Migraine Headaches

Migraines, the chronic, recurrent and often debilitating attacks of pain in the head or neck affect millions of people. These unilateral headaches usually attack a sufferer with various warning signs. 40-60% of migraine sufferers experience sleepiness, depression, fatigue and irritability, some patients report cravings for salty or sweet foods and yawning or euphoria. An interesting warning sign in 20% of migraine suffering patients report a type of aura that precedes an attack. This aura is sometimes manifested by fortification spectra, commonly known as flashing, brightly colored lights in a zigzag pattern, typically beginning in the center of the patient’s visual field and spreading outward. A blind spot in the patient’s visual field, or a scotoma (a hole in vision) can also occur prior to a migraine. A sensation of pins and needles in the arm, hand, mouth or nose or auditory hallucinations and aberrant senses of smell and taste can also preclude a migraine.
A migraine sufferer may suffer from a lack of energy and sensitivity to light and sound for 24 hours after an attack. Migraines also cause patients to experience vertigo, double vision, nausea, vomiting, paralysis and fainting in extreme cases.
When a migraine attack occurs, the temporal artery, the artery outside the skull just below the skin of the temple, enlarges. This enlargement stretches the nerves that spiral around the artery, releasing chemicals that cause pain and inflammation. The artery continues to enlarge during the duration of the headache, thereby intensifying the pain.
Migraine headaches can be treated with medications that counteract the cause of the enlargement of the temporal artery. These medications do not relieve the pain but are directed at the dilation and narrowing of the arteries, thus reducing the pain the patient experiences. Triptans constrict the blood vessels by attaching themselves to serotonin receptors on the nerves and blood vessels, reducing inflammation and stopping the headache. Sumatriptan, Zolmitriptan, rizatriptan, Naratriptan, Almotriptan, frovatriptan are available in oral form for the patient to take. When a patient notices the symptoms of the migraine early, using a triptan can severly lessen the attack of the pain. Within 2 hours of taking the triptan, a patient is 80% likely to abort the headache.
Triptans do have side effects including heart attacks, strokes, drowsiness, fatigue, tingling of the skin, facial flushing and dizziness. The possibility of such severe side effects such as heart attack or strokes is caused by the narrowing of the arteries that the triptan induces, also narrowing the arteries in the heart which could increase the risk of heart attack. Ergots are another medication that, like triptans, abort the onset of a migraine headache. Ergotamine preparations (Ergomar, Wigraine and Cafergot) and dihydroergotamine preparations (Migranal, DHE-45) are common medications among ergots.
These are not as safe as triptans because ergots tend to constrict the vessels in the heart and other body parts more than triptans. Midrin is another option in the treatment and abortion of migraine and tension headaches. This compination of blood vessel constrictor (isometheptene), pain reliever (acetominophen) and a mild sedative (dichloralphenazone) is most helpful if taken early during a headache. It also causes potent blood vessel constriction and is dangerous for patients with high blood pressure and liver disease.
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