A migraine headache is defined by the specific mechanism of headache production and the presence of typical symptoms, not by the severity of the pain. In fact, "migraines" can occur without any pain at all, but instead cause other symptoms that adversely affect the general workings of the brain, such as temporary visual loss. Also, other parts of the body can be affected by migraines. For example, abdominal migraines may lead to severe gastrointestinal complaints.
The mechanism of migraine is due to an apparent abnormality, inherited or acquired, in which the control mechanism of specific blood vessels in the brain are altered, leading initially to blood vessel spasm (vasoconstriction) and decreased blood flow, followed by excessive relaxation (vasodilation). It is during the vasodilation phase that pain occurs.
Newer research has demonstrated a major role for a certain chemical, serotonin, in the regulation of cerebral blood vessels. Other investigators list a variety of potential mechanisms. Suffice it to say that this ailment is the result of a basic chemical, electrical, or structural abnormality in a specific area of the brain that oversees regulation of blood vessel caliber. Unfortunately, like most other areas of the brain, interconnections with other brain functions exist with varying degrees from patient to patient. To complicate matters further, normal hormonal changes can alter the delicate balance in the migraine regulatory center of the brain. Such is evident in women who suffer excruciating migraine headaches during their menstrual cycles. Emotional and physical stresses play a major role in certain individuals. Foods containing nitrates as preservatives may adversely affect some migraine sufferers but not others. Food allergies may affect 30% of migraine patients. As is evident then, each migraine patient is wired differently and has their own list of aggravating factors. Therefore, treatment must be individualized to take into account the varying affects of hormones, physical and emotional stresses, food preservatives, food allergies, and chemical irritation.
Treatment is based on a single goal. That is, to prevent cerebral vasodilation by any manner. In addition, treatment is broken down into two categories, abortive versus prophylactic therapy. Abortive therapy is given only at the onset of each headache. On the other hand, headaches that occur at least twice weekly need prophylaxis, in which an attempt is made to reduce the frequency, severity, and duration of attacks. Specific categories of medications used for prophylaxis are listed below.
Antidepressants - The anti-migraine effect is independent of the antidepressant effect. One class of antidepressants usually prescribed are called "tricyclic" antidepressants. The beneficial effects are believed due to the antiserotonin effects of these medications. It must be emphasized that antidepressants, although sedating, are NOT tranquilizers and therefore are not habituating. Newer antidepressants may also benefit. These include Prozac, Paxil, Serzone, Effexor, and Zoloft.
Antihistamines - One specific antihistamine, Periactin (cyproheptadine), has antiserotonin effects that may help some patients. This product is frequently administered to children.
Anti-inflammatory drugs - Used commonly in arthritic conditions, they may benefit some. Long term side effects can be induction of stomach ulcers and gradual deterioration of kidney function.
Inderal (propranolol) - Primarily used for blood pressure control, this medicine helps directly regulate the caliber of blood vessels and prevents excessive vasodilation in some. Weakness can be a side effect of this medication.
"Migraine medications" - Drugs typically used for abortive therapy are occasionally given for prophylaxis. Ergotamines and Sansert (methysergide) are such drugs. Chronic use of these drugs require a patient to understand their potential long-term side effects.
Psychological intervention - Biofeedback and behavioral control may be of benefit in select cases. Many functions of the brain can be "re-programmed" with persistent effort. Motivation and persistence is required to take advantage of this therapy which may provide permanent benefits, potentially reducing the necessity to take additional medications.
Miscellaneous - Hormonal control and specific diets may be prescribed for some. All patients should seek a full nights rest, engage in physical activity in a reasonable manner, and pursue a quality of life that is less stressing.
Specific food restrictions - Nitrates, particularly, are known to cause headaches in some people. Nitrates are effective preservatives and are especially used to retard spoilage in sausages and canned meats. Additionally, fresh meats on your grocery shelf maintain their reddened hue partially as a result of nitrates. A trial of nitrate avoidance should be attempted for at least 2 - 4 weeks to determine if such additives may be contributing to your headaches. In select cases, food skin tests are used to evaluate for food allergies in patients who have headaches typically within 2 - 4 hours of their last meal. In wine, additives or byproducts (sulfates, nitrates, histamine) may trigger migraines.
Remember, migraine headaches are the result of a malfunctioning control center within the brain itself. You can't necessarily cure the problem, but recognizing individual factors that affect the frequency and severity of the disorder will optimize the benefit derived from any treatment program.
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