Migraine Health Dictionary

“Half of all migraine patients suffer from anxiety, and one in five experiences depression,” according to a study carried out at Manchester University. (Dr Jennifer Devlen)

Causes: many and varied. Alcohol, excess coffee and caffeine stimulants, gluten food allergies, dairy products, chocolate, citrus fruits. Related to carbohydrate metabolism. May be associated with menstruation or emotional disturbance, nervous or physical fatigue; liver, stomach or kidney disturbance, or The Pill.

Symptoms: temporary blindness, or sight may be only half the visual field. Flashing lights, throbbing headache, loud noises worsen, nausea, vomiting, depression.

Treatment. In the initial (constrictive) stage any of the following simple teas may resolve: German Chamomile, Betony, Skullcap, Wild Thyme, Valerian.

Where the condition has progressed to vasodilation (engorgement of cerebral blood vessels) give any of the following alternatives. Whilst the requirements of each individual case is observed, inclusion of a remedy for stomach and liver may enhance efficacy. Sometimes a timely diuretic to reduce volume of the blood aborts an attack.

Associated with menstrual disorders: Agnus Castus, Evening Primrose oil.

Tea: Formula. (1) Equal parts: Betony, Valerian, Dandelion root. (2) Alfalfa 1; Valerian half; Hops quarter. One heaped teaspoon to each cup boiling water; infuse 15 minutes. Half-1 cup 2-3 times daily. Formula. Skullcap 2; Mistletoe 1; Hops half. Dose: Liquid Extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon) 2-3 times daily.

Valerian. German traditional.

Feverfew. 2-3 fresh leaves on bread. Tincture (or essence) 5-10 drops.

Practitioner: Tincture Gelsemium, BPC (1963) 5 drops.

Diet: Fruit juice fast. Oily fish. Hay diet. Salt-free.

Vitamins. A. B-complex, B6, B12, C (up to 1000mg). E, Niacin.

Minerals. Manganese, Calcium, Magnesium, Zinc.

Rose-tinted glasses. Ophthalmology Department, Birmingham University.

Information. British Migraine Association, 178A High Road, West Byfleet, Surrey KT14 7ED. Send SAE. 

There is no single cause of migraine, although it tends to run in families. Stress-related, food-related, or sensoryrelated factors may trigger an attack. Menstruation and oral contraceptives may also trigger migraine.

There are 2 types: migraine with aura (an impression of flashing lights and/or numbness and tingling), and migraine without aura. In migraine without aura, there is a slowly worsening headache, often on one side of the head, with nausea and sometimes vomiting.

In migraine with aura, there may be visual disturbances for up to an hour, followed by a severe one-sided headache, nausea, vomiting and light-sensitivity. Other temporary neurological symptoms, such as weakness in one half of the body, may occur.

Diagnosis is usually made from the history and a physical examination. Treatment for an attack is an analgesic drug such as aspirin or paracetamol, plus an antiemetic drug, if needed. If this is not effective, treatment with serotonin agonists such as sumatriptan may be prescribed. Ergotamine may prevent an attack if taken before the headache begins, but is now rarely used. Sleeping in a darkened room may hasten recovery. For frequent attacks, preventive treatment may be needed. Keeping a diary can help pinpoint trigger factors, and prophylactic drugs may be prescribed.(See also cluster headaches.)

It usually begins at puberty – although young children can be affected – and tends to stop in middle age: in women, for example, attacks often cease after MENOPAUSE. It frequently disappears during pregnancy. The disorder tends to run in families. In susceptible individuals, attacks may be provoked by a wide variety of causes including: anxiety, emotion, depression, shock, and excitement; physical and mental fatigue; prolonged focusing on computer, television or cinema screens; noise, especially loud and high-pitched sounds; certain foods – such as chocolate, cheese, citrus fruits, pastry; alcohol; prolonged lack of food; irregular meals; menstruation and the pre-menstrual period.

Anything that can provoke a headache in the ordinary individual can probably precipitate an attack in a migrainous subject. It seems as if there is an inherited predispostion that triggers a mechanism whereby in the migrainous subject, the headache and the associated sickness persist for hours, a whole day or even longer.

The precise cause is not known, but the generally accepted view is that in susceptible individuals, one or other of these causes produces spasm or constriction of the blood vessels of the brain. This in turn is followed by dilatation of these blood vessels which also become more permeable and so allow ?uid to pass out into the surrounding tissues. This combination of dilatation and outpouring of ?uid is held to be responsible for the headache.

Two types of migraine have been recognised: classical and common. The former is relatively rare and the headache is preceded by a slowly extending area of blindness in one or both eyes, usually accompanied by intermittent ‘lights’. The phenomenon lasts for up to 30 minutes and is followed by a bad, often unilateral headache with nausea, sometimes vomiting and sensitivity to light. Occasionally, passing neurological symptoms such as weakness in a limb may accompany the attack. The common variety has similar but less severe symptoms. It consists of an intense headache, usually situated over one or other eye. The headache is usually preceded by a feeling of sickness and disturbance of sight. In 15–20 per cent of cases this disturbance of sight takes the form of bright lights: the so-called AURA of migraine. The majority of attacks are accompanied by vomiting. The duration of the headache varies, but in the more severe cases the victim is usually con?ned to bed for 24 hours.

Treatment consists, in the ?rst place, of trying to avoid any precipitating factor. Patients must ?nd out which drug, or drugs, give them most relief, and they must always carry these about with them wherever they go. This is because it is a not uncommon experience to be aware of an attack coming on and to ?nd that there is a critical quarter of an hour or so during which the tablets are e?ective. If not taken within this period, they may be ine?ective and the unfortunate victim ?nds him or herself prostrate with headache and vomiting. In addition, sufferers should immediately lie down; at this stage a few hours’ rest may prevent the development of a full attack.

When an attack is fully developed, rest in bed in a quiet, darkened room is essential; any loud noise or bright light intensi?es the headache or sickness. The less food that is taken during an attack the better, provided that the individual drinks as much ?uid as he or she wants. Group therapy, in which groups of around ten migrainous subjects learn how to relax, is often of help in more severe cases, whilst in others the injection of a local anaesthetic into tender spots in the scalp reduces the number of attacks. Drug treatment can be e?ective and those a?icted by migraine may ?nd a particular drug or combination of drugs more suitable than others. ANALGESICS such as PARACETAMOL, aspirin and CODEINE phosphate sometimes help. A combination of buclizine hydrochloride and analgesics, taken when the visual aura occurs, prevents or diminishes the severity of an attack in some people. A commonly used remedy for the condition is ergotamine tartrate, which causes the dilated blood vessels to contract, but this must only be taken under medical supervision. In many cases METOCLOPRAMIDE (an antiemetic), followed ten minutes later by three tablets of either aspirin or paracetamol, is e?ective if taken early in an attack. In milder attacks, aspirin, with or without codeine and paracetamol, may be of value. SUMATRIPTAN (5-hydroxytryptamine [5HT1] AGONIST – also known as a SEROTONIN agonist) is of value for acute attacks. It is used orally or by subcutaneous injection, but should not be used for patients with ischaemic heart disease. Naratriptan is another 5HT1 agonist that is an e?ective treatment for acute attacks; others are almotriptan, rizariptan and zolmitriptan. Some patients ?nd beta blockers such as propranolol a valuable prophylactic.

People with migraine and their relatives can obtain help and guidance from the Migraine Action Association.