drug (OTC) treatment for migraine.

Patients themselves often start off with paracetamol (known as acetaminophen in the USA), aspirin, ibuprofen, or other simple analgesics that are useful for tension headaches. Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve Ibuprofen ( INN) (ˌaɪbjuːˈpɹəʊfɛn (from the now outdated nomenclature i so- bu tyl- pro panoic- phen olic acid is a Non-steroidal OTC drugs may provide some relief, although they are typically not effective for most sufferers. It is one of doctors' practical diagnoses of migraine head pain when patients say typical OTC drugs "won't touch it".

Analgesics combined with antiemetics

Anti-emetics by mouth may help relieve symtoms of nausea and help prevent vomiting, which can diminish the effectiveness of orally taken analgesia. An anti-emetic is a drug that is effective against Vomiting and Nausea. In addition some antiemetics such as metoclopramide are prokinetics and help gastric emptying which is often impaired during episodes of migraine. Metoclopramide ( INN) (ˌmɛtəˈkloʊprəmaɪd or /ˌmɛtəˈklɒprəmaɪd is a potent Dopamine receptor antagonist used for its Antiemetic and Prokinetic Prokinetics are a class of drugs used on the Digestive system. In the UK there are three combination antiemetic and analgesic preparations available: MigraMax (aspirin with metoclopramide), Migraleve (paracetamol/codeine for analgesia, with buclizine as the antiemetic) and paracetamol/metoclopramide (Paramax in UK). Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve Migraleve is the brand name of a range of Migraine -relief medications made by Pfizer. Buclizine is an Antihistamine of the Piperazine derivative family Paracetamol/metoclopramide hydrochloride is an oral Fixed dose combination prescription medication containing the Analgesic Paracetamol (500 mg and the ^[55] The earlier these drugs are taken in the attack, the better their effect.

Some patients find relief from taking other sedative antihistamines which have anti-nausea properties, such as Benadryl which in the US contains diphenhydramine (but a different non-sedative product in the UK). Benadryl is a brand name of McNeil Healthcare (UK Limited and is used to sell Hay fever treatments in various forms around the world Pharmacological action Diphenhydramine (dye fen hye' dra meen works by blocking the effect of histamine at H1 receptor sites

Serotonin agonists

Main article: triptans

Sumatriptan and related selective serotonin receptor agonists are excellent for severe migraines or those that do not respond to NSAIDs^[52] or other over-the-counter drugs. Triptans are a family of Tryptamine based drugs used as Abortive medication in the treatment of Migraine and Cluster headaches They Sumatriptan ( Imitrex, Imigran, Imigran Recovery) is a Triptan drug including a Sulfonamide group which was marketed A serotonin receptor agonist is a compound that activates Serotonin receptors mimicking the effect of the neurotransmitter Serotonin. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher ^[53] Triptans are a mid-line treatment suitable for many migraineurs with typical migraines. Triptans are a family of Tryptamine based drugs used as Abortive medication in the treatment of Migraine and Cluster headaches They They may not work for atypical or unusually severe migraines, transformed migraines, or status (continuous) migraines.

Ergot alkaloids

Until the introduction of sumatriptan in 1991, ergot derivatives (see ergoline) were the primary oral drugs available to abort a migraine once it is established. Ergot is the common name of a Fungus in the Genus Claviceps that is parasitic on certain grains and grasses Ergoline is a Chemical compound whose structural skeleton is contained in a diverse range of Alkaloids and a few Psychedelic drugs

Ergot drugs can be used either as a preventive or abortive therapy, though their relative expense and cumulative side effects suggest reserving them as an abortive rescue medicine. However, ergotamine tartrate tablets (usually with caffeine), though highly effective, and long lasting (unlike triptans), have fallen out of favour due to the problem of ergotism. Ergotamine is an Ergopeptine and part of the Ergot family of Alkaloids it is structurally and biochemically closely related to Ergoline. Ergotism is the effect of long-term Ergot Poisoning traditionally due to the Ingestion of the Alkaloids produced by the Claviceps purpurea Oral ergotamine tablet absorption is reliable unless the patient is nauseated. Anti-nausea administration is available by ergotamine suppository (or Ergostat sublingual tablets made until circa 1992). Ergot drugs themselves can be so nauseating it is advisable for the sufferer to have something at hand to counteract this effect when first using this drug. Ergotamine-caffeine 1/100 mg fixed ratio tablets (like Cafergot, Ercaf, etc. Cafergot is the proprietary name of a Medication consisting of Ergotamine tartrate and Caffeine. ) are much less expensive per headache than triptans, and are commonly available in Asia. They are difficult to obtain in the USA. Ergotamine-caffeine can't be regularly used to abort evening or night onset migraines due to debilitating caffeine interference with sleep. Pure ergotamine tartrate is highly effective for evening-night migraines, but is rarely or never available in the USA. Dihydroergotamine (DHE), which must be injected or inhaled, can be as effective as ergotamine tartrate, but is much more expensive than $2 USD Cafergot tablets. Dihydroergotamine (brand names DHE 45 and Migranal) is an Ergot alkaloid used to treat Migraines For FDA information on this drug

