Migraine headaches have four phases: 1) the prodrome (beginning); 2)
the aura or visual disturbances that precede the headache; 3) the
headache; and 4) resolution.

The prodrome may vary in
presentation but usually presents as weakness, poor concentration, or a
stiff neck. This phase can last for hours or days.

The aura may present as visual changes and lasts approximately sixty minutes or less.

The
classic migraine headache is generally one-sided, throbbing, and varies
in severity. The headache worsens over time and is more common in the
morning. Nausea, vomiting, and anorexia may also be present.

The
diagnosis is made by the patient's history. Migraines can be confused
with other type of headaches such as tension or sinus headaches.

The
history should include diet, eating patterns, medications, level of
stress, and environmental exposures. The description of the migraine
should include timing, location, frequency, severity, aggravating
factors, improving factors, and associated symptoms.

Certain
foods such as red wine, alcohol nitrites, lactose, aspartame,
monosodium glutamate (MSG), and nitrates (cured meats). You may have
other food triggers.

A headache diary listing the timing, meals, and activities of the moment may help you find your specific triggering events.

Lifestyle
changes that are beneficial include exercise, weight loss, regular
sleep, stop smoking, and avoid substances (see above) that trigger
migraines.

There are a large number of medications that can be
used to treat migraines including triptans, narcotics, and
nonsteroidals. The success of triptans vary with individuals. If one
does not work, try another one. In those patient's with severs nausea
and vomiting, a non-oral medication can be used.

Sometimes, daily
suppressive medical therapy can make a tremendous difference in
migraine sufferers. These daily regimens are usually written by primary
care physicians or neurologists.

Therapy should be individualized based on the patient's history and physical examination. 

Menstrual
migraines are felt to be caused by estrogen withdrawal, especially if a
patient is taking oral contraceptives. Continuous oral contraceptives
would decrease the frequency of one's migraine as well as her cycle.
The migraine will generally start as one begins taking the non-active
pills.

Although most women consider a monthly menstrual cycle to
be necessary, one can stretch out the time between cycles with medical
management by using oral contraceptives. 

Sometimes, the use of
transdermal estrogen patches during the pill- free portion of the oral
contraceptive will decrease the severity of the menstrual migraine.
There are many choices for the estrogen.

If certain medication or
therapies do not work, then give other medication or therapies a try.
Lifestyle modifications can make a significant impact on the frequency
and severity of your migraine.

Migraines that persist despite proper medical management should be referred to a neurologist. 

Have a great week!

Joe Edwards M.D.