Migraine: Difference between revisions
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===Migraine without aura=== |
===Migraine without aura=== |
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The common form of migraine headache; the patient primarily suffers migraine without [[aura (symptom)|aura]], and might also suffer migraine with aura. The International Classification of Headache Disorders<ref name="pmid14979299"/> definition is: |
The common form of migraine headache; the patient primarily suffers migraine without [[aura (symptom)|aura]], and might also suffer migraine with aura. The International Classification of Headache Disorders<ref name="pmid14979299"/> definition is: |
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{{quotation|'''Description:''' 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|phonophobia]]. |
{{quotation|'''Description:''' 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|phonophobia]]. |
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'''Diagnostic criteria:'''<br> |
'''Diagnostic criteria:'''<br> |
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The second-most common form of migraine headache: the patient primarily suffers migraine with aura, and might also suffer migraine without aura. The International Classification of Headache Disorders<ref name="pmid14979299"/> definition is: |
The second-most common form of migraine headache: the patient primarily suffers migraine with aura, and might also suffer migraine without aura. The International Classification of Headache Disorders<ref name="pmid14979299"/> definition is: |
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{{quotation| |
{{quotation| |
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'''Description''': 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, headache lacks migrainous feature or is completely absent [i.e., the aura may occur without any subsequent headache]. |
'''Description''': 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, headache lacks migrainous feature or is completely absent [i.e., the aura may occur without any subsequent headache]. |
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'''Diagnostic criteria''':<br> |
'''Diagnostic criteria''':<br> |
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A. At least two attacks fulfilling criterion B<br> |
A. At least two attacks fulfilling criterion B<br> |
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B. Migraine aura fulfilling criteria [described below]<br> |
B. Migraine aura fulfilling criteria [described below]<br> |
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C. Not attributed to another disorder. |
C. Not attributed to another disorder. |
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...['''Criteria for "Typical aura"''':]<br> |
...['''Criteria for "Typical aura"''':]<br> |
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1. [[Homonymous hemianopsia|Homonymous visual symptoms]] [i.e., affecting just one side of the field of vision] and/or unilateral sensory symptoms [i.e., affecting just one side of the body]<br> |
1. [[Homonymous hemianopsia|Homonymous visual symptoms]] [i.e., affecting just one side of the field of vision] and/or unilateral sensory symptoms [i.e., affecting just one side of the body]<br> |
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2. At least one aura symptom develops gradually over [at least] 5 minutes and/or different aura symptoms occur [one after the other] over [at least] 5 minutes<br> |
2. At least one aura symptom develops gradually over [at least] 5 minutes and/or different aura symptoms occur [one after the other] over [at least] 5 minutes<br> |
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3. Each symptom lasts [from] 5 [to] 60 minutes |
3. Each symptom lasts [from] 5 [to] 60 minutes |
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...['''Other potential aura criteria''':]<br> |
...['''Other potential aura criteria''':]<br> |
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The first line of treatment is [[over-the-counter]] [[abortive medication]]. |
The first line of treatment is [[over-the-counter]] [[abortive medication]]. |
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* Regarding [[non-steroidal anti-inflammatory drug]]s, a [[randomized controlled trial]] found that [[naproxen]] can abort about one third of migraine attacks, which was 5% less than the benefit of [[sumatriptan]].<ref name="pmid17405970">{{cite journal |author=Brandes JL, Kudrow D, Stark SR, ''et al'' |title=Sumatriptan-naproxen for acute treatment of migraine: a randomized trial |journal=JAMA |volume=297 |issue=13 |pages=1443–54 |year=2007 |pmid=17405970 |doi=10.1001/jama.297.13.1443}}</ref> |
* Regarding [[non-steroidal anti-inflammatory drug]]s, a [[randomized controlled trial]] found that [[naproxen]] can abort about one third of migraine attacks, which was 5% less than the benefit of [[sumatriptan]].<ref name="pmid17405970">{{cite journal |author=Brandes JL, Kudrow D, Stark SR, ''et al'' |title=Sumatriptan-naproxen for acute treatment of migraine: a randomized trial |journal=JAMA |volume=297 |issue=13 |pages=1443–54 |year=2007 |pmid=17405970 |doi=10.1001/jama.297.13.1443}}</ref> |
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* [[Paracetamol]], at a dose of 1000 |
* [[Paracetamol]], at a dose of 1000 mg, benefited over half of patients with mild or moderate migraines in a [[randomized controlled trial]].<ref name="pmid11112243">{{cite journal |author=Lipton RB, Baggish JS, Stewart WF, Codispoti JR, Fu M |title=Efficacy and safety of paracetamol in the treatment of migraine: results of a randomized, double-blind, placebo-controlled, population-based study |journal=Arch. Intern. Med. |volume=160 |issue=22 |pages=3486–92 |year=2000 |pmid=11112243| doi = 10.1001/archinte.160.22.3486 <!--Retrieved from CrossRef by DOI bot-->}}</ref> |
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* Simple analgesics combined with [[caffeine]] may help.<ref name="pmid10524663">{{cite journal |author=Goldstein J, Hoffman HD, Armellino JJ, ''et al'' |title=Treatment of severe, disabling migraine attacks in an over-the-counter population of migraine sufferers: results from three randomized, placebo-controlled studies of the combination of paracetamol, aspirin, and caffeine |journal=Cephalalgia : an international journal of headache |volume=19 |issue=7 |pages=684–91 |year=1999 |pmid=10524663 |doi=}}</ref> 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. [[Excedrin]] is an example of an aspirin with caffeine product. Caffeine is recognized by the [[U.S. Food and Drug Administration]] as an Over The Counter Drug (OTC) treatment for migraine when compounded with aspirin and paracetamol.<ref>{{cite web |url=http://www.fda.gov/cder/foi/appletter/1999/20802s02ltr.pdf|title=Approval Letter, Application 20-802/S802 |accessdate=2008-08-26 |author=Center for Drug Evaluation and Research |date=1999-10-07 |format=PDF |publisher=U.S. Food and Drug Administration}}</ref> |
* Simple analgesics combined with [[caffeine]] may help.<ref name="pmid10524663">{{cite journal |author=Goldstein J, Hoffman HD, Armellino JJ, ''et al'' |title=Treatment of severe, disabling migraine attacks in an over-the-counter population of migraine sufferers: results from three randomized, placebo-controlled studies of the combination of paracetamol, aspirin, and caffeine |journal=Cephalalgia : an international journal of headache |volume=19 |issue=7 |pages=684–91 |year=1999 |pmid=10524663 |doi=}}</ref> 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. [[Excedrin]] is an example of an aspirin with caffeine product. Caffeine is recognized by the [[U.S. Food and Drug Administration]] as an Over The Counter Drug (OTC) treatment for migraine when compounded with aspirin and paracetamol.<ref>{{cite web |url=http://www.fda.gov/cder/foi/appletter/1999/20802s02ltr.pdf|title=Approval Letter, Application 20-802/S802 |accessdate=2008-08-26 |author=Center for Drug Evaluation and Research |date=1999-10-07 |format=PDF |publisher=U.S. Food and Drug Administration}}</ref> |
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| author= Ben | title= Managing Migraines| journal=FDA Consumer Magazine. | year=2006}}</ref>{{Verify credibility|date=December 2008}} |
| author= Ben | title= Managing Migraines| journal=FDA Consumer Magazine. | year=2006}}</ref>{{Verify credibility|date=December 2008}} |
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====Analgesics combined with antiemetics==== |
====Analgesics combined with antiemetics==== |
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[[Anti-emetic]]s by mouth may help relieve symtoms of nausea and help prevent vomiting, which can diminish the effectiveness of orally taken analgesia. In addition some antiemetics such as [[metoclopramide]] are [[prokinetic]]s and help gastric emptying which is often impaired during episodes of migraine. 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).<ref>{{cite book |title=[[British National Formulary]] |edition=55 |month=March | year=2008 |chapter=4.7.4.1 Treatment of acute migraine |pages=p.239}}</ref> The earlier these drugs are taken in the attack, the better their effect. |
[[Anti-emetic]]s by mouth may help relieve symtoms of nausea and help prevent vomiting, which can diminish the effectiveness of orally taken analgesia. In addition some antiemetics such as [[metoclopramide]] are [[prokinetic]]s and help gastric emptying which is often impaired during episodes of migraine. 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).<ref>{{cite book |title=[[British National Formulary]] |edition=55 |month=March | year=2008 |chapter=4.7.4.1 Treatment of acute migraine |pages=p.239}}</ref> The earlier these drugs are taken in the attack, the better their effect. |
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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. |
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. |
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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]]. 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 |
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]]. 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.) 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. |
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====Steroids==== |
====Steroids==== |
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==== Comparative studies ==== |
==== Comparative studies ==== |
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Regarding comparative effectiveness of these drugs used to abort migraine attacks, a 2004 placebo-controlled trial<ref name="ASADiener">{{cite journal | author = Diener H, Bussone G, de Liano H, Eikermann A, Englert R, Floeter T, Gallai V, Göbel H, Hartung E, Jimenez M, Lange R, Manzoni G, Mueller-Schwefe G, Nappi G, Pinessi L, Prat J, Puca F, Titus F, Voelker M | title = Placebo-controlled comparison of effervescent acetylsalicylic acid, sumatriptan and ibuprofen in the treatment of migraine attacks | journal = Cephalalgia | volume = 24 | issue = 11 | pages = 475 | year = 2004 | pmid = 15482357 | doi = 10.1111/j.1468-2982.2004.00783.x <!--Retrieved from CrossRef by DOI bot-->}}</ref> reveals that high dose acetylsalicylic acid (1000 |
