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Migraine

Health    Migraine

Summary

What are Migraines?

Migraines are a recurring type of headache. They cause moderate to severe pain that is throbbing or pulsing. The pain is often on one side of your head. You may also have other symptoms, such as nausea and weakness. You may be sensitive to light and sound.

What Causes Migraines?

Researchers believe that migraine has a genetic cause. There are also a number of factors that can trigger a migraine, including

  • Stress
  • Anxiety
  • Hormonal changes in women
  • Bright or flashing lights
  • Loud noises
  • Strong smells
  • Medicines
  • Too much or not enough sleep
  • Sudden changes in weather or environment
  • Overexertion (too much physical activity)
  • Tobacco
  • Caffeine or caffeine withdrawal
  • Skipped meals
  • Medication overuse (taking medicine for migraines too often)
  • Certain foods and food additives such as
    • Alcohol
    • Chocolate
    • Aged cheeses
    • Monosodium glutamate (MSG)
    • Some fruits and nuts
    • Fermented or pickled goods
    • Yeast
    • Cured or processed meats

Who is at risk for migraines?

It can affect anyone, but you are more likely to have them if you

What are the symptoms of migraines?

There are four different phases of migraines. You may not always go through every phase each time you have a migraine.

Prodome

This phase starts up to 24 hours before you get the migraine. You have early signs and symptoms, such as food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination.

Aura

If you have this phase, you might see flashing or bright lights or zig-zag lines. You may have muscle weakness or feel like you are being touched or grabbed. An aura can happen just before or during a migraine.

Headache

A migraine usually starts gradually and then becomes more severe. It typically causes throbbing or pulsing pain, which is often on one side of your head. But sometimes you can have a migraine without a headache. Other migraine symptoms may include * Increased sensitivity to light, noise, and odors * Nausea and vomiting * Worsened pain when you move, cough, or sneeze

Postdrome (following the headache)

You may feel exhausted, weak, and confused after a migraine. This can last up to a day.

Migraines are more common in the morning; people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.

How are migraines diagnosed?

To make a diagnosis, your health care provider will

  • Take your medical history
  • Ask about your symptoms
  • Do a physical and neurological exam

An important part of diagnosing migraines is to rule out other medical conditions which could be causing the symptoms. So you may also have blood tests, an MRI or CT scan, or other tests.

How are migraines treated?

There is no cure for migraines. Treatment focuses on relieving symptoms and preventing additional attacks.

There are different types of medicines to relieve symptoms. They include triptan drugs, ergotamine drugs, and pain relievers. The sooner you take the medicine, the more effective it is.

There are also other things you can do to feel better:

  • Resting with your eyes closed in a quiet, darkened room
  • Placing a cool cloth or ice pack on your forehead
  • Drinking fluids

There are some lifestyle changes you can make to prevent migraines:

  • Stress management strategies, such as exercise, relaxation techniques, and biofeedback, may reduce the number and severity of migraines. Biofeedback uses electronic devices to teach you to control certain body functions, such as your heartbeat, blood pressure, and muscle tension.
  • Make a log of what seems to trigger your migraines. You can learn what you need to avoid, such as certain foods and medicines. It also help you figure out what you should do, such as establishing a consistent sleep schedule and eating regular meals.
  • Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle
  • If you have obesity, losing weight may also be helpful

If you have frequent or severe migraines, you may need to take medicines to prevent further attacks. Talk with your health care provider about which drug would be right for you.

Certain natural treatments, such as riboflavin (vitamin B2) and coenzyme Q10, may help prevent migraines. If your magnesium level is low, you can try taking magnesium. There is also an herb, butterbur, which some people take to prevent migraines. But butterbur may not be safe for long-term use. Always check with your health care provider before taking any supplements.

Headaches: In Depth

What's the Bottom Line?

What do we know about the usefulness of complementary approaches for headaches?

Mind and Body Approaches

  • Acupuncture can be helpful for headaches. Much of its benefit may be due to nonspecific factors including expectation, beliefs, and placebo responses rather than specific effects of needling.
  • Some studies indicate that biofeedback- based techniques may be helpful for tension headaches and migraines, but not all research results agree.
  • For massage, relaxation techniques, spinal manipulation, and tai chi, the evidence is too limited or inconsistent to allow conclusions to be reached.

What do we know about the safety of complementary approaches for headaches?

