My Aching Head
Everyone gets the occasional headache, but not all headaches are the same. Rear Adm. Joyce Johnson, D.O., reviews the symptoms, triggers, and treatment of migraines.

Perhaps the most troublesome headaches are migraines. About one in 10 people, more women than men, has had a migraine headache. Most people have their first migraine between 15 and 45 years of age, and most migraine sufferers have a close relative who also has them. Although very debilitating when they occur, migraine headaches generally do not signify a more serious medical problem.

Perhaps one-fifth of migraine sufferers have “classic” migraines with a warning sign, or aura, that precedes the headache. Auras might be caused by a temporary constriction of a blood vessel in the brain. Common auras include seeing stars or zigzag lines, tunnel vision, or a blind spot, and can typically last 20 minutes to an hour or until the headache begins. About 75 percent of migraines are “common” migraines, which don’t have an aura and usually are characterized by a pounding, severe, one-sided headache.

Nausea, vomiting, and sensitivity to light can occur with a migraine. There might be numbness or tingling in the face, neck, or upper extremities. The headache can last a few hours to a day or two. The day after the headache ends a migraine sufferer still can feel fatigued, tired, and mentally exhausted. There also can be residual neck pain.

Migraines occur less frequently if you can identify and avoid triggers. Common triggers include bright lights; loud noise; physical or emotional stress; lack of sleep; skipping meals; caffeine, alcohol, or nicotine; and hormonal changes. Some foods are triggers, including fermented foods such as soy sauce, aged cheese, and red wine; nitrate-containing foods such as bacon, corned beef, hot dogs, and salami; foods containing MSG; and other foods, including chocolate and nuts.

Going to a quiet, dimly lit room during a migraine can help. Drinking fluids is important to keep from being dehydrated. Biofeedback is often a useful tool in treating migraines, and some patients find self-hypnosis valuable.

If you have migraines as often as once a week, preventive medication, taken daily, may be prescribed. If your migraine headaches are less frequent, medication can be taken at the first sign of a headache (or aura). The medication can be injected (by the patient) or taken in the form of a nasal spray, rectal suppository, or fast-acting oral preparation. The goal is to provide treatment as soon as possible and to ward off a more serious headache.

Migraine medications have various side effects, especially for patients with heart disease or other health problems. Some medications affect the vascular system, while others are strong painkillers (which can become habit-forming if taken too frequently). Always work closely with the physician prescribing your medication.

— Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va.