Regarding comparative effectiveness of these drugs used to abort migraine attacks, a 2004 placebo-controlled trial<ref name="ASADiener">{{cite journal | author = Diener H, Bussone G, de Liano H, Eikermann A, Englert R, Floeter T, Gallai V, Göbel H, Hartung E, Jimenez M, Lange R, Manzoni G, Mueller-Schwefe G, Nappi G, Pinessi L, Prat J, Puca F, Titus F, Voelker M | title = Placebo-controlled comparison of effervescent acetylsalicylic acid, sumatriptan and ibuprofen in the treatment of migraine attacks | journal = Cephalalgia | volume = 24 | issue = 11 | pages = 475 | year = 2004 | pmid = 15482357 | doi = 10.1111/j.1468-2982.2004.00783.x <!--Retrieved from CrossRef by DOI bot-->}}</ref> 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. |
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Another [[randomized controlled trial]], funded by the manufacturer of the study drug, found that a combination of [[sumatriptan]] 85 |
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.<ref name="pmid17405970">{{cite journal |author=Brandes JL, Kudrow D, Stark SR, ''et al'' |title=Sumatriptan-naproxen for acute treatment of migraine: a randomized trial |journal=JAMA |volume=297 |issue=13 |pages=1443–54 |year=2007 |pmid=17405970 |doi=10.1001/jama.297.13.1443}}</ref> |
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Recently the combination of [[sumatriptan]] 85 |
Recently the combination of [[sumatriptan]] 85 mg and [[naproxen]] sodium 500 mg was demonstrated to be effective and well tolerated in an early intervention paradigm for the acute treatment of migraine. Significant pain-free responses in favor of [[sumatriptan]]/[[naproxen]] were demonstrated as early as 30 minutes, maintained at 1 hour, and sustained from 2 to 24 hours. At 2 and 4 hours, [[sumatriptan]]/[[naproxen]] provided significantly lower rates of traditional migraine-associated symptoms (nausea, photophobia, and phonophobia) and nontraditional migraine-associated symptoms (neck pain/discomfort and sinus pain/pressure).<ref name="pmid18606965">{{cite journal |author=Silberstein SD, Mannix LK, Goldstein J, ''et al'' |title=Multimechanistic (sumatriptan-naproxen) early intervention for the acute treatment of migraine |journal=Neurology |volume=71 |issue=2 |pages=114–21 |year=2008 |pmid=18606965 |doi=10.1212/01.wnl.0000316800.22949.20}}</ref> |
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== Preventive treatment == |
== Preventive treatment == |
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* [[Sansert]] was withdrawn from the US market by [[Novartis]], but is available in Canadian pharmacies. Although highly effective, it has rare but serious side effects, including [[retroperitoneal fibrosis]]. |
* [[Sansert]] was withdrawn from the US market by [[Novartis]], but is available in Canadian pharmacies. Although highly effective, it has rare but serious side effects, including [[retroperitoneal fibrosis]]. |
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* [[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. It has not yet been approved by the FDA for the treatment of migraines. |
* [[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. It has not yet been approved by the FDA for the treatment of migraines. |
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* [[ASA]] or [[Aspirin]] can be taken daily in low doses such as 80 |
* [[ASA]] or [[Aspirin]] can be taken daily in low doses such as 80 mg, the blood thinners in ASA have been shown to help some migrainures, especially those who have an aura. |
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=== Trigger avoidance === |
=== Trigger avoidance === |
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=== Herbal and nutritional supplements === |
=== Herbal and nutritional supplements === |
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==== Butterbur ==== |
==== Butterbur ==== |
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50 |
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.[http://www.webmd.com/content/article/98/105003.htm?z=1728_00000_1000_tn_04] |
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==== Cannabis ==== |
==== Cannabis ==== |
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==== Coenzyme Q10 ==== |
==== Coenzyme Q10 ==== |
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Supplementation of [[coenzyme Q10]] has been found to have a beneficial effect on the condition of some sufferers of migraines. In an [[open-label trial]],<ref name="CoenzymeRozen">{{cite journal | author = Rozen T, Oshinsky M, Gebeline C, Bradley K, Young W, Shechter A, Silberstein S | title = Open label trial of coenzyme Q10 as a migraine preventive | journal = Cephalalgia | volume = 22 | issue = 2 | pages = 137–41 | year = 2002 | pmid = 11972582 | doi = 10.1046/j.1468-2982.2002.00335.x <!--Retrieved from CrossRef by DOI bot-->}}</ref> Young and Silberstein found that 61.3% of patients treated with 100 |
Supplementation of [[coenzyme Q10]] has been found to have a beneficial effect on the condition of some sufferers of migraines. In an [[open-label trial]],<ref name="CoenzymeRozen">{{cite journal | author = Rozen T, Oshinsky M, Gebeline C, Bradley K, Young W, Shechter A, Silberstein S | title = Open label trial of coenzyme Q10 as a migraine preventive | journal = Cephalalgia | volume = 22 | issue = 2 | pages = 137–41 | year = 2002 | pmid = 11972582 | doi = 10.1046/j.1468-2982.2002.00335.x <!--Retrieved from CrossRef by DOI bot-->}}</ref> Young and Silberstein found that 61.3% 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.<ref>{{cite journal |author=Sándor PS, et al.|title=Efficacy of coenzyme Q10 in migraine prophylaxis: A randomized controlled trial |journal=Neurology |volume=64 |pages=713–715 |year=2005 |url = http://www.neurology.org/cgi/content/abstract/64/4/713|pmid=15728298|doi=10.1212/01.WNL.0000151975.03598.ED|doi_brokendate=2008-06-25}}</ref> |
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==== Feverfew ==== |
==== Feverfew ==== |
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==== Magnesium Citrate ==== |
==== Magnesium Citrate ==== |
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[[Magnesium citrate]] has reduced the frequency of migraine in an experiment in which the magnesium citrate group received 600 |
[[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. 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.<ref name="MagesiumPeikert">{{cite journal | author = Peikert A, Wilimzig C, Köhne-Volland R | title = Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study | journal = Cephalalgia | volume = 16 | issue = 4 | pages = 257–63 | year = 1996 | pmid = 8792038 | doi = 10.1046/j.1468-2982.1996.1604257.x <!--Retrieved from CrossRef by DOI bot-->}}</ref> |
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==== Riboflavin ==== |
==== Riboflavin ==== |
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The supplement [[Riboflavin]] (also called Vitamin B<sub>2</sub>) has been shown (in a placebo-controlled trial)<ref>{{cite journal | author = J Schoenen, J Jacquay, M Lenaerts | year=1998 | title=Effectiveness of high dose riboflavin in migraine prophylaxis: A randomized controlled trial | journal=Neurology | volume=150 | pages=466–470}}</ref> to reduce the number of migraines, when taken at the high dose of 400 |
The supplement [[Riboflavin]] (also called Vitamin B<sub>2</sub>) has been shown (in a placebo-controlled trial)<ref>{{cite journal | author = J Schoenen, J Jacquay, M Lenaerts | year=1998 | title=Effectiveness of high dose riboflavin in migraine prophylaxis: A randomized controlled trial | journal=Neurology | volume=150 | pages=466–470}}</ref> to reduce the number of migraines, when taken at the high dose of 400 mg daily for three months.<ref name="Bianchi"/><ref>[http://www.uspharmacist.com/index.asp?show=article&page=8_1481.htm Riboflavin in Prophylactic Treatment of Migraine], EA Balbisi, EM Ambizas, ''U.S. Pharmacist'' Vol. 30, No. 05, accessed Jan. 4 2008.</ref> |
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==== Vitamin B12 ==== |
==== Vitamin B12 ==== |
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There is tentative evidence that [[Vitamin B12|Vitamin B<sub>12</sub>]] may be effective in preventing migraines.<ref name="Bianchi">{{cite journal | title=Role of Magnesium, Coenzyme Q10, Riboflavin, and Vitamin B12 in Migraine Prophylaxis | author=A Bianchi, S Salomone, F Caraci, V Pizza, R Bernardini, CC D'Amato | journal=Vitamins and Hormones | year=2004 | volume=69 | pages=297–312 | doi=10.1016/S0083-6729(04)69011-X}}</ref> In particular, in an open-label pilot study, 1 |
There is tentative evidence that [[Vitamin B12|Vitamin B<sub>12</sub>]] may be effective in preventing migraines.<ref name="Bianchi">{{cite journal | title=Role of Magnesium, Coenzyme Q10, Riboflavin, and Vitamin B12 in Migraine Prophylaxis | author=A Bianchi, S Salomone, F Caraci, V Pizza, R Bernardini, CC D'Amato | journal=Vitamins and Hormones | year=2004 | volume=69 | pages=297–312 | doi=10.1016/S0083-6729(04)69011-X}}</ref> 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.<ref>{{cite journal|author=P-HM van der Kuy, FWHM Merkus, JJHM Lohman, JWM ter Berg, PM Hooymans |year=2002|title=Hydroxocobalamin, a nitric oxide scavenger, in the prophylaxis of migraine: an open, pilot study|journal=Cephalalgia| volume=22 | issue=7 | pages=513–519 | doi = 10.1046/j.1468-2982.2002.00412.x}}</ref> Although the study was not placebo-controlled, this response is larger than the typical placebo effect in migraine prophylaxis.<ref name=PlaceboStudy>{{cite journal |author=P-HM van der Kuy, JJHM Lohman | year=2002 | title=A quantification of the placebo response in migraine prophylaxis | journal=Cephalalgia | volume=22 | issue=4 | pages=265–270 | doi=10.1046/j.1468-2982.2002.00363.x}}</ref> |
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==== Melatonin ===== |
==== Melatonin ===== |
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Melatonin has been studied in migraine and other headache disorders. Peres et al studied in an open label studied migraine patients taking melatonin 3 |
Melatonin has been studied in migraine and other headache disorders. Peres et al studied in an open label studied migraine patients taking melatonin 3 mg before bedtime with a good headache response and tolerability. Melatonin has multiple mechanisms affecting migraine pathophysiology |
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=== Surgical treatments === |
=== Surgical treatments === |
Revision as of 06:50, 6 February 2009
![]() | This article may be too long to read and navigate comfortably. |
![]() | This headache disorder article lacks information pertaining to its ICHD-2 diagnostic criteria and/or classification. |
Migraine | |
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Specialty | Neurology ![]() |
Frequency | 12.6% |
Migraine is a neurological syndrome characterized by altered bodily perceptions, headaches, and nausea. Physiologically, the migraine headache is a neurological condition more common to women than to men. Etymologically, the French word migraine derives from the Greek hemicrania (half skull) and the Old English megrim (severe headache).