In general, the complementary approaches discussed in this fact sheet have good safety records. However, that doesn't mean that they're risk-free for everyone. Your age, health, special circumstances (such as pregnancy), and medicines or supplements that you take may affect the safety of complementary approaches.

Some Basics About Headaches

Headaches are the most common form of pain. They're a major reason why people miss work or school or visit a health care provider. This fact sheet focuses on two types of headache: tension headaches and migraines. Researchers have studied complementary health approaches for both.

Tension Headaches and Migraines: What's the Difference?

Tension Headaches

The most common type of headache—are caused by tight muscles in the shoulders, neck, scalp, and jaw. They may be related to stress, depression, or anxiety and may occur more often in people who work too much, sleep too little, miss meals, or drink alcoholic beverages.

Migraine Headaches

Migraine headaches involve moderate to severe throbbing pain, often on one side of the head. During a migraine, people are sensitive to light and sound and may feel nauseated. Some people have visual disturbances before a migraine—like seeing zigzag lines or flashing lights, or temporarily losing their vision.

Anxiety, stress, lack of food or sleep, exposure to light, or hormonal changes (in women) can trigger migraines. Genes that control the activity of some brain cells may play a role in causing migraines.

What the Science Says About Complementary Health Approaches for Headache

Research has produced promising results for some complementary health approaches for tension headache or migraine. For other approaches, evidence of effectiveness is limited or conflicting.

Mind and Body Approaches

Mind and body approaches that have been studied for headache include acupuncture, biofeedback, massage, relaxation techniques, spinal manipulation, and tai chi.

Acupuncture

Acupuncture is a technique in which practitioners stimulate specific points on the body, most often by inserting thin needles through the skin.

There have been many studies of acupuncture for headache. The combined results from these studies indicate that acupuncture may help relieve headache pain, but that much of its benefit may be due to nonspecific effects including expectation, beliefs, and placebo responses rather than specific effects of needling.

Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.

Biofeedback

Biofeedback measures body functions and gives you information about them so that you can become more aware of those functions and learn to control them. For example, a biofeedback device may show you measurements of muscle tension. By watching how these measurements change, you can become more aware of when your muscles are tense and learn to relax them.

Several types of biofeedback have been studied for headaches, including techniques that help people learn to relax and more specific techniques that focus on changes that occur during headaches.

Tension Headaches

Many studies have tested biofeedback for tension headaches, and several evaluations of this research have concluded that biofeedback may be helpful. However, an evaluation that included only the highest quality studies concluded that there is conflicting evidence about whether biofeedback is helpful for tension headaches.

Migraines

Studies have shown decreases in the frequency of migraines in people who were using biofeedback. However, it's unclear whether biofeedback is better than a placebo for migraines.

Biofeedback generally does not have harmful side effects.

Massage

Massage therapy includes a variety of techniques in which practitioners manipulate the soft tissues of the body.

Limited evidence from two small studies suggests massage therapy is possibly helpful for migraines, but clear conclusions cannot be drawn.

Massage therapy appears to have few risks when performed by a trained practitioner. However, people with health conditions and pregnant women may need to avoid some types of massage and should consult their health care providers before having massage therapy.

Relaxation Techniques

Relaxation techniques—such as progressive muscle relaxation, guided imagery, and breathing exercises—are practices that can produce the body's natural relaxation response.

Although some experts consider relaxation techniques to be promising for tension headaches, there isn't much evidence to support their effectiveness. An evaluation of high-quality studies on relaxation techniques found conflicting evidence on whether they're better than no treatment or a placebo. Some studies suggest that relaxation techniques are less helpful than biofeedback.

Relaxation techniques generally don't have side effects. However, rare harmful effects have been reported in people with serious physical or mental health conditions.

Spinal Manipulation

Spinal manipulation is a technique in which practitioners use their hands or a device to apply a controlled force to a joint of the spine. Chiropractors or other health professionals may use this technique.

Spinal manipulation is frequently used for headaches. However, it's uncertain whether manipulation is helpful because studies have had contradictory results.

Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the area that was manipulated. There have been rare reports of strokes occurring after manipulation of the upper (cervical) spine, but whether manipulation actually caused the strokes is unclear.

Tai Chi

Tai chi, which originated in China, combines meditation with slow, graceful movements, deep breathing, and relaxation.

One small randomized study has evaluated tai chi for tension headaches. Some evidence of improvements in headache status and health-related quality of life was found among patients on the tai chi program compared to others on a wait list. These data are too limited to draw meaningful conclusions about whether this practice is helpful for tension headaches.