Other agents

If over-the-counter medications do not work, or if triptans are unaffordable, the next step for many doctors is to prescribe Fioricet or Fiorinal, which is a combination of butalbital (a barbiturate), Paracetamol (in Fioricet) or acetylsalicylic acid (more commonly known as aspirin and present in Fiorinal), and caffeine. Fioricet and Esgic are brand name drugs made from a combination of Butalbital (a Barbiturate, 50 mg Acetaminophen (325 mg and Caffeine See also Fioricet, a preparation using Paracetamol (acetaminophen instead of Aspirin. Butalbital, 5-allyl-5-isobutylbarbituric acid is a Barbiturate with an intermediate duration of action Barbiturates are drugs that act as central nervous system Depressants and by virtue of this they produce a wide spectrum of effects from mild Sedation Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic While the risk of addiction is low, butalbital can be habit-forming if used daily, and it can also lead to rebound headaches. Rebound headaches, also known as medication overuse headaches, occur when pain medications ( Analgesics) are taken too frequently to relieve Headache. Barbiturate-containing medications are not available in many European countries.

Narcotic pain killers (for example, codeine, morphine or other opiates) provide variable relief, but their side effects include the possibility of causing rebound headaches or analgesic overuse headache. The term narcotic (ναρκωτικός is believed to have been coined by the Greek physician Galen to refer to agents that benumb or deaden causing loss Codeine ( INN) or methylmorphine is an Opiate used for its Analgesic, antitussive and antidiarrheal properties Medical uses Morphine can be used as an analgesic in hospital settings to relieve pain in Myocardial infarction pain in For other uses see Opiate (disambiguation, or for the class of drugs see Opioid. Rebound headaches, also known as medication overuse headaches, occur when pain medications ( Analgesics) are taken too frequently to relieve Headache. Following an awareness campaign in the US there has been a major shift away from "toughing it out" in terms of pain control, and narcotics are much more widely prescribed than just a decade ago. In the UK and New Zealand, the combination product Migraleve which uses both paracetamol and codeine phosphate is widely used and available both on prescription and as an over the counter drug. Migraleve is the brand name of a range of Migraine -relief medications made by Pfizer. Over-the-counter (OTC drugs are medicines that may be sold without a prescription, in contrast to Prescription drugs The name "over-the-counter"

Amidrine (a cocktail of a pain reliever, a sedative, and a vasoconstrictor) is sometimes prescribed for migraine headaches. Amidrine, Duradrin or Midrin, is a combination of Acetaminophen, Dichloralphenazone, and Isometheptene used mostly to treat Headaches

Anti-emetics may need to be given by suppository or injection where vomiting dominates the symptoms. An anti-emetic is a drug that is effective against Vomiting and Nausea. A suppository is a drug delivery system that is inserted either into the Rectum (rectal suppository Vagina (vaginal suppository or Urethra (urethral An injection is an infusion method of putting Liquid into the Body, usually with a hollow needle and a Syringe which is pierced through

Status migrainosus

Status migrainosus is characterized by migraine lasting more than 72 hours, with not more than four hours of relief during that period. It is generally understood that status migrainosus has been refractory to usual outpatient management upon presentation.

Treatment of migrainous status consists of managing comorbidities (ie, correcting fluid and electrolyte abnormalities resulting from the anorexia and nausea/vomiting often accompanying status), and usually administering parenteral medication to "break" (abort) the headache.

Although the literature is full of many case reports concerning treatment of status, first line therapy usually consists of the parenteral administration of DHE or a neuromodulator (ie, a valproic acid derivative or topiramate), followed by the institution of a prophylactic regimen. Alternative therapies have included parenteral narcotics, intravenous lidocaine, magnesium, serotonergic antiemetics such as promethazine or chlorpromazine, and corticosteroids. The later is often advocated in the therapy of intractable headache resulting from medication rebound.