The typical migraine headache is unilateral and pulsating, lasting from 4 to 72 hours; [1] symptoms include nausea, vomiting, photophobia (increased sensitivity to bright light), and hyperacusis (increased sensitivity to noise); [2][3][4] approximately one third of people who suffer migraine headache perceive an aura — visual, olfactory — announcing the headache. [5]
Initial treatment is with analgesics for the head-ache, an anti-emetic for the nausea, and the avoidance of triggering conditions. The cause of migraine headache is unknown; the accepted theory is a disorder of the serotonergic control system, as PET scan has demonstrated the aura coincides with diffusion of cortical depression consequent to increased blood flow (up to 300% greater than baseline). There are migraine headache variants, some originate in the brainstem (featuring intercellular transport dysfunction of calcium and potassium ions) and some are genetically disposed. [6] Studies of twins indicate a 60 to 65 per cent genetic influence upon their developing propensity to migraine headache. [7][8] Moreover, fluctuating hormone levels indicate a migraine relation: 75 percent of adult patients are women, although migraine affects approximately equal numbers of prepubescent boys and girls; propensity to migraine headache is known to disappear during pregnancy. [citation needed]
Classification
The International Headache Society (IHS) classifies migraine headache. [9]
Defining pain severity
The IHS defines the intensity of pain with a verbal, four-point scale: [10]
Number | Name | Annotations |
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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
The common form of migraine headache; the patient primarily suffers migraine without aura, and might also suffer migraine with aura. The International Classification of Headache Disorders[9] definition is:
Description: 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 phonophobia.
Diagnostic criteria:
A. At least five attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hours [when untreated]
C. Headache has at least two of the following characteristics:
- 1. unilateral location
- 2. pulsating quality
- 3. moderate or severe pain intensity
- 4. aggravation by or causing avoidance of routine physical activity
D. During the headache at least one of the following:
- 1. Nausea and/or vomiting
- 2. Photophobia and phonophobia
E. Not attributed to another disorder
— International Classification of Headache Disorders[9]
When these criteria are partially fulfilled, there are alternative diagnoses, i.e. "probable migraine without aura" or "episodic tension-type headache".
Migraine with aura
The second-most common form of migraine headache: the patient primarily suffers migraine with aura, and might also suffer migraine without aura. The International Classification of Headache Disorders[9] definition is:
Description: 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, headache lacks migrainous feature or is completely absent [i.e., the aura may occur without any subsequent headache].
Diagnostic criteria:
A. At least two attacks fulfilling criterion B
B. Migraine aura fulfilling criteria [described below]
C. Not attributed to another disorder....[Criteria for "Typical aura":]
Aura consisting of at least one of the following, but no motor weakness:
1. Fully reversible visual symptoms including positive features (e.g. flickering lights, spots or lines) and/or negative features (i.e., loss of vision)
2. Fully reversible sensory symptoms including positive features (i.e., pins and needles) and/or negative features (i.e., numbness)
3. Fully reversible dysphasic speech disturbance
[Aura also has] at least two of the following:
1. Homonymous visual symptoms [i.e., affecting just one side of the field of vision] and/or unilateral sensory symptoms [i.e., affecting just one side of the body]
2. At least one aura symptom develops gradually over [at least] 5 minutes and/or different aura symptoms occur [one after the other] over [at least] 5 minutes
3. Each symptom lasts [from] 5 [to] 60 minutes...[Other potential aura criteria:]
- Fully reversible motor weakness...
- Each aura symptom lasts [from] 5 minutes [to] 24 hours...
- [In the case of a "Basilar-type" migraine], Dysarthria [difficulty speaking], vertigo [dizziness], tinnitus [ringing in the ears], [and other symptoms].
— International Classification of Headache Disorders[9]
Basilar type migraine
Basilar type migraine (BTM) (previously basilar artery migraine [BAM] and basilar migraine [BM]) is an uncommon, complicated migraine with symptoms caused by brainstem dysfunction. Serious episodes of BTM can lead to stroke, coma, and death. Using triptans and other vasoconstrictors as abortive treatments for BTM is contraindicated. Abortive treatments for BTM address vasodilation and restoration of normal blood flow to the vertebrobasilar territory to restore normal brainstem function.
Familial hemiplegic migraine
Familial hemiplegic migraine (FHM) is migraine with a possible polygenetic cause. An FHM episode might last 4–72 hours [9] and appear caused by ion channel mutations; FHM is in three types. The patient experiences typical migraine headache either preceded or accompanied with unilateral, reversible limb weakness and sensory and speech difficulties. There also exists the "sporadic hemiplegic migraine" (SHM) a non-familial form. Effecting a differential diagnosis, between basilar migraine and hemiplegic migraine, is difficult; often, the decisive symptom is either motor weakness or unilateral paralysis, that occurs in FHM and SHM; basilar migraine can present tingling and numbness, true motor weakness and paralysis occur only in hemiplegic migraine.
Abdominal migraine
Abdominal migraine is a recurrent disorder of unknown origin, principally affecting children; episodes feature nausea, vomiting, and moderate-to-severe central, abdominal pain (ca. 1–72 hrs); the child is well between episodes. Formal diagnosis requires at least five (5) episodes (unattributable to another cause) and fulfilment of these criteria:
- Episodes last 1–72 hours, untreated
- Pain must feature ALL these characteristics:
- Location in the mid-abdomen, around the umbilicus; or poorly localised
- Dull pain; 'just sore' quality
- Moderate-to-severe intensity
- An episode must feature at least two of these symptoms:
- Loss of appetite
- Nausea
- Vomiting
- Pallor
Most children suffering abdominal migraine will develop propensity to migraine headache in adult life; the two propensities might co-exist during the child's 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. 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.
If symptoms are primarily visual, it may be necessary to consult an ophthalmologist or optometrist to rule out potential eye disease before considering this diagnosis.
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 suggests 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]
- 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:
- The prodrome, which occurs hours or days before the headache.
- The aura, which immediately precedes the headache.
- The pain phase, also known as headache phase.
- The postdrome.
Prodrome phase
Prodromal symptoms occur in 40–60% of migraineurs (migraine sufferers). This phase may consist of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e.g. chocolate), stiff muscles (especially in the neck), constipation or diarrhea, increased urination, and other visceral symptoms.[19] 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%[20][21] 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.[22]
Visual aura is the most common of the neurological events. 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"). 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. 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 nose-mouth area on the same side. 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.
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. Many patients experience sensory hyperexcitability manifested by photophobia, phonophobia, osmophobia and seek a dark and quiet room. Blurred vision, nasal stuffiness, diarrhea, polyuria, pallor or sweating may be noted during the headache phase. 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. Impairment of concentration and mood are common. Lightheadedness, rather than true vertigo and a feeling of faintness may occur. The extremities tend to be cold and moist.
Postdrome phase
The patient may feel tired, have head pain, cognitive difficulties, "hungover", gastrointestinal symptoms, mood changes and weakness.[23] Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise. Often, some of the minor headache phase symptoms may continue, such as loss of appetite, photophobia, and lightheadedness. For 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[24] and misdiagnosed.[25] 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 mnemonic POUNDing (Pulsating, duration of 4–72 hOurs, Unilateral, Nausea, Disabling) can help diagnose migraine. If 4 of the 5 criteria are met, then the positive likelihood ratio for diagnosing migraine is 24.[26]
The presence of either disability, nausea or sensitivity, can diagnose migraine with:[27]
- sensitivity of 81%
- specificity of 75%
Migraine should be differentiated from other causes of headaches such as cluster headaches. These are extremely painful, unilateral headaches of a piercing quality. The duration of the common attack is 15 minutes to three hours. Onset of an attack is rapid, and most often without the preliminary signs that are characteristic of a migraine.
Pathophysiology
Migraines were once thought to be initiated exclusively by problems with blood vessels. The vascular theory of migraines is now considered secondary to brain dysfunction[28] and claimed to have been discredited by others.[29] Trigger points can be at least part of the cause, and perpetuate most kinds of headaches.[30]
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.[citation needed]
Depolarization theory
A phenomenon known as cortical spreading depression can cause migraines.[31] In cortical spreading depression, neurological activity is depressed over an area of the cortex of the brain. 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.
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). 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.[32]
Vascular theory
Migraines can begin when blood vessels in the brain contract and expand inappropriately. 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.[28]
When the constriction stops and the blood vessels dilate, they become too wide. The once solid walls of the blood vessels become permeable and some fluid leaks out. This leakage is recognized by pain receptors in the blood vessels of surrounding tissue. In response, the body supplies the area with chemicals which cause inflammation. With each heart beat, blood passes through this sensitive area causing a throb of pain.[28]
The vascular theory of migraines is now seen as secondary to brain dysfunction.[28]
Serotonin theory
Serotonin is a type of neurotransmitter, or "communication chemical" which passes messages between nerve cells. 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.[28] Triptans activate serotonin receptors to stop a migraine attack.[28]
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.[28]
Unifying theory
Both vascular and neural influences cause migraines.
