What is a migraine?
A migraine is a severe headache that usually starts in one area of the head. Migraine headaches are often accompanied by extreme sensitivity to light and sound, fatigue, nausea, and vomiting. Some people also experience aura- an abnormal neurologic event that precedes the onset of migraine, which can be manifest by visual changes, numbness, tingling, weakness, or even confusion. Most auras develop between 10 to 15 minutes before the onset of the migraine, although they can occur up to 24 hours before the headache. Migraines can last for several hours or days, and they can be extremely debilitating.
What causes a migraine headache?
Most experts believe that migraine is caused by a genetic hyperexcitability of the brain. The migraine brain has a more difficult time processing incoming sensory stimuli this can be exacerbated by intrinsic factors such as menstruation or depression as well as external factors such as food, allergen, travel, barometric pressure, etc. These are known as “triggers”. Each person’s triggers are unique.
Who is at risk of migraine headaches?
Most migraine headaches first appear between the ages of 10 and 45. More women than men suffer from migraines, but migraines tend to run in families. Typically migraine starts with the onset of menstruation in females and tapers off with menopause.
Signs and tests
There are no tests that are needed to make the diagnosis. However, your doctor may order a brain MRI or CT scan if you have never had a migraine before or if you have unusual symptoms, including weakness, memory problems, or loss of alertness. Your doctor may order other tests, including an electroencephalogram (EEG) to rule out seizures and a spinal tap, or lumbar puncture, to look for signs of infection if an alternative type of headache is suspected.
There is no specific cure for migraine headaches. The main objective is to reduce the frequency and severity of the episodes.
Lifestyle modification is the first line of defense against migraine. You will be taught how to recognize and avoid your specific migraine triggers to reduce the number of attacks. You will also be educated in regard to sleep, diet and exercise and their benefit in migraine treatment.
Medications are also used. Over-the-counter pain medications are commonly used. If they are not effective, you may be prescribed a preventive medication which is taken daily to prevent the headache. Additionally, you may be prescribed an abortant, most commonly a family of medications known as “Tritpans” used to stop the migraine once it starts. Because nausea may make it difficult to take medication orally, most medications are available in other forms including, orally dissolvable tabs, nasal sprays, suppositories, and injections.
Finally there are procedures such as injections of Botulinum toxin (Botox) may also help prevent migraine attacks, and nerve blocks which are typically used for more chronic migrainuers (with headaches more than 15 days per month).
Care at Stanford
The Division of Pain Medicine has partnered with the Stanford Headache Clinic in the Department of Neurology and Neurological Sciences to provide interdisciplinary care for migraine.
Cerebrospinal fluid leak (CSF)
At Stanford, patient discovers the source of her headaches, nausea
By the time she was 24, Rachel Hale was on her fourth diagnosis and had been on headache medication for years. Then she met with Ian Carroll, MD, a headache and orofacial pain specialist at Stanford.
What research are you conducting for migraines?
We do not have any current research studies specifically for patients with migraines. However, we have a number of ongoing research studies for other pain conditions.