Tai chi is generally considered to be a safe practice.

More To Consider

  • Most dietary supplements have not been tested in pregnant women, nursing mothers, or children. If you're pregnant or nursing a child, or if you're considering giving a child a dietary supplement, consult your (or your child's) health care provider.
  • Be aware that some dietary supplements may interact with conventional medical treatments.
  • If you're considering a practitioner-provided complementary health practice such as biofeedback or acupuncture, ask a trusted source (such as your health care provider or nearby hospital) to recommend a practitioner. Find out about the training and experience of any complementary health practitioner you're considering.
  • Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Relaxation Techniques for Health

What's the Bottom Line?

How much do we know about relaxation techniques?

A substantial amount of research has been done on relaxation techniques. However, for many health conditions, the number or size of the studies has been small, and some studies have been of poor quality.

What do we know about the effectiveness of relaxation techniques?

Relaxation techniques may be helpful in managing a variety of health conditions, including anxiety associated with illnesses or medical procedures, insomnia, labor pain, chemotherapy-induced nausea, and temporomandibular joint dysfunction. Psychological therapies, which may include relaxation techniques, can help manage chronic headaches and other types of chronic pain in children and adolescents.

Relaxation techniques have also been studied for other conditions, but either they haven't been shown to be useful, research results have been inconsistent, or the evidence is limited.

What do we know about the safety of relaxation techniques?

Relaxation techniques are generally considered safe for healthy people, although there have been a few reports of negative experiences such as increased anxiety. People with serious physical or mental health problems should discuss relaxation techniques with their health care providers.

What Are Relaxation Techniques?

Relaxation techniques include a number of practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises. The goal is similar in all: to produce the body's natural relaxation response, characterized by slower breathing, lower blood pressure, and a feeling of increased well-being.

Meditation and practices that include meditation with movement, such as yoga and tai chi, can also promote relaxation.

Stress management programs commonly include relaxation techniques. Relaxation techniques have also been studied to see whether they might be of value in managing various health problems.

The Importance of Practice

Relaxation techniques are skills, and like other skills, they need practice. People who use relaxation techniques frequently are more likely to benefit from them. Regular, frequent practice is particularly important if you're using relaxation techniques to help manage a chronic health problem. Continuing use of relaxation techniques is more effective than short-term use.

Relaxation techniques include the following:

Autogenic Training

In autogenic training, you learn to concentrate on the physical sensations of warmth, heaviness, and relaxation in different parts of your body.

Biofeedback-Assisted Relaxation

Biofeedback techniques measure body functions and give you information about them so that you can learn to control them. Biofeedback-assisted relaxation uses electronic devices to teach you to produce changes in your body that are associated with relaxation, such as reduced muscle tension.

Deep Breathing or Breathing Exercises

This technique involves focusing on taking slow, deep, even breaths.

Guided Imagery

For this technique, people are taught to focus on pleasant images to replace negative or stressful feelings. Guided imagery may be self-directed or led by a practitioner or a recording.

Progressive Relaxation

This technique, also called Jacobson relaxation or progressive muscle relaxation, involves tightening and relaxing various muscle groups. Progressive relaxation is often combined with guided imagery and breathing exercises.

Self-Hypnosis

In self-hypnosis programs, people are taught to produce the relaxation response when prompted by a phrase or nonverbal cue (called a "suggestion").

What the Science Says About the Effectiveness of Relaxation Techniques

Researchers have evaluated relaxation techniques to see whether they could play a role in managing a variety of health conditions, including the following:

Anxiety

Studies have shown relaxation techniques may reduce anxiety in people with ongoing health problems such as heart disease or inflammatory bowel disease, and in those who are having medical procedures such as breast biopsies or dental treatment. Relaxation techniques have also been shown to be useful for older adults with anxiety.

On the other hand, relaxation techniques may not be the best way to help people with generalized anxiety disorder. Generalized anxiety disorder is a mental health condition, lasting for months or longer, in which a person is often worried or anxious about many things and finds it hard to control the anxiety.

Studies indicate that long-term results are better in people with generalized anxiety disorder who receive a type of psychotherapy called cognitive-behavioral therapy than in those who are taught relaxation techniques.

Asthma

There hasn't been enough research to show whether relaxation techniques can relieve asthma symptoms in either adults or children.