- stress triggers changes in the brain
- these changes cause serotonin to be released
- blood vessels constrict
- chemicals including substance P irritate nerves and blood vessels causing pain[28]
Epidemiology
![](http://upload.wikimedia.org/wikipedia/commons/thumb/f/fd/Migraine_gender_age.png/256px-Migraine_gender_age.png)
Migraine is an extremely common condition which will affect 12–28% of people at some point in their lives.[33] 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.[33] 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.[34] There is then a rapid growth in incidence amongst girls occurring after puberty,[35][36][37] which continues throughout early adult life.[38] By early middle age, around 25% of women experience a migraine at least once a year, compared with fewer than 10% of men.[33][39] 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%.[33][39]
At all ages, migraine without aura is more common than migraine with aura, with a ratio of between 1.5:1 and 2:1.[40][41] Incidence figures show that the excess of migraine seen in women of reproductive age is mainly due to migraine without aura.[40] Thus in pre-pubertal and post-menopausal populations, migraine with aura is somewhat more common than amongst 15–50 year olds.[38][42]
There is a strong relationship between age, gender and type of migraine.[43]
Geographical differences in migraine prevalence are not marked. Studies in Asia and South America suggest that the rates there are relatively low,[44][45] but they do not fall outside the range of values seen in European and North American studies.[33][39]
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.[46]
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.'
The MedlinePlus Medical Encyclopedia, for example, offers the following list of migraine triggers:
Migraine attacks may be triggered by:
- 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
- Alcohol
- Menstrual cycle fluctuations, birth control pills, hormone fluctuations during the menopause transition
- Tension headaches
- Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG) or nitrates (like bacon, hot dogs, and salami)
- Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods.
— MedlinePlus medical encyclopedia[47]
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. 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 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.
Food
A 2005 literature review found that the available information about dietary trigger factors relies mostly on the subjective assessments of patients.[48] 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. Little or no evidence associated notorious suspected triggers like chocolate, cheese, histamine, tyramine, nitrates, or nitrites with migraines. Some people may develop migraines from consuming aspartame. In a University of Parkinson's-Florida study, the incidence of migraine doubled for the majority of participants when they took aspartame, and their headaches lasted longer and were marked by increased signs of shakiness and diminished vision. Headaches are the most common side effect cited by those who consume aspartame-containing products[49]. In a large and definitive study monosodium glutamate (MSG) in large doses (2.5 grams) was associated with adverse symptoms including headache more often than was placebo. 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.[50]
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.[51] 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:
- Temperature mixed with humidity. High humidity plus high or low temperature was the biggest cause.
- Significant changes in weather
- 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. 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.[52]
Other
One study found that for some migraineurs in India, washing hair in a bath was a migraine trigger. The triggering effect also had to do with how the hair was later dried.[53]
Treatment
Conventional treatment focuses on three areas: trigger avoidance, symptomatic control, and prophylactic pharmocological drugs. Patients who experience migraines often find that the recommended migraine treatments are not 100% effective at preventing migraines, and sometimes may not be effective at all. Pharmological treatments are considered effective if they reduce the frequency or severity of migraine attacks by 50%.[54]
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.[55]
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. Treating the attack at the onset can often abort it before it becomes serious, and can reduce the near-term frequency of subsequent attacks.[citation needed]
Paracetamol or non-steroidal anti-inflammatory drug (NSAIDs)
The first line of treatment is over-the-counter abortive medication.
- 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.[56]
- Paracetamol, at a dose of 1000 mg, benefited over half of patients with mild or moderate migraines in a randomized controlled trial.[57]
- Simple analgesics combined with caffeine may help.[58] 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. Excedrin is an example of an aspirin with caffeine product. Caffeine is recognized by the U.S. Food and Drug Administration as an Over The Counter Drug (OTC) treatment for migraine when compounded with aspirin and paracetamol.[59]
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. OTC drugs may provide some relief, although they are typically not effective for most sufferers.
In all, the U.S. Food and Drug Administration has approved three OTC products specifically for migraine: Excedrin Migraine, Advil Migraine, and Motrin Migraine Pain. Excedrin Migraine, as mentioned above, is a combination of aspirin, acetaminophen, and caffeine. Both Advil Migraine and Motrin Migraine Pain are straight NSAIDs, with ibuprofen as the only active ingredient.[60][unreliable source?]
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. In addition some antiemetics such as metoclopramide are prokinetics and help gastric emptying which is often impaired during episodes of migraine. 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).[61] 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).
Serotonin agonists
Sumatriptan and related selective serotonin receptor agonists are excellent for severe migraines or those that do not respond to NSAIDs[56] or other over-the-counter drugs.[57] Triptans are a mid-line treatment suitable for many migraineurs with typical migraines. They may not work for atypical or unusually severe migraines, transformed migraines, or status (continuous) migraines.
Serotonin specific reuptake inhibitors (SSRIs) are not approved by the U.S. Food and Drug Administration (FDA) for treatment of migraines, but have been found to be effective by clinical consensus[54].
Anti-depressants
In addition to SSRIs, anti-depressant drugs such as tricyclics have been long established as highly efficacious prophylactic treatments[54]. Despite not being approved by the FDA for this purpose, these drugs are widely prescribed[54]. Other anti-depressant drugs, such as bupropion and venlafaxine, have also been shown to be clinically efficacious[54]. These drugs, however, may give rise to undesirable side effects, such as insomnia, sedation or sexual dysfunction. They do offer advantages for treating patients with coexistant depression[54].
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 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. 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.) 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.
Steroids
Based on a recent meta analysis a single dose of iv dexamethasone, when added to standard treatment, is associated with a 26% decrease in headache recurrence.[62]
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. While the risk of addiction is low, butalbital can be habit-forming if used daily, and it can also lead to rebound headaches. Barbiturate-containing medications are not available in many European countries.
Amidrine, sold as Duradrin or Midrin, is a cocktail of a pain reliever, a sedative, and a vasoconstrictor); this drug is often prescribed for migraine headaches. Some studies have recently shown that this drug may work better than Imitrex for treating migraines. [63]
Anti-emetics may need to be given by suppository or injection where vomiting dominates the symptoms.
Recently it has been found that calcitonin gene related peptides (CGRPs) play a role in the pathogenesis of the pain associated with migraine as triptans also decrease its realease and action. CGRP receptor antagonists such as olcegepant and telcagepant are being investigated both in vitro and in clinical studies for the treatment of migraine.[64]
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 status migrainosus consists of managing comorbidities (i. e. correcting fluid and electrolyte abnormalities resulting from anorexia and nausea/vomiting often accompanying status migr.), and usually administering parenteral medication to "break" (abort) the headache.
Although the literature is full of many case reports concerning treatment of status migrainosus, first line therapy consists of intravenous fluids, metoclopramide, and triptans or DHE.[65]
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.[66] An open-label study (funded by GelStat) found some tentative evidence of the treatment's effectiveness,[67] but no scientifically sound study has been done. Cannabis in addition to prevention, is also known to relieve pain during the onset of a migraine.[68]
Comparative studies
Regarding comparative effectiveness of these drugs used to abort migraine attacks, a 2004 placebo-controlled trial[69] 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.[56]
Recently the combination of sumatriptan 85 mg and naproxen sodium 500 mg was demonstrated to be effective and well tolerated in an early intervention paradigm for the acute treatment of migraine. Significant pain-free responses in favor of sumatriptan/naproxen were demonstrated as early as 30 minutes, maintained at 1 hour, and sustained from 2 to 24 hours. At 2 and 4 hours, sumatriptan/naproxen provided significantly lower rates of traditional migraine-associated symptoms (nausea, photophobia, and phonophobia) and nontraditional migraine-associated symptoms (neck pain/discomfort and sinus pain/pressure).[70]
Preventive treatment
Preventive (also called prophylactic) treatment of migraines can be an important component of migraine management. 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. One such book that outlines these preventative measures quite well is "7 Steps To A Healthy Brain" by Dr. Winner.
The goals of preventive therapy are to reduce the frequency, painfulness, and/or duration of migraines, and to increase the effectiveness of abortive therapy.[71] 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. This is believed to occur in part due to overuse of pain medications, and can result in chronic daily headache.[72][73]
Many of the preventive treatments described below are quite effective: Even with a placebo (sham treatment), one-quarter of patients find that their migraine frequency is reduced by half or more, and actual treatments often far exceed this figure.[74]
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.
— [71]
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. 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 1.94.[75]
- anticonvulsants such as valproic acid and topiramate. A meta-analysis by the Cochrane Collaboration of ten randomized controlled trials or crossover studies, which together included 1341 patients, found anticonvulsants had an "2.4 times more likely to experience a 50% or greater reduction in frequency with anticonvulsants than with placebo" and a number needed to treat of 3.8.[76] However, concerns have been raised about the marketing of gabapentin.[77]
- antidepressants include tricyclic antidepressants (TCAs) such as amitriptyline and the newer selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine. A meta-analysis by the Cochrane Collaboration found selective serotonin reuptake inhibitors are no more effective than placebo.[78] 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.[79] A randomized controlled trial found that amitriptyline was better than placebo and similar to propranolol.[80]
A wide range of pharmacological drugs have been evaluated to determine their efficacy in reducing the frequency or severity of migraine attacks[54]. These drugs include beta-blockers, calcium antagonists, neurostabalizers, nonsteroidal anti-inflammatory drugs (NSAIDs),tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), other antidepressants, and other specialized drug therapies[54]. The US Headache Consortium lists five drugs as having medium to high efficacy: amitriptyline, divalproex, timolol, propranolol and topiramate.[54] Lower efficacy drugs listed include aspirin, atenolol, fenoprofen, flurbiprofen, fluoxetine, gabapentin, ketoprofen, metoprolol, nadolol, naproxen, nimodipine, verapamil and Botulinum A[54]. Additionally, most antidepressants (tricyclic, SSRIs and others such as Bupropion) are listed as "clinically efficacious based on consensus of experience" without scientific support[54]. Many of these drugs may give rise to undesirable side-effects, or may be efficacious in treating comorbid conditions, such as depression.
Other drugs:
- Sansert was withdrawn from the US market by Novartis, but is available in Canadian pharmacies. Although highly effective, it has rare but serious side effects, including retroperitoneal fibrosis.
- 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. It has not yet been approved by the FDA for the treatment of migraines.