Herbal treatment

The herbal supplement feverfew (more commonly used for migraine prevention, see below) is marketed by the GelStat Corporation as an OTC migraine abortive, administered sublingually (under the tongue) in a mixture with ginger. Feverfew ( Tanacetum parthenium; syn Chrysanthemum parthenium ( L Ginger is commonly used as a cooking spice throughout the world ^[56] An open-label study (funded by GelStat) found some tentative evidence of the treatment's effectiveness,^[57] but no scientifically sound study has been done.

Comparative studies

Regarding comparative effectiveness of these drugs used to abort migraine attacks, a 2004 placebo-controlled trial^[58] reveals that high dose acetylsalicylic acid (1000 mg), sumatriptan 50 mg and ibuprofen 400 mg are equally effective at providing relief from pain, although sumatriptan was superior in terms of the more demanding outcome of rendering patients entirely free of pain and all other migraine-related symptoms.

Another randomized controlled trial, funded by the manufacturer of the study drug, found that a combination of sumatriptan 85 mg and naproxen sodium 200 mg was better than either drug alone. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Sumatriptan ( Imitrex, Imigran, Imigran Recovery) is a Triptan drug including a Sulfonamide group which was marketed Naproxen ( INN) (nəˈprɒksən is a Non-steroidal anti-inflammatory drug (NSAID commonly used for the reduction of moderate to severe Pain, Fever ^[52]

Preventive treatment

Preventive (also called prophylactic) treatment of migraines can be an important component of migraine management. Prophylaxis ( Greek "προφυλάσσω" to guard or prevent beforehand) is any medical or Public health procedure whose purpose Such treatments can take many forms, including everything from taking certain drugs or nutritional supplements, to lifestyle alterations such as increased exercise and avoidance of migraine triggers.

The goals of preventive therapy are to reduce the frequency, painfulness, and/or duration of migraines, and to increase the effectiveness of abortive therapy. ^[59] Another reason to pursue these goals is to avoid medication overuse headache (MOH), otherwise known as rebound headache, which is a common problem among migraneurs. Rebound headaches, also known as medication overuse headaches, occur when pain medications ( Analgesics) are taken too frequently to relieve Headache. This is believed to occur in part due to overuse of pain medications, and can result in chronic daily headache. ^[60]

Prescription drugs

A 2006 review article by S. Modi and D. Lowder offers some general guidelines on when a physician should consider prescribing drugs for migraine prevention:

Following appropriate management of acute migraine, patients should be evaluated for initiation of preventive therapy. Factors that should prompt consideration of preventive therapy include the occurrence of two or more migraines per month with disability lasting three or more days per month; failure of, contraindication for, or adverse events from acute treatments; use of abortive medication more than twice per week; and uncommon migraine conditions (e. g. , hemiplegic migraine, migraine with prolonged aura, migrainous infarction). Patient preference and cost also should be considered.

. . . Therapy should be initiated with medications that have the highest levels of effectiveness and the lowest potential for adverse reactions; these should be started at low dosages and titrated slowly. A full therapeutic trial may take two to six months. After successful therapy (e. g. , reduction of migraine frequency by approximately 50 percent or more) has been maintained for six to 12 months, discontinuation of preventive therapy can be considered. ^[59]

Preventive medication has to be taken on a daily basis, usually for a few weeks, before the effectiveness can be determined. Supervision by a neurologist is advisable. A large number of medications with varying modes of action can be used. Selection of a suitable medication for any particular patient is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next. Often preventive medications do not have to be taken indefinitely. Sometimes as little as six months of preventive therapy is enough to "break the headache cycle" and then they can be discontinued.

