Headaches: When to worry about throbbing, constant, sharp pain

A migraine is a severe, painful headache that can be preceded or accompanied by sensory warning signs such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting, and increased sensitivity to light and sound.

The excruciating pain that migraines bring can last for hours or even days. Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, may help. Migraines are often undiagnosed and untreated.

If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches. Several factors make you more prone to having migraines, including family history, age, it’s commonly seen in adolescence, and women are three times more likely to get them.

Symptoms

Migraines can start in childhood, adolescence or early adulthood.

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Auras:

These are symptoms of the nervous system. They are usually visual disturbances, such as flashes of light or wavy, zigzag vision. Sometimes auras can also be touching sensations (sensory), movement (motor) or speech (verbal) disturbances. Your muscles may get weak, or you may feel as though someone is touching you. Each of these symptoms usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes.

Attack:

The headache usually lasts from four to 72 hours if untreated. The frequency with which headaches occur varies from person to person. Migraines may be rare or strike several times a month.

Post-drome:

The final phase, known as post-drome, occurs after a migraine attack. You may feel drained and washed out, while some people feel elated. For about 24 hours, you may also experience confusion, moodiness, dizziness, weakness, sensitivity to light and sound.

Causes

Imbalances in brain chemicals, including serotonin, which helps regulate pain in your nervous system are said to be involved.

Migraine triggers

• Hormonal changes in women. Fluctuations in oestrogen seem to trigger headaches in many women. Women with a history of migraines often report headaches before or during their periods, when they have a major drop in oestrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications, such as oral contraceptives and hormone replacement therapy, also may worsen migraines.v
• Foods. Aged cheeses, salty foods and processed foods may trigger migraines. Skipping meals or fasting also can trigger attacks.
• Food additives. The sweetener aspartame and the preservative monosodium glutamate may trigger migraines.
• Drinks. Alcohol, especially wine, and highly caffeinated beverages may trigger migraines.
• Stress. Stress at work or home can cause migraines.
• Sensory stimuli. Bright lights, loud sounds and sun glare can induce migraines. Strong smells – including perfume, paint thinner, secondhand smoke and others – can trigger migraines in some people.
• Changes in wake-sleep pattern. Missing sleep or getting too much sleep may trigger migraines in some people, as can jet lag.
• Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
• Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
• Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.

Diagnosis

If you have migraines or a family history of migraines, or symptoms suggestive of a migraine, see your doctor who will be able to diagnose you based on your medical history, symptoms, and a physical and neurological examination.

Treatment

Migraine treatments can help stop symptoms and prevent future attacks. Many medications have been designed to treat migraines. Some drugs often used to treat other conditions also may help relieve or prevent migraines. Your treatment strategy depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions.

Medications used to combat migraines fall into two broad categories:

• Pain-relieving medications. These types of drugs are taken during migraine attacks and are designed to stop symptoms. Take pain-relieving drugs as soon as you experience signs or symptoms of a migraine for the best results.
• Acupuncture. Clinical trials have found that acupuncture may be helpful for headache pain. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points.
• Biofeedback. This appears to be effective in relieving migraine pain. This is a relaxation technique that uses special equip-ment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.