- ASA or Aspirin can be taken daily in low doses such as 80 mg, the blood thinners in ASA have been shown to help some migrainures, especially those who have an aura.
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.[81]
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.[3]
Cannabis
Cannabis was a standard treatment for migraines from 1874 to 1942.[82] 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.[82]
Coenzyme Q10
Supplementation of coenzyme Q10 has been found to have a beneficial effect on the condition of some sufferers of migraines. In an open-label trial,[83] Young and Silberstein found that 61.3% 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.[84]
Feverfew
The plant feverfew (Tanacetum parthenium) is a traditional herbal remedy believed to reduce the frequency of migraine attacks. 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.[85] However, since then, more studies have been carried out.[86] 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. 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.[87]
Riboflavin
The supplement Riboflavin (also called Vitamin B2) has been shown (in a placebo-controlled trial)[88] to reduce the number of migraines, when taken at the high dose of 400 mg daily for three months.[89][90]
Vitamin B12
There is tentative evidence that Vitamin B12 may be effective in preventing migraines.[89] 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.[91] Although the study was not placebo-controlled, this response is larger than the typical placebo effect in migraine prophylaxis.[74]
Melatonin =
Melatonin has been studied in migraine and other headache disorders. Peres et al studied in an open label studied migraine patients taking melatonin 3 mg before bedtime with a good headache response and tolerability. Melatonin has multiple mechanisms affecting migraine pathophysiology
Surgical treatments
Surgery may be used to treat migraines by severing the corrugator supercilii muscle and zygomaticotemporal nerve.[92] The treatment may reduce or eliminate headaches in some individuals.[93]
In 2005, research[94] was published indicating that 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. 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.[95] It appears to be effective for chronic migraines but not useful in the treatment of episodic migraine.[96][97]
Spinal cord stimulators are an implanted medical device sometimes used for those who suffer severe migraines several days each month.[98]
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. This treatment essentially disrupts the aura phase of migraines before patients develop full-blown migraines.[4] In about 74% of the migraine headaches, TMS was found to eliminate or reduce nausea and sensitivity to noise and light.[5] 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.[99] In June 2008, a hand-held apparatus designed to apply TMS as a preemptive therapy to avert a migraine attack at the onset of the aura phase was introduced in California.[6]
Biofeedback has been used successfully by some to control migraine symptoms through training and practice.[100]
Hyperbaric oxygen therapy has been used successfully in treating migraines.[101][102][103] 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).
Bruxism, clenching or grinding of teeth, especially at night, is a trigger for many migraineurs. 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[104] and another from 1956[105] 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 [7] 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.[106]
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.
Sexual activity has been reported by a proportion of male and female migraine sufferers to relieve migraine pain significantly in some cases.[8]
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.[citation needed]
Alternative medicine
A number of forms of alternative medicine, particularly bodywork, are used in preventing migraines.
Clinical trials have suggested that chiropractic care may be an efficacious treatment for migraine headaches[107][108] Likewise, Massage therapy, physical therapy, and Bowen Technique[109] are often very effective forms of treatment to reduce the frequency and intensity of migraines.[citation needed] These initial studies are limited by lack of control subjects, poor control subjects, lack of blind study design, small sample sizes, and other methodological flaws.[110]. Chiropractic researchers have argued that the current evidence for chiropractic treatment of migraines indicates that "evidence is steadily increasing to the point where there is now seen to be a moderate level of efficacy for chiropractic SMT in the treatment of headaches or migraines"[110]. The effect of chiropractic treatment may be mediated by stress release[110], and may be more efficacious for tension-type headaches than migraines[111] A review of the literature until 2004 found that "Chiropractic manipulation demonstrated a trend toward benefit in the treatment of TTH, but evidence is weak. ... In the absence of clear evidence regarding their role in treatment, physicians and patients are advised to make cautious and individualized judgments about the utility of physical treatments for headache management; in most cases, the use of these modalities should complement rather than supplant better-validated forms of therapy."[111]
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.[citation needed]
Some migraine sufferers find relief through acupuncture, which is usually used to help prevent headaches from developing.[112] Sometimes acupuncture is used to relieve the pain of an active migraine headache.[113] 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.[citation needed]
Additionally acupressure is used by some for relief. For instance pressure between the thumbs and index finger to help subside headaches if the headache or migraine isn't too severe.[citation needed]
Incense and scents are shown to help. The smell and incense of peppermint and lavender have been proven to help with migraines and headaches more so than most other scents.[114] However, some scents can be a trigger factor.
History
9000 year old skulls exist with evidence of trepanation. It is hypothesized that this drastic step was taken in response to headaches, though there is no clear evidence proving this. [citation needed]. Headache with neuralgia was recorded in the medical documents of the ancient Egyptians as early as 1200 BC. In 400 BC Hippocrates described the visual aura that can precede the migraine headache and the relief which can occur through vomiting. 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. Galenus of Pergamon used the term "hemicrania" (half-head), from which the word "migraine" was derived. He thought there was a connection between the stomach and the brain because of the nausea and vomiting that often accompany an attack. For relief of migraine, Andalusian-born physician Abulcasis, also known as Abu El Qasim, suggested application of a hot iron to the head or insertion of garlic into an incision made in the temple. In the Medieval Ages migraine was recognized as a discrete medical disorder with treatment ranging from hot irons to blood letting and even witchcraft[citation needed]. Followers of Galenus explained migraine as caused by aggressive yellow bile. Ebn Sina (Avicenna) described migraine in his textbook "El Qanoon fel teb" as "... 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."
In Bibliotheca Anatomica, Medic, Chirurgica, published in London in 1712, five major types of headaches are described, including the "Megrim", recognizable as classic migraine. Graham and Wolff (1938) published their paper advocating ergotamine tart for relieving migraine. 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,[citation needed] with total costs including lost productivity averaging $313. 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. Young adult sufferers and women using hormonal contraception appear to be at particular risk.[115] The mechanism of any association is unclear, but chronic abnormalities of cerebral blood vessel tone may be involved. 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.[116][115] Migraine sufferers seem to be at risk for both thrombotic and hemorrhagic stroke as well as transient ischemic attacks.[117] 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.[118][119]
References
Migraine triggers
- Federation of American Societies for Experimental Biology [FASEB] [1995]. Analysis of adverse reactions to monosodium glutamate (MSG). Bethesda, MD: Life Sciences Research Office, FASEB.
- Ravishankar, K (2006). 'Hair wash' or 'Head bath' triggering migraine - observations in 94 Indian patients". Cephalagia 26 (11): 1330–1334. ISSN 0333-1024.
Treatment
- Pearce, J.M.S. (1994). Headache. Neurological Management series. Journal of Neurology Neurosurgery and Psychiatry. 57, 134–144.
- Mayo Clinic Staff. (2005). Migraine Headache. Retrieved August 14, 2005
- Cathy Wong, ND. (2005). Migraine Elimination Diet Retrieved August 14, 2005
- Treatment Articles (2005). Butterbur, Co-enzyme Q-10, Melatonin, Folic Acid
- Buchholz, D. (2002) Heal your headache: The 1-2-3 Program, New York: Workman Publishing, ISBN 0-7611-2566-3
- Livingstone, I. and Novak, D. (2003) Breaking the Headache Cycle, New York: Henry Holt and Co. ISBN 0-8050-7221-7
- Izecksohn L, and Izecksohn C. . Fluids' Hypertension Syndromes, ISBN 978-85-906664-0-0.
- Cohen JA, Beall D, Beck A, et al. Sumatriptan treatment for migraine in a health maintenenace organization: economic, humanistic, and clinical outcomes. Clin Ther 1999;21:190–205.
- Adelman JU, Sharfman M, Johnson R, et al. Impact of oral sumatriptan on workplace productivity, health-related quality of life, healthcare use, and patient satisfaction with medication in nurses with migraine. Am J Manag Care 1996;2:1407–1416.
- Cohen JA, Beall DG, Miller DW, Beck A, Pait G, Clements BD. Subcutaneous sumatriptan for the treatment of migraine: humanistic, economic, and clinical consequences. Fam Med 1996;28:171–177.
- Jhingran P, Cady RK, Rubino J, Miller D, Grice RB, Gutterman DL. Improvements in health-related quality of life with sumatriptan treatment for migraine. J Med Econ 1996;42:36–42.
- Solomon GD, Nielsen K, Miller D. The effects of sumatriptan on migraine: health-related quality of life. Med Interface 1995;June:134–141.
- Solomon GD, Skobieranda FG, Genzen JR. Quality of life assessment among migraine patients treated with sumatriptan. Headache 1995;35:449–454.
- Santanello NC, Polis AB, Hartmaier SL, Kramer MS, Block GA, Silberstein SD. Improvement in migrainespecific quality of life in a clinical trial of rizatriptan. Cephalalgia 1997;17:867–872.
- Caro JJ, Getsios D. Pharmacoeconomic evidence and considerations for triptan treatment of migraine. Expert Opin Pharmacother 2002;3:237–248.
- Lofland JH, Johnson NE, Batenhorst AS, Nash DB. Changes in resource use and outcomes for patients with migraine treated with sumatriptan: a managed care perspective. Arch Intern Med 1999;159: 857–863.
- Cady RC, Ryan R, Jhingran P, O’Quinn S, Pait DG. Sumatriptan injection reduces productivity loss during a migraine attack. Arch Intern Med 1998;158: 1013–1018.
- Litaker DG, Solomon GD, Genzen JR. Impact of sumatriptan on clinic utilization and costs of care in migraineurs. Headache 1996;36:538–541.
- Greiner DL, Addy SN. Sumatriptan use in a large group-model health maintenance organization. Am J Health Syst Pharm 1996;53:633–638.
- Lofland JH, Kim SS, Batenhorst AS, et al. Cost-effectiveness and cost-benefit of sumatriptan in patients with migraine. Mayo Clin Proc 2001;76:1093–1101.