The most effective prescription medications include several drug classes:

• beta blockers such as propranolol and atenolol. Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias Propranolol ( INN) is a non-selective Beta blocker mainly used in the treatment of Hypertension. Atenolol is a β1 receptor specific antagonist a drug belonging to the group of β-blockers, a class of drugs used primarily in Cardiovascular diseases A meta-analysis by the Cochrane Collaboration of nine randomized controlled trials or crossover studies, which together included 668 patients, found that propranolol had an "overall relative risk of response to treatment (here called the 'responder ratio')" was 1. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare A crossover trial also referred to as a crossover study is a Clinical trial in which patients are given all of the medications to be studied or one medication and Propranolol ( INN) is a non-selective Beta blocker mainly used in the treatment of Hypertension. In Statistics and mathematical Epidemiology, relative risk (RR is the risk of an event (or of developing a disease relative to exposure 94. ^[61]
• anticonvulsants such as valproic acid and topiramate. The anticonvulsants, also called antiepileptic drugs (abbreviated "AEDs" are a diverse group of pharmaceuticals used in the treatment of epileptic Valproic acid ( VPA) is a Chemical compound that has found clinical use as an Anticonvulsant and mood-stabilizing drug, primarily in Topiramate (brand name Topamax) is an Anticonvulsant drug produced by Ortho-McNeil Neurologics and Noramco Inc A meta-analysis by the Cochrane Collaboration of ten randomized controlled trials or crossover studies, which together included 1341 patients, found anticonvulsants had an "2. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare A crossover trial also referred to as a crossover study is a Clinical trial in which patients are given all of the medications to be studied or one medication and The anticonvulsants, also called antiepileptic drugs (abbreviated "AEDs" are a diverse group of pharmaceuticals used in the treatment of epileptic 4 times more likely to experience a 50% or greater reduction in frequency with anticonvulsants than with placebo" and a number needed to treat of 3. The number needed to treat (NNT is an epidemiological measure used in assessing the effectiveness of a health-care intervention typically a treatment with Medication 8. ^[62] However, concerns have been raised about the marketing of gabapentin. Gabapentin (brand name Neurontin) is a medication originally developed for the treatment of Epilepsy. ^[63]
• antidepressants include tricyclic antidepressants (TCAs) such as amitriptyline and the newer selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine. An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression Tricyclic antidepressants (abbreviation TCAs) are a class of Antidepressant drugs first used in the 1950s Amitriptyline (or Amitryptyline) hydrochloride (sold as Elavil Tryptanol Endep Elatrol Tryptizol Trepiline Laroxyl Saroten is a Tricyclic antidepressant Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders A meta-analysis by the Cochrane Collaboration found selective serotonin reuptake inhibitors are no more effective than placebo. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders ^[64] Another meta-analysis found benefit from SSRIs among patients with migraine or tension headache; however, the effect of SSRIs on only migraines was not separately reported. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses ^[65] A randomized controlled trial found that amitriptyline was better than placebo and similar to propranolol. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Amitriptyline (or Amitryptyline) hydrochloride (sold as Elavil Tryptanol Endep Elatrol Tryptizol Trepiline Laroxyl Saroten is a Tricyclic antidepressant Propranolol ( INN) is a non-selective Beta blocker mainly used in the treatment of Hypertension. ^[66]

Other drugs:

• Sansert was withdrawn from the US market by Novartis, but is available in Canadian pharmacies. Methysergide (UML-491 is a prescription drug used for prophylaxis of migraine headaches and is sold under the brand names Sansert and Deseril in 2mg dosages Novartis International AG is a multinational Pharmaceutical company based in Basel Switzerland that manufactures drugs such as Clozapine Although highly effective, it has rare but serious side effects, including retroperitoneal fibrosis. Retroperitoneal fibrosis or Ormond's disease is a disease featuring the proliferation of fibrous tissue in the Retroperitoneum, the compartment of the body containing
• Namenda, memantine HCI tablets, which is used in the treatment of Alzheimer's Disease, is beginning to be used off label for the treatment of migraines. Memantine is the first in a novel class of Alzheimer's disease medications acting on the Glutamatergic system by blocking NMDA glutamate receptors It has not yet been approved by the FDA for the treatment of migraines.
• ASA or Asprin can be taken daily in low doses such as 80 to 81 mg, the blood thinners in ASA has been shown to help some migrainures, especially those who have an aura. Robert Lynn Asprin ( June 28, 1946 – May 22, 2008) was an American Science fiction and fantasy author best known

Trigger avoidance

Patients can attempt to identify and avoid factors that promote or precipitate migraine episodes. Moderation in alcohol and caffeine intake, consistency in sleep habits, and regular meals may be helpful. General dietary restriction has not been demonstrated to be an effective approach to treating migraine, and migraine is remarkably resistant to the placebo effect [3]

Nonetheless, some people fervently claim that they have successfully identified foods that are likely to result in migraines, and by avoiding them, can decrease the likelihood of an episode. Placebo is a substance or procedure a patient accepts as medicine or therapy but which has no specific therapeutic activity