Childbirth

Relaxation techniques such as guided imagery, progressive muscle relaxation, and breathing techniques may be useful in managing labor pain. Studies have shown that women who were taught self-hypnosis have a decreased need for pain medicine during labor. Biofeedback hasn't been shown to relieve labor pain.

Depression

An evaluation of 15 studies concluded that relaxation techniques are better than no treatment in reducing symptoms of depression but are not as beneficial as psychological therapies such as cognitive-behavioral therapy.

Epilepsy

There's no reliable evidence that relaxation techniques are useful in managing epilepsy.

Fibromyalgia

  • Studies of guided imagery for fibromyalgia have had inconsistent results.
  • A 2013 evaluation of the research concluded that electromyographic (EMG) biofeedback, in which people are taught to control and reduce muscle tension, helped to reduce fibromyalgia pain, at least for short periods of time. However, EMG biofeedback didn't affect sleep problems, depression, fatigue, or health-related quality of life in people with fibromyalgia, and its long-term effects haven't been established.

Headache

Biofeedback

Biofeedback has been studied for both tension headaches and migraines.

* An evaluation of high-quality studies concluded that there's conflicting evidence about whether biofeedback can relieve tension headaches.
* Studies have shown decreases in the frequency of migraines in people who were using biofeedback. However, it's unclear whether biofeedback is better than a placebo.

Other Relaxation Techniques

Relaxation techniques other than biofeedback have been studied for tension headaches. An evaluation of high-quality studies found conflicting evidence on whether relaxation techniques are better than no treatment or a placebo. Some studies suggest that other relaxation techniques are less effective than biofeedback.

Heart Disease

In people with heart disease, studies have shown relaxation techniques can reduce stress and anxiety and may also have beneficial effects on physical measures such as heart rate.

High Blood Pressure

Stress can lead to a short-term increase in blood pressure, and the relaxation response has been shown to reduce blood pressure on a short-term basis, allowing people to reduce their need for blood pressure medication. However, it's uncertain whether relaxation techniques can have long-term effects on high blood pressure.

Insomnia

There's evidence that relaxation techniques can be helpful in managing chronic insomnia. Relaxation techniques can be combined with other strategies for getting a good night's sleep, such as maintaining a consistent sleep schedule; avoiding caffeine, alcohol, heavy meals, and strenuous exercise too close to bedtime; and sleeping in a quiet, cool, dark room.

Irritable Bowel Syndrome

An evaluation of research results concluded that relaxation techniques have not been shown to help irritable bowel syndrome. However, other psychological therapies, including cognitive-behavioral therapy and hypnotherapy, are associated with overall symptom improvement in people with irritable bowel syndrome.

Menopause Symptoms

Relaxation techniques have been studied for hot flashes and other symptoms associated with menopause, but the quality of the research isn't high enough to allow definite conclusions to be reached.

Menstrual Cramps

Some research suggests that relaxation techniques may be beneficial for menstrual cramps, but definite conclusions can't be reached because of the small number of participants in the studies and the poor quality of some of the research.

Nausea

An evaluation of the research evidence concluded that some relaxation techniques, including guided imagery and progressive muscle relaxation, are likely to be effective in relieving nausea caused by cancer chemotherapy when used in combination with anti-nausea drugs.

Nightmares

Some studies have indicated that relaxation exercises may be an effective approach for nightmares of unknown cause and those associated with posttraumatic stress disorder. However, an assessment of many studies concluded that relaxation is less helpful than more extensive forms of treatment (psychotherapy or medication).

Pain

Evaluations of the research evidence have found promising but not conclusive evidence that guided imagery may help relieve some musculoskeletal pain (pain involving the bones or muscles) and other types of pain.

An analysis of data on hospitalized cancer patients showed that those who received integrative medicine therapies, such as guided imagery and relaxation response training, during their hospitalization had reductions in both pain and anxiety.

Pain in Children and Adolescents

A 2014 evaluation of the scientific evidence found that psychological therapies, which may include relaxation techniques as well as other approaches such as cognitive-behavioral therapy, can reduce pain in children and adolescents with chronic headaches or other types of chronic pain. The evidence is particularly promising for headaches: the effect on pain may last for several months after treatment, and the therapies also help to reduce anxiety.

Posttraumatic Stress Disorder

Studies of biofeedback and other relaxation techniques for posttraumatic stress disorder have had inconsistent results.