- Biddle AK, Shih YC, Kwong WJ. Cost-benefit analysis of sumatriptan tablets versus usual therapy for treatment of migraine. Pharmacotherapy 2000;20: 1356–1364.
- Caro JJ, Getsios D, Raggio G, Caro G, Black L. Treatment of migraine in Canada with naratriptan: a costeffectiveness analysis. Headache 2001;41:456–464.
General
- Sacks, Oliver (1999) Migraine, Vintage ISBN 0-520-08223-0
- Relouzat, Raoul & Thiollet, Jean-Pierre, Vaincre la migraine, Anagramme, 2006 ISBN 2-35035046
- Blondin, Betsy, (2008) "Migraine Expressions: A Creative Journey through Life with Migraine, WordMetro Press ISBN 0615201970
Economic impact
- Edmeads J, Mackell JA. The economic impact of migraine: an analysis of direct and indirect costs. Headache 2002;42:501–509.
- Gerth WC, Carides GW, Dasbach EJ, Visser WH, Santanello NC. The multinational impact of migraine symptoms on healthcare utilisation and work loss. Pharmacoeconomics 2001;19:197–206.
- Hu XH, Markson LE, Lipton RB, Stewart WF, Berger ML. Burden of migraine in the United States: disability and economic costs. Arch Intern Med 1999;159:813–818.
- Osterhaus JT, Gutterman DL, Plachetka JR. Healthcare resource and low labour costs of migraine headaches in the US. Pharmacoeconomics 1992;2:2–11.
Clinical picture
- Blau JN. Classical migraine: symptoms between visual aura and headache onset. Lancet 1992;340:355-6.
- Silberstein SD: Migraine symptoms: Results of a survey of self-reported migraineurs. Headache 1995;35:387-96.
- Silberstein SD, Saper JR, Freitag F. Migraine: Diagnosis and treatment. In: Silberstein SD, Lipton RB, Dalessio DJ, eds. Wolff's headache and other head pain. 7th ed. New York: Oxford University Press, 2001:121–237.
Footnotes
- ^ The International Classification of Headache Disorders, 2nd Edition
- ^ "NINDS Migraine Information Page". National Institute of Neurological Disorders and Stroke, National Institutes of Health. Retrieved 2007-06-25.
- ^ "Advances in Migraine Prophylaxis: Current State of the Art and Future Prospects" (PDF). National Headache Foundation (CME monograph). Retrieved 2007-06-25.
- ^ Gallagher RM, Cutrer FM (2002). "Migraine: diagnosis, management, and new treatment options". Am J Manag Care. 8 (3 Suppl): S58–73. PMID 11859906.
- ^ "Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type, cluster and medication-overuse headache, Jan 2007,British Association for the Study of Headache" (PDF). Retrieved 2007-06-25.
- ^ Ogilvie AD, Russell MB, Dhall P; et al. (1998). "Altered allelic distributions of the serotonin transporter gene in migraine without aura and migraine with aura". Cephalalgia. 18 (1): 23–6. doi:10.1046/j.1468-2982.1998.1801023.x. PMID 9601620.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ Gervil M, Ulrich V, Kaprio J, Olesen J, Russell MB (1999). "The relative role of genetic and environmental factors in migraine without aura". Neurology. 53 (5): 995–9. PMID 10496258.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Ulrich V, Gervil M, Kyvik KO, Olesen J, Russell MB (1999). "The inheritance of migraine with aura estimated by means of structural equation modelling". J. Med. Genet. 36 (3): 225–7. PMC 1734315. PMID 10204850.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ a b c d e f Headache Classification Subcommittee of the International Headache Society (2004). "The International Classification of Headache Disorders: 2nd edition". Cephalalgia : an international journal of headache. 24 Suppl 1: 9–160. doi:10.1111/j.1468-2982.2004.00653.x. PMID 14979299. Complete supplement online
- ^ Headache Classification Subcommittee of the International Headache Society (2004). "The International Classification of Headache Disorders: 2nd edition". Cephalalgia : an international journal of headache. 24 Suppl 1: 150. doi:10.1111/j.1468-2982.2004.00653.x. PMID 14979299. Complete supplement online (see page 150)
- ^ Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M (2001). "Prevalence and burden of migraine in the United States: data from the American Migraine Study II". Headache. 41 (7): 646–57. doi:10.1046/j.1526-4610.2001.041007646.x. PMID 11554952.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Granella F, Sances G, Zanferrari C, Costa A, Martignoni E, Manzoni GC (1993). "Migraine without aura and reproductive life events: a clinical epidemiological study in 1300 women". Headache. 33 (7): 385–9. doi:10.1111/j.1526-4610.1993.hed3307385.x. PMID 8376100.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ (2004) "The International Classification of Headache Disorders: 2nd edition". Cephalalgia 24 Suppl 1: 9–160.
- ^ Brandes JL (2006). "The influence of estrogen on migraine: a systematic review". JAMA. 295 (15): 1824–30. doi:10.1001/jama.295.15.1824. PMID 16622144.
- ^ a b MacGregor EA, Hackshaw A (2004). "Prevalence of migraine on each day of the natural menstrual cycle". Neurology. 63 (2): 351–3. PMID 15277635.
- ^ Granella F, Sances G, Allais G; et al. (2004). "Characteristics of menstrual and nonmenstrual attacks in women with menstrually related migraine referred to headache centres". Cephalalgia. 24 (9): 707–16. doi:10.1111/j.1468-2982.2004.00741.x. PMID 15315526.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ Couturier EG, Bomhof MA, Neven AK, van Duijn NP (2003). "Menstrual migraine in a representative Dutch population sample: prevalence, disability and treatment". Cephalalgia. 23 (4): 302–8. doi:10.1046/j.1468-2982.2003.00516.x. PMID 12716349.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Martin VT, Wernke S, Mandell K; et al. (2005). "Defining the relationship between ovarian hormones and migraine headache". Headache. 45 (9): 1190–201. doi:10.1111/j.1526-4610.2005.00242.x. PMID 16178949.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ Kelman L (2004). "The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs". Headache. 44 (9): 865–72. doi:10.1111/j.1526-4610.2004.04168.x. PMID 15447695. Retrieved 2008-08-30.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Silberstein, Stephen D. (2005). Atlas Of Migraine And Other Headaches. London: Taylor & Francis Group. ISBN 1842142739.
- ^ Mathew, Ninan T.; Evans, Randolph W. (2005). Handbook of headache. Hagerstown, MD: Lippincott Williams & Wilkins. ISBN 078175223X.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - ^ Silberstein, Stephen D. (2002). Headache in Clinical Practice, 2nd Edition. London: Taylor & Francis Group. ISBN 1-901865-88-6.
- ^ Kelman L (2006). "The postdrome of the acute migraine attack". Cephalalgia. 26 (2): 214–20. doi:10.1111/j.1468-2982.2005.01026.x. PMID 16426278. Retrieved 2008-08-30.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Lipton RB, Stewart WF, Celentano DD, Reed ML (1992). "Undiagnosed migraine headaches. A comparison of symptom-based and reported physician diagnosis". Arch. Intern. Med. 152 (6): 1273–8. doi:10.1001/archinte.152.6.1273. PMID 1599358.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C (2004). "Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache". Arch. Intern. Med. 164 (16): 1769–72. doi:10.1001/archinte.164.16.1769. PMID 15364670.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM (2006). "Does this patient with headache have a migraine or need neuroimaging?". JAMA. 296 (10): 1274–83. doi:10.1001/jama.296.10.1274. PMID 16968852.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Lipton RB, Dodick D, Sadovsky R; et al. (2003). "A self-administered screener for migraine in primary care: The ID Migraine validation study". Neurology. 61 (3): 375–82. PMID 12913201.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ a b c d e f g h Alexander Mauskop; Fox, Barry (2001). What Your Doctor May Not Tell You About(TM): Migraines : The Breakthrough Program That Can Help End Your Pain (What Your Doctor May Not Tell You About...(Paperback)). New York: Warner Books. ISBN 0-446-67826-0.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - ^ Cohen AS, Goadsby PJ (2005). "Functional neuroimaging of primary headache disorders". Curr Pain Headache Rep. 9 (2): 141–6. doi:10.1007/s11916-005-0053-0. PMID 15745626.
- ^ Trigger Point Therapy for Headaches & Migraines, DeLaune, Valerie (New Harbinger: 2008) [1]
- ^ Lauritzen M (1994). "Pathophysiology of the migraine aura. The spreading depression theory". Brain. 117 ( Pt 1): 199–210. PMID 7908596.
- ^ Denuelle M, Fabre N, Payoux P, Chollet F, Geraud G (2007). "Hypothalamic activation in spontaneous migraine attacks". Headache. 47 (10): 1418–26. doi:10.1111/j.1526-4610.2007.00776.x. PMID 18052951.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b c d e Stovner LJ, Zwart JA, Hagen K, Terwindt GM, Pascual J (2006). "Epidemiology of headache in Europe". Eur. J. Neurol. 13 (4): 333–45. doi:10.1111/j.1468-1331.2006.01184.x. PMID 16643310.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Mortimer MJ, Kay J, Jaron A (1992). "Epidemiology of headache and childhood migraine in an urban general practice using Ad Hoc, Vahlquist and IHS criteria". Dev Med Child Neurol. 34 (12): 1095–101. PMID 1451940.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Linet MS, Stewart WF, Celentano DD, Ziegler D, Sprecher M (1989). "An epidemiologic study of headache among adolescents and young adults". JAMA. 261 (15): e1197. doi:10.1001/jama.261.15.2211. PMID 2926969.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Ziegler DK, Hassanein RS, Couch JR (1977). "Characteristics of life headache histories in a nonclinic population". Neurology. 27 (3): 265–9. PMID 557763.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ SELBY G, LANCE JW (1960). "Observations on 500 cases of migraine and allied vascular headache". J. Neurol. Neurosurg. Psychiatr. 23: 23–32. PMID 14444681.