Herbal and nutritional supplements

Butterbur

50 mg or 75 mg/day of butterbur (Petasites hybridus) rhizome extract was shown in a controlled trial to provide 50% or more reduction in the number of migraines to 68% of participants in the 75 mg dose group, 56% in the 50 mg dose group and 49% in the placebo group after four months. Native butterbur contains some carcinogenic compounds, but a purified version, Petadolex, does not. [4]

Cannabis

Cannabis was a standard treatment for migraines from the mid-19th century until it was outlawed in the early 20th century in the USA. Cannabis ( Cán-na-bis) is a Genus of Flowering plants that includes three putative species Cannabis sativa subsp It has been reported to help people through an attack by relieving the nausea and dulling the head pain, as well as possibly preventing the headache completely when used as soon as possible after the onset of pre-migraine symptoms, such as aura. There is some indication that semi-regular use may reduce the frequency of attacks. Further studies are being conducted. Some migraine sufferers report that cannabis decreases throbbing and pain, especially if smoked. A pharmaceutical company is currently conducting trials of a whole cannabis extract spray for migraine[5]

Coenzyme Q10

Supplementation of coenzyme Q10 has been found to have a beneficial effect on the condition of some sufferers of migraines. Coenzyme Q10 (also known as ubiquinone ubidecarenone coenzyme Q and abbreviated at times to CoQ10 CoQ Q10 or Q is a Benzoquinone, where Q In an open-label trial,^[67] Young and Silberstein found that 61. An open-label trial is a type of Clinical trial in which both the researchers and participants know which treatment is being administered 3% of patients treated with 100 mg/day had a greater than 50% reduction in number of days with migraine, making it more effective than most prescription prophylactics. Fewer than 1% reported any side effects. A double-blind placebo-controlled trial has also found positive results. ^[68]

Feverfew

The plant feverfew (Tanacetum parthenium) is a traditional herbal remedy believed to reduce the frequency of migraine attacks. Feverfew ( Tanacetum parthenium; syn Chrysanthemum parthenium ( L A number of clinical trials have been carried out to test this claim, but a 2004 review article concluded that the results have been contradictory and inconclusive. ^[69] However, since then, more studies have been carried out. ^[70] As well as its prophylactic properties, feverfew is also touted as a migraine abortative.

Magnesium Citrate

Magnesium citrate has reduced the frequency of migraine in an experiment in which the magnesium citrate group received 600 mg per day oral of trimagnesium dicitrate. Magnesium citrate is a chemical agent used medicinally as a saline Laxative and to empty the bowel prior to a surgery or Colonoscopy. In weeks 9–12, the frequency of attacks was reduced by 41. 6% in the magnesium citrate group and by 15. 8% in the placebo group. ^[71]

Riboflavin

The supplement Riboflavin (also called Vitamin B₂) has been shown (in a placebo-controlled trial)^[72] to reduce the number of migraines, when taken at the high dose of 400 mg daily for three months. Riboflavin ( E101) also known as vitamin B2, is an easily absorbed Micronutrient with a key role in maintaining Health ^[73][74]

Vitamin B12

There is tentative evidence that Vitamin B₁₂ may be effective in preventing migraines. ^[73] In particular, in an open-label pilot study, 1 mg of intranasal hydroxocobalamin (a form of Vitamin B12), taken daily for three months, was shown to reduce migraine frequency by 50% or more in 10 of 19 participants. Hydroxocobalamin (OHCbl is a natural analog of Vitamin B-12, a basic member of the cobalamin family of compounds ^[75] Although the study was not placebo-controlled, this response is larger than the typical placebo effect in migraine prophylaxis. ^[76]

Surgical treatments

Surgery may be used to treat migraines by severing the corrugator supercilii muscle and zygomaticotemporal nerve. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental The Corrugator supercilii is a small narrow pyramidal muscle placed at the medial end of the Eyebrow, beneath the Frontalis and Orbicularis oculi. The zygomaticotemporal nerve or zygomaticotemporal branch (temporal branch is derived from the maxillary branch of the trigeminal nerve (Cranial nerve 5 ^[77] The treatment may reduce or eliminate headaches in some individuals. ^[78]

In 2005, research^[79] was published indicating that in some people with a patent foramen ovale (PFO), a hole between the upper chambers of the heart, suffer from migraines which may have been caused by the PFO. Atrial septal defect ( ASD) is a form of congenital heart defect that enables blood flow between the left and right atria via the Interatrial septum. The migraines reduce in frequency if the hole is patched. Several clinical trials are currently under way in an effort to determine if a causal link between PFO and migraine can be found. Early speculation as to this relationship has centered on the idea that the lungs detoxify blood as it passes through. The PFO allows uncleaned blood to go directly from the right side of the heart to the left without passing through the lungs.

