Migraine

by Scott Pautler, MD

 

What is migraine?
Migraine is a common cause of headache affecting 10% of the population. Migraine may also cause unusual visual symptoms with or without a headache.

What causes migraine?
The cause of migraine is unknown, but heredity may play a role. Many people with migraines have family members who also have had migraine. Migraine may be caused by abnormal episodes of blood vessel constriction within the brain. A number of events may trigger a migraine: stress, hormonal changes (puberty, menopause, and hormone pills), bright lights, loud noises, high altitude, and certain foods (including caffeine, chocolate, alcohol, and red wine).

What are the symptoms of a migraine?
Hours or days before a migraine episode occurs, subtle symptoms may be noticed including depression, fluid retention, and stomach disturbances. Visual symptoms can precede a headache or be the sole symptom of a migraine (migraine equivalent or acephalgic migraine). Without warning, the vision is impaired just off to the side of central vision and is bordered by a jagged light (“like cracked glass”) that may seem to shimmer or repeatedly flash. The jagged light causes a missing area of vision and gradually works away from the center to the peripheral vision over a period of 10 to 20 minutes. It usually involves