- ^ a b Anttila P, Metsähonkala L, Sillanpää M (2006). "Long-term trends in the incidence of headache in Finnish schoolchildren". Pediatrics. 117 (6): e1197–201. doi:10.1542/peds.2005-2274. PMID 16740819.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b c Lipton RB, Stewart WF (1993). "Migraine in the United States: a review of epidemiology and health care use". Neurology. 43 (6 Suppl 3): S6–10. PMID 8502385.
- ^ a b Rasmussen BK, Olesen J (1992). "Migraine with aura and migraine without aura: an epidemiological study". Cephalalgia. 12 (4): 221–8, discussion 186. doi:10.1046/j.1468-2982.1992.1204221.x. PMID 1525797.
- ^ Steiner TJ, Scher AI, Stewart WF, Kolodner K, Liberman J, Lipton RB (2003). "The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity". Cephalalgia. 23 (7): 519–27. doi:10.1046/j.1468-2982.2003.00568.x. PMID 12950377.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Bigal ME, Liberman JN, Lipton RB (2006). "Age-dependent prevalence and clinical features of migraine". Neurology. 67 (2): 246–51. doi:10.1212/01.wnl.0000225186.76323.69. PMID 16864816.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Stewart WF, Linet MS, Celentano DD, Van Natta M, Ziegler D (1991). "Age- and sex-specific incidence rates of migraine with and without visual aura". Am. J. Epidemiol. 134 (10): 1111–20. PMID 1746521.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Wang SJ (2003). "Epidemiology of migraine and other types of headache in Asia". Curr Neurol Neurosci Rep. 3 (2): 104–8. doi:10.1007/s11910-003-0060-7. PMID 12583837.
- ^ Lavados PM, Tenhamm E (1997). "Epidemiology of migraine headache in Santiago, Chile: a prevalence study". Cephalalgia. 17 (7): 770–7. doi:10.1046/j.1468-2982.1997.1707770.x. PMID 9399008.
- ^ Ottman R, Lipton RB (1994). "Comorbidity of migraine and epilepsy". Neurology. 44 (11): 2105–10. PMID 7969967.
- ^ Kantor, D (2006-11-21). "MedlinePlus Medical Encyclopedia: Migraine". Retrieved 2008-04-04.
- ^ Holzhammer J, Wöber C (2006). "[Alimentary trigger factors that provoke migraine and tension-type headache]". Schmerz (in German). 20 (2): 151–9. doi:10.1007/s00482-005-0390-2. PMID 15806385.
- ^ Robert Milne MD and Blake More. "Headaches". p. 109.
- ^ "Low Tyramine Headache Diet" (PDF). National Headache Foundation. 2004. Retrieved 2008-04-04.
- ^ Prince PB, Rapoport AM, Sheftell FD, Tepper SJ, Bigal ME (2004). "The effect of weather on headache". Headache. 44 (6): 596–602. doi:10.1111/j.1526-4610.2004.446008.x. PMID 15186304.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Cooke LJ, Rose MS, Becker WJ (2000). "Chinook winds and migraine headache". Neurology. 54 (2): 302–7. PMID 10668687.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Ravishankar K (2006). "'Hair wash' or 'head bath' triggering migraine - observations in 94 Indian patients". Cephalalgia. 26 (11): 1330–4. doi:10.1111/j.1468-2982.2006.01223.x. PMID 17059440.
- ^ a b c d e f g h i j k Kaniecki R, Lucas S. (2004
page=40-52), Treatment of primary headache: preventive treatment of migraine. In: Standards of care for headache diagnosis and treatment., National Headache Foundation
{{citation}}
: Check date values in:|year=
(help); Missing pipe in:|year=
(help); Unknown parameter|city=
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suggested) (help); line feed character in|year=
at position 5 (help)CS1 maint: year (link) - ^ Millichap JG, Yee MM (2003). "The diet factor in pediatric and adolescent migraine". Pediatr. Neurol. 28 (1): 9–15. doi:10.1016/S0887-8994(02)00466-6. PMID 12657413.
- ^ a b c Brandes JL, Kudrow D, Stark SR; et al. (2007). "Sumatriptan-naproxen for acute treatment of migraine: a randomized trial". JAMA. 297 (13): 1443–54. doi:10.1001/jama.297.13.1443. PMID 17405970.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ a b Lipton RB, Baggish JS, Stewart WF, Codispoti JR, Fu M (2000). "Efficacy and safety of paracetamol in the treatment of migraine: results of a randomized, double-blind, placebo-controlled, population-based study". Arch. Intern. Med. 160 (22): 3486–92. doi:10.1001/archinte.160.22.3486. PMID 11112243.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Goldstein J, Hoffman HD, Armellino JJ; et al. (1999). "Treatment of severe, disabling migraine attacks in an over-the-counter population of migraine sufferers: results from three randomized, placebo-controlled studies of the combination of paracetamol, aspirin, and caffeine". Cephalalgia : an international journal of headache. 19 (7): 684–91. PMID 10524663.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ Center for Drug Evaluation and Research (1999-10-07). "Approval Letter, Application 20-802/S802" (PDF). U.S. Food and Drug Administration. Retrieved 2008-08-26.
- ^ Ben (2006). "Managing Migraines". FDA Consumer Magazine.
- ^ "4.7.4.1 Treatment of acute migraine". British National Formulary (55 ed.). 2008. pp. p.239.
{{cite book}}
:|pages=
has extra text (help); Unknown parameter|month=
ignored (help) - ^ Colman I, Friedman BW, Brown MD; et al. (2008). "Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence". BMJ. 336 (7657): 1359–61. doi:10.1136/bmj.39566.806725.BE. PMC 2427093. PMID 18541610.
{{cite journal}}
: Explicit use of et al. in:|author=
(help); Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Freitag, Frederick G., Cady, Roger, DiSerio, Frank, Elkind, Arthur, Gallagher, R. Michael, Goldstein, Jerome, Klapper, Jack A., Rapoport, Alan M., Sadowsky, Carl, Saper, Joel R. & Smith, Timothy R. "Comparative Study of a Combination of Isometheptene Mucate, Dichloralphenazone With Acetaminophen and Sumatriptan Succinate in the Treatment of Migraine." Headache: The Journal of Head and Face Pain 41 (4), 391-398.
- ^ Tepper SJ, Stillman MJ (2008). "Clinical and preclinical rationale for CGRP-receptor antagonists in the treatment of migraine". Headache. 48 (8): 1259–68. doi:10.1111/j.1526-4610.2008.01214.x. PMID 18808506.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ UpToDate.
- ^ Migraine News for February 2005, accessed Jan. 4 2008
- ^ RK Cady, CP Schreiber, ME Beach, CC Hart (2005). "Gelstat Migraine (sublingually administered feverfew and ginger compound) for acute treatment of migraine when administered during the mild pain phase". Medical Science Monitor. 11 (9). PMID 16127373.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) See also summary poster. - ^ Russo, Ethan (1998). Cannabis for migraine treatment: the once and future prescription? An historical and scientific review. Pain 76:3-8.
- ^ Diener H, Bussone G, de Liano H, Eikermann A, Englert R, Floeter T, Gallai V, Göbel H, Hartung E, Jimenez M, Lange R, Manzoni G, Mueller-Schwefe G, Nappi G, Pinessi L, Prat J, Puca F, Titus F, Voelker M (2004). "Placebo-controlled comparison of effervescent acetylsalicylic acid, sumatriptan and ibuprofen in the treatment of migraine attacks". Cephalalgia. 24 (11): 475. doi:10.1111/j.1468-2982.2004.00783.x. PMID 15482357.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Silberstein SD, Mannix LK, Goldstein J; et al. (2008). "Multimechanistic (sumatriptan-naproxen) early intervention for the acute treatment of migraine". Neurology. 71 (2): 114–21. doi:10.1212/01.wnl.0000316800.22949.20. PMID 18606965.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ a b Modi S, Lowder D (2006). "Medications for migraine prophylaxis". American Family Physician. 73 (1): 72. PMID 16417067.
- ^ Diener H, Limmroth V (2004). "Medication-overuse headache: a worldwide problem". The Lancet Neurology. 3: 475. doi:10.1016/S1474-4422(04)00824-5.
- ^ Fritsche G (2002). "Medication overuse headaches -- what is new?". Expert Opin Drug Saf. 1 (4): 331–8. doi:10.1517/14740338.1.4.331. PMID 12904133.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help); Unknown parameter|month=
ignored (help) - ^ a b P-HM van der Kuy, JJHM Lohman (2002). "A quantification of the placebo response in migraine prophylaxis". Cephalalgia. 22 (4): 265–270. doi:10.1046/j.1468-2982.2002.00363.x.
- ^ Linde K, Rossnagel K (2004). "Propranolol for migraine prophylaxis". Cochrane Database Syst Rev: CD003225. doi:10.1002/14651858.CD003225.pub2. PMID 15106196.
- ^ Chronicle E, Mulleners W (2004). "Anticonvulsant drugs for migraine prophylaxis". Cochrane Database Syst Rev: CD003226. doi:10.1002/14651858.CD003226.pub2. PMID 15266476.
- ^ Steinman M, Bero L, Chren M, Landefeld C (2006). "Narrative review: the promotion of gabapentin: an analysis of internal industry documents". Ann Intern Med. 145 (4): 284–93. PMID 16908919.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Moja P, Cusi C, Sterzi R, Canepari C (2005). "Selective serotonin re-uptake inhibitors (SSRIs) for preventing migraine and tension-type headaches". Cochrane Database Syst Rev: CD002919. doi:10.1002/14651858.CD002919.pub2. PMID 16034880.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Tomkins G, Jackson J, O'Malley P, Balden E, Santoro J (2001). "Treatment of chronic headache with antidepressants: a meta-analysis". Am J Med. 111 (1): 54–63. doi:10.1016/S0002-9343(01)00762-8. PMID 11448661.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Ziegler D, Hurwitz A, Hassanein R, Kodanaz H, Preskorn S, Mason J (1987). "Migraine prophylaxis. A comparison of propranolol and amitriptyline". Arch Neurol. 44 (5): 486–9. PMID 3579659.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Holzhammer J, Wöber C (2006). "Alimentary trigger factors that provoke migraine and tension-type headache". Schmerz (in German). 20: 151. PMID 15806385.