Botulin toxin has been used to treat individuals with frequent or chronic migraines. Botulinum toxin is a Neurotoxin Protein produced by the Bacterium Clostridium botulinum. ^[80] Its usefulness is uncertain with evidence suggesting it is not superior to placebo treatment^[81] and does not appear to be useful in the treatment of episodic migraine. Placebo is a substance or procedure a patient accepts as medicine or therapy but which has no specific therapeutic activity ^[82]

Spinal cord stimulators are an implanted medical device sometimes used for those who suffer severe migraines several days each month. Spinal Cord Stimulator (SCS or Dorsal Column Stimulator (DCS is an implantable Medical device used to treat chronic pain of neurologic origin ^[83]

Noninvasive medical treatments

Transcranial Magnetic Stimulation (TMS): At the 49th Annual meeting of the American Headache Society in June 2006, scientists from Ohio State University Medical Center presented medical research on 47 candidates that demonstrated that TMS — a medically non-invasive technology for treating depression, obsessive compulsive disorder and tinnitus, among other ailments — helped to prevent and even reduce the severity of migraines among its patients. Transcranial magnetic stimulation ( TMS) is a noninvasive method to excite neurons in the Brain: weak Electric currents are induced in the tissue by rapidly The American Headache Society (AHS is a professional society of health care providers dedicated to the study and treatment of Headache and facial pain. The Ohio State University ( OSU) is a Coeducational public Research university in the state of Ohio. Obsessive-compulsive disorder (OCD is a Chronic Anxiety disorder most commonly characterized by obsessive Distressing Intrusive thoughts Tinnitus (tɪˈnaɪtəs or /ˈtɪnɪtəs/ from the Latin word for " Ringing " is the perception of sound within the human ear in the absence of corresponding This treatment essentially disrupts the aura phase of migraines before patients develop full-blown migraines. [6] In about 74% of the migraine headaches, TMS was found to eliminate or reduce nausea and sensitivity to noise and light. [7] Their research suggests that there is a strong neurological component to migraines. A larger study will be conducted soon to better assess TMS's complete effectiveness. ^[84]

Biofeedback has been used successfully by some to control migraine symptoms through training and practice. Biofeedback is a form of Alternative medicine that involves measuring a subject's quantifiable bodily functions such as Blood pressure, Heart rate, ^[85]

Hyperbaric oxygen therapy has been used successfully in treating migraines. Hyperbaric medicine, also known as hyperbaric oxygen therapy (HBOT is the medical use of Oxygen at a higher than Atmospheric pressure. ^[86] This suggests that sufferers might be treated during an attack with a hyperbaric chamber of some sort, such as a Gamow bag (as is done in the treatment of "The Bends" and altitude sickness). A diving chamber or submersible chamber has two main functions as a simpler form of submersible vessel to take divers Underwater A Gamow bag is an inflatable pressure bag that is large enough to fit a person inside Decompression sickness (DCS, the diver’s disease, the bends, caisson disease is the name given to a variety of symptoms suffered by a person Altitude sickness, also known as acute mountain sickness ( AMS) altitude illness, or soroche, is a pathological condition that is caused by acute

Bruxism, clenching or grinding of teeth, especially at night, is a trigger for many migraineurs. Bruxism (from the Greek βρυγμός (brugmós gnashing of teeth) is the grinding of the teeth and is typically accompanied by the clenching A device called a nociceptive trigeminal inhibitor (NTI) takes advantage of a reflex limiting the force of clenching. It can be fitted by dentists and clips over the front teeth at night, preventing contact between the back teeth. It has a success rate similar to butterbur and co-enzyme Q10, although it has not been subjected to the same rigorous testing as the supplements. Massage therapy of the jaw area can also reduce such pain.