Rheumatoid Arthritis

There's limited evidence that biofeedback or other relaxation techniques might be valuable additions to treatment programs for rheumatoid arthritis.

Ringing in the Ears (Tinnitus)

Only a few studies have evaluated relaxation techniques for ringing in the ears. The limited evidence from these studies suggests that relaxation techniques might be useful, especially in reducing the intrusiveness of the problem.

Smoking Cessation

  • Limited evidence suggests that guided imagery may be a valuable tool for people who are working to quit smoking.
  • In a study that compared the two techniques, autogenic training was found to be less effective than cognitive-behavioral therapy as a quit-smoking aid.
  • Preliminary research suggests that a guided relaxation routine might help reduce cigarette cravings.

Temporomandibular Joint Dysfunction

Problems with the temporomandibular joint (the joint that connects the jaw to the side of the head) can cause pain and difficulty moving the jaw. A few studies have shown that programs that include relaxation techniques may help relieve symptoms of temporomandibular joint dysfunction.

What the Science Says About the Safety and Side Effects of Relaxation Techniques

  • Relaxation techniques are generally considered safe for healthy people. However, occasionally, people report negative experiences such as increased anxiety, intrusive thoughts, or fear of losing control.
  • There have been rare reports that certain relaxation techniques might cause or worsen symptoms in people with epilepsy or certain psychiatric conditions, or with a history of abuse or trauma. People with heart disease should talk to their health care provider before doing progressive muscle relaxation.

Who Teaches Relaxation Techniques?

A variety of professionals, including physicians, psychologists, social workers, nurses, and complementary health practitioners, may teach relaxation techniques. Also, people sometimes learn the simpler relaxation techniques on their own.

More to Consider

  • If you have severe or long-lasting symptoms of any kind, see your health care provider. You might have a condition that needs to be treated promptly. For example, if depression or anxiety persists, it's important to seek help from a qualified health care professional.
  • Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Definition

The pain of a migraine headache is often described as an intense pulsing or throbbing pain in one area of the head. However, it is much more; the International Headache Society diagnoses a migraine by its pain and number of attacks (at least 5, lasting 4-72 hours if untreated), and additional symptoms including nausea and/or vomiting, or sensitivity to both light and sound.

Migraine is three times more common in women than in men and affects more than 10 percent of people worldwide. Roughly one-third of affected individuals can predict the onset of a migraine because it is preceded by an "aura," visual disturbances that appear as flashing lights, zig-zag lines or a temporary loss of vision.

People with migraine tend to have recurring attacks triggered by a number of different factors, including stress, anxiety, hormonal changes, bright or flashing lights, lack of food or sleep, and dietary substances.

Migraine in some women may relate to changes in hormones and hormonal levels during their menstrual cycle. For many years, scientists believed that migraines were linked to the dilation and constriction of blood vessels in the head. Investigators now believe that migraine has a genetic cause.

Treatment

There is no absolute cure for migraine since its pathophysiology has yet to be fully understood. There are two ways to approach the treatment of migraine headache with drugs: prevent the attacks, or relieve the symptoms during the attacks. Prevention involves the use of medications and behavioral changes. The drug works by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks.

Drugs originally developed for epilepsy, depression, or high blood pressure to prevent future attacks have been shown to be extremely effective in treating migraine. Botulinum toxin A has been shown to be effective in prevention of chronic migraine. Behaviorally, stress management strategies, such as exercise, relaxation techniques, biofeedback mechanisms, and other therapies designed to limit daily discomfort, may reduce the number and severity of migraine attacks.

Making a log of personal triggers of migraine can also provide useful information for trigger-avoiding lifestyle changes, including dietary considerations, eating regularly scheduled meals with adequate hydration, stopping certain medications, and establishing a consistent sleep schedule. Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle. A weight loss program is recommended for obese individuals with migraine.

Relief of symptoms, or acute treatments, during attacks consists of sumatriptan, ergotamine drugs, and analgesics such as ibuprofen and aspirin. The sooner these treatments are administered, the more effective they are.

Prognosis

Responsive prevention and treatment of migraine is incredibly important. Evidence shows an increased sensitivity after each successive attack, eventually leading to chronic daily migraine in some individuals With proper combination of drugs for prevention and treatment of migraine attacks most individuals can overcome much of the discomfort from this debilitating disorder. Women whose migraine attacks occur in association with their menstrual cycle are likely to have fewer attacks and milder symptoms after menopause.

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