- ^ a b Russo E (1998). "Cannabis for migraine treatment: the once and future prescription? An historical and scientific review". Pain. 76 (1–2): 3–8. PMID 9696453. Retrieved 2008-08-30.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Rozen T, Oshinsky M, Gebeline C, Bradley K, Young W, Shechter A, Silberstein S (2002). "Open label trial of coenzyme Q10 as a migraine preventive". Cephalalgia. 22 (2): 137–41. doi:10.1046/j.1468-2982.2002.00335.x. PMID 11972582.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Sándor PS; et al. (2005). "Efficacy of coenzyme Q10 in migraine prophylaxis: A randomized controlled trial". Neurology. 64: 713–715. doi:10.1212/01.WNL.0000151975.03598.ED. PMID 15728298.
{{cite journal}}
: Explicit use of et al. in:|author=
(help); Unknown parameter|doi_brokendate=
ignored (|doi-broken-date=
suggested) (help) - ^ Pittler MH, Ernst E. (2004). "Feverfew for preventing migraine". Cochrane Database of Systematic Reviews (1): CD002286. doi:10.1002/14651858.CD002286.pub2. PMID 14973986.
- ^ For example: Diener HC, Pfaffenrath V, Schnitker J, Friede M, Henneicke-von Zepelin HH (2005). "Efficacy and safety of 6.25 mg t.i.d. feverfew CO2-extract (MIG-99) in migraine prevention—a randomized, double-blind, multicentre, placebo-controlled study". Cephalalgia. 25: 1031–41. doi:10.1111/j.1468-2982.2005.00950.x. PMID 16232154.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Peikert A, Wilimzig C, Köhne-Volland R (1996). "Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study". Cephalalgia. 16 (4): 257–63. doi:10.1046/j.1468-2982.1996.1604257.x. PMID 8792038.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ J Schoenen, J Jacquay, M Lenaerts (1998). "Effectiveness of high dose riboflavin in migraine prophylaxis: A randomized controlled trial". Neurology. 150: 466–470.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b A Bianchi, S Salomone, F Caraci, V Pizza, R Bernardini, CC D'Amato (2004). "Role of Magnesium, Coenzyme Q10, Riboflavin, and Vitamin B12 in Migraine Prophylaxis". Vitamins and Hormones. 69: 297–312. doi:10.1016/S0083-6729(04)69011-X.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Riboflavin in Prophylactic Treatment of Migraine, EA Balbisi, EM Ambizas, U.S. Pharmacist Vol. 30, No. 05, accessed Jan. 4 2008.
- ^ P-HM van der Kuy, FWHM Merkus, JJHM Lohman, JWM ter Berg, PM Hooymans (2002). "Hydroxocobalamin, a nitric oxide scavenger, in the prophylaxis of migraine: an open, pilot study". Cephalalgia. 22 (7): 513–519. doi:10.1046/j.1468-2982.2002.00412.x.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Guyuron B, Tucker T, Davis J (2002). "Surgical treatment of migraine headaches". Plast. Reconstr. Surg. 109 (7): 2183–9. doi:10.1097/00006534-200206000-00001. PMID 12045534.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Guyuron B, Kriegler JS, Davis J, Amini SB (2005). "Comprehensive surgical treatment of migraine headaches". Plast. Reconstr. Surg. 115 (1): 1–9. PMID 15622223.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Schwerzmann M, Wiher S, Nedeltchev K, Mattle HP, Wahl A, Seiler C, Meier B, Windecker S (2004). "Percutaneous closure of patent foramen ovale reduces the frequency of migraine attacks". Neurology. 62 (8): 1399–401. PMID 15111681.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Samton J, Mauskop A (2006). "Treatment of headaches with botulinum toxin". Expert Rev Neurother. 6 (3): 313–22. doi:10.1586/14737175.6.3.313. PMID 16533136.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Cady R, Schreiber C (2007). "Botulinum Toxin Type A as Migraine Preventive Treatment in Patients Previously Failing Oral Prophylactic Treatment Due To Compliance Issues". Headache. 48: 900. doi:10.1111/j.1526-4610.2007.00953.x. PMID 18047501.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Schürks M, Diener HC, Goadsby P (2008). "Update on the prophylaxis of migraine" ([dead link] – Scholar search). Curr Treat Options Neurol. 10 (1): 398. doi:10.1007/s11940-008-0003-3. PMID 18325296.
{{cite journal}}
: External link in
(help); Unknown parameter|format=
|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Matharu MS, Bartsch T, Ward N, Frackowiak RS, Weiner R, Goadsby PJ (2004). "Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study". Brain. 127 (Pt 1): 220–30. doi:10.1093/brain/awh022. PMID 14607792.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Mohammad, Yousef (2006-06-22). "Magnets Zap Migraines". 49th Annual Scientific Meeting of the American Headache Society. Los Angeles, California. Retrieved 2006-07-04.
{{cite conference}}
: Check date values in:|date=
(help); Unknown parameter|booktitle=
ignored (|book-title=
suggested) (help) - ^ Nestoriuc Y, Martin A (2007). "Efficacy of biofeedback for migraine: a meta-analysis". Pain. 128 (1–2): 111–27. doi:10.1016/j.pain.2006.09.007. PMID 17084028.
- ^ Bennett MH, French C, Schnabel A, Wasiak J, Kranke P (2008). "Normobaric and hyperbaric oxygen therapy for migraine and cluster headache". Cochrane Database Syst Rev (3): CD005219. doi:10.1002/14651858.CD005219.pub2. PMID 18646121.
{{cite journal}}
:|access-date=
requires|url=
(help)CS1 maint: multiple names: authors list (link) - ^ Eftedal OS, Lydersen S, Helde G, White L, Brubakk AO, Stovner LJ (2004). "A randomized, double blind study of the prophylactic effect of hyperbaric oxygen therapy on migraine". Cephalalgia. 24 (8): 639–44. doi:10.1111/j.1468-2982.2004.00724.x. PMID 15265052.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Fife WP, Fife CE (1989). "Treatment of Migraine with Hyperbaric Oxygen". J. Hyperbaric Med. 4 (1): 7–15. Retrieved 2008-08-06.
- ^ Turville, A. E. (1934) "Refraction and migraine". Br. J. Physiol. Opt. 8, 62–89
- ^ Wilmut, E. B. (1956) "Migraine". Br. J. Physiol. Opt. 13, 93–97
- ^ [2] (PDF)
- ^ Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV (1998). "The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache". J Manipulative Physiol Ther. 21(8)
page=511-9.
{{cite journal}}
: Missing pipe in:|volume=
(help); line feed character in|volume=
at position 6 (help)CS1 maint: multiple names: authors list (link) - ^ Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJ, Bouter LM (2004). "Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev". 3.
{{cite journal}}
: Cite journal requires|journal=
(help)CS1 maint: multiple names: authors list (link) - ^ http://www.thebowentechnique.com/content/migraine.htm
- ^ a b c Tuchin, PJ, Pollard, H & Bonello, R. (2000). ""A randomized controlled trial of chiropractic spinal manipulative therapy for migraine"". Journal of Manipulative and Physiological Therapeutics.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Biondi, DM (2005). "Physical Treatments for Headache: A Structured Review"". The Journal of Head and Face Pain. 45, : 738-746.
{{cite journal}}
: CS1 maint: extra punctuation (link) - ^ Facco E, Liguori A, Petti F; et al. (2007). "Traditional Acupuncture in Migraine: A Controlled, Randomized Study". Headache. 48: 398. doi:10.1111/j.1526-4610.2007.00916.x. PMID 17868354.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ Melchart D, Thormaehlen J, Hager S, Liao J, Linde K, Weidenhammer W (2003). "Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks: a randomized controlled trial". J. Intern. Med. 253 (2): 181–8. doi:10.1046/j.1365-2796.2003.01081.x. PMID 12542558.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Alexander Mauskop; Fox, Barry (2001). What Your Doctor May Not Tell You About: Migraines : The Breakthrough Program That Can Help End Your Pain (What Your Doctor May Not Tell You About...(Paperback)). New York: Warner Books. p. 130. ISBN 0-446-67826-0.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - ^ a b Etminan M, Takkouche B, Isorna FC, et al. Risk of ischaemic stroke in people with migraine: Systematic review and meta-analysis of observational studies. BMJ. 2005;330:63. PMID 15596418
- ^ Kurth, T (2006). "Migraine and risk of cardiovascular disease in women". Journal of the American Medical Association. 296 (3): 283–91. doi:10.1001/jama.296.3.283. PMID 16849661.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help); Unknown parameter|month=
ignored (help) - ^ Becker C, Brobert GP, Almqvist PM, Johansson S, Jick SS, Meier CR. Migraine and the risk of stroke, TIA, or death in the UK (CME). Headache. 2007;47(10):1374–84. PMID 18052947
- ^ Waters WE, Campbell MJ, Elwood PC. Migraine, headache, and survival in women. BMJ (Clin Res Ed). 1983;287:1442–1443. PMID 6416449
- ^ Kurth T, Gaziano JM, Cook NR, et al. Migraine and risk of cardiovascular disease in women. JAMA. 2006;296:283–291.
External links
General information
- Migraine Information from the US National Institute of Neurological Disorders and Stroke
- Template:PDF
Organizations
- World Headache Alliance
- Headache, a medical journal
- The City of London Migraine Clinic, medical charity for treatment and research
- Migraine Action, charity offering support and information to adults and children affected by migraine