There is a speculative connection between vision correction (particular with prism eyeglasses) and migraines. Two British studies, one from 1934^[87] and another from 1956^[88] claimed that many patients were provided with complete relief from migraine symptoms with proper eyeglass prescriptions, which included prescribed prism. However, both studies are subject to criticism because of sample bias, sample size, and the lack of a control group. A more recent study [8] found that precision tinted lenses may be an effective migraine treatment. (Most optometrists avoid prescribing prism because, when incorrectly prescribed, it can cause headaches. )

Behavioral treatments

Many physicians believe that exercise for 15–20 minutes per day is helpful for reducing the frequency of migraines. ^[89]

Sleep is often a good solution if a migraine is not so severe as to prevent it, as when a person awakes the symptoms will have most likely subsided.

Diet, visualization, and self-hypnosis are also alternative treatments and prevention approaches. This article is primarily about the human diet For a discussion of animal diets see List of feeding behaviours. The term autosuggestion is used for positive or negative physical Symptoms explained by the thoughts and beliefs of a person The term autosuggestion is used for positive or negative physical Symptoms explained by the thoughts and beliefs of a person

Sexual activity has been reported by a proportion of male and female migraine sufferers to relieve migraine pain significantly in some cases. Human sexual behavior or different human sexual practices encompass a wide range of activities such as strategies to find or attract partners ( Mating and display [9]

In many cases where a migraine follows a particular cycle, attempting to interrupt the cycle may prolong the symptoms. Letting a headache "run its course" by not using painkillers can sometimes decrease the length of an episode. This is especially true of cases where vomiting is common, as often the headache will subside immediately after vomiting. Curbing the pain may delay vomiting, and prolong the headache.

Alternative medicine

A number of forms of alternative medicine, particularly bodywork, are used in preventing migraines. The term alternative medicine, as used in the modern western world encompasses any healing practice "that does not fall within the realm of conventional Medicine. Bodywork is a term used in Alternative medicine or Complementary medicine to describe any therapeutic healing or personal development work which involves some form

Massage therapy and physical therapy are often very effective forms of treatment to reduce the frequency and intensity of migraines. However, it is important to be treated by a well-trained therapist who understands the pathophysiology of migraines. Deep massage can 'trigger' a migraine attack in a person who is not used to such treatments. It is advisable to start sessions as short in duration and then work up to longer treatments. Likewise, some migraine sufferers find relief through chiropractic care.

Frequent migraines can leave the sufferer with a stiff neck which can cause stress headaches that can then exacerbate the migraines. Claims have been made that Myofascial Release can relieve this tension and in doing so reduce or eliminate the stress headache element. Myofascial Release is a form of Soft tissue therapy which includes but is not limited to structural assessments and manual Massage techniques for stretching the

Some migraine sufferers find relief through acupuncture, which is usually used to help prevent headaches from developing. History Antiquity In China, the practice of acupuncture can perhaps be traced as far back as ^[90] Sometimes acupuncture is used to relieve the pain of an active migraine headache. ^[91] In one controlled trial of acupuncture with a sham control in migraine, the acupuncture was not more effective than the sham acupuncture but was more effective than delayed acupuncture.

Additionally acupressure is used by some for relief. Acupressure For instance pressure between the thumbs and index finger to help subside headaches if the headache or migraine isn't too severe.

Incense and scents are shown to help. Incense is composed of Aromatic biotic materials It releases fragrant Smoke when burned The smell and incense of peppermint and lavender have been proven to help with migraines and headaches more so than most other scents. ^[92] However, some scents can be a trigger factor.

History

9000 year old skulls exist with evidence of trepanation. Trepanation (also known as trepanning, trephination, trephining or burr hole) is surgery in which a hole is Drilled or scraped into It is hypothesized that this drastic step was taken in response to headaches, though there is no clear evidence proving this. . Headache with neuralgia was recorded in the medical documents of the ancient Egyptians as early as 1200 BC. Neuralgia is a painful disorder of the Nerves. Under the general heading of neuralgia are Trigeminal neuralgia (TN Atypical trigeminal neuralgia (ATN In 400 BC Hippocrates described the visual aura that can precede the migraine headache and the relief which can occur through vomiting. Hippocrates of Cos II or Hippokrates of Kos ( ca. 460 BC – ca An aura is the perceptual disturbance experienced by some Migraine sufferers before a migraine headache and the telltale sensation experienced by some people with Epilepsy Aretaeus of Cappadocia is credited as the "discoverer" of migraines because of his second century description of the symptoms of a unilateral headache associated with vomiting, with headache-free intervals in between attacks. Cappadocia (or Capadocia, Turkish Kapadokya, from Greek: Καππαδοκία / Kappadokía which in turn is from the Persian: Galenus of Pergamon used the term "hemicrania" (half-head), from which the word "migraine" was derived. Galen ( Greek: Γαληνός Galēnos; Latin: Claudius Galenus, Aelius Galenus, Claudius Aelius Galenus, or He thought there was a connection between the stomach and the brain because of the nausea and vomiting that often accompany an attack. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following For relief of migraine, Andalusian-born physician Abulcasis, also known as Abu El Quasim, suggested application of a hot iron to the head or insertion of garlic into an incision made in the temple. TemplateInfobox Muslim scholars --> Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi (936 - 1013 (أبو القاسم بن خلف In the Medieval Ages migraine was recognized as a discrete medical disorder with treatment ranging from hot irons to blood letting and even witchcraft. Followers of Galenus explained migraine as caused by aggressive yellow bile. Erich Adickes, Eduard Spränger, Ernst Kretschmer, and Erich Fromm all theorized on the four temperaments (with different names and greatly Ebn Sina (Avicenna) described migraine in his textbook "El Qanoon fel teb" as ". TemplateInfobox Muslim scholars --> ( Persian /ابو علی الحسین ابن عبدالله ابن سینا (born . . small movements, drinking and eating, and sounds provoke the pain. . . the patient cannot tolerate the sound of speaking and light. He would like to rest in darkness alone. " Abu Bakr Mohamed Ibn Zakariya Râzi noted the association of headache with different events in the lives of women, ". . . And such a headache may be observed after delivery and abortion or during menopause and dysmenorrhea. An Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan Dysmenorrhea (or dysmenorrhoea) is a medical condition characterized by severe Uterine Pain during Menstruation. "

In Bibliotheca Anatomica, Medic, Chirurgica, published in London in 1712, five major types of headaches are described, including the "Megrim", recognizable as classic migraine. London ( ˈlʌndən is the capital and largest urban area in the United Kingdom. Graham and Wolff (1938) published their paper advocating ergotamine tart for relieving migraine. Ergotamine is an Ergopeptine and part of the Ergot family of Alkaloids it is structurally and biochemically closely related to Ergoline. Later in the 20th century, Harold Wolff (1950) developed the experimental approach to the study of headache and elaborated the vascular theory of migraine, which has come under attack as the pendulum again swings to the neurogenic theory.

Economic impact

In addition to being a major cause of pain and suffering, chronic migraine attacks are a significant source of both medical costs and lost productivity. Medical costs per migraine sufferer (mostly physician and emergency room visits) averaged $107 USD over six months in one 1988 study, with total costs including lost productivity averaging $313. The United States dollar ( sign: $; code: USD) is the unit of Currency of the United States; it has also been Annual employer cost of lost productivity due to migraines was estimated at $3,309 per sufferer. Total medical costs associated with migraines in the United States amounted to one billion dollars in 1994, in addition to lost productivity estimated at thirteen to seventeen billion dollars per year. Employers may benefit from educating themselves on the effects of migraines in order to facilitate a better understanding in the workplace. The workplace model of 9–5, 5 days a week may not be viable for a migraine sufferer. With education and understanding an employer could compromise with an employee to create a workable solution for both.

Migraine and cardiovascular risks

The risk of stroke may be increased two- to threefold in migraine sufferers. A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain Young adult sufferers and women using hormonal contraception appear to be at particular risk. Hormonal contraception refers to Birth control methods that act on the hormonal system ^[93] The mechanism of any association is unclear, but chronic abnormalities of cerebral blood vessel tone may be involved. The blood vessels are part of the Circulatory system and function to transport Blood throughout the body Women who experience auras have been found to have twice the risk of strokes and heart attacks over non-aura migraine sufferers and women who do not have migraines. ^[94][93] Migraine sufferers seem to be at risk for both thrombotic and hemorrhagic stroke as well as transient ischemic attacks. A transient ischemic attack ( TIA, often colloquially referred to as “ mini stroke ” is caused by the changes in the blood supply to a particular area of the ^[95] Death from cardiovascular causes was higher in people with migraine with aura in a Women's Health Initiative study, but more research is needed to confirm this. ^[96][97]

References

Footnotes

External links

• Migraine at the Open Directory Project

General information

• Migraine Information from the US National Institute of Neurological Disorders and Stroke
• Diagnostic criteriaPDF (1. The Open Directory Project ( ODP) also known as dmoz (from directory 21 MB)

Organizations

• World Headache Alliance
• Headache, a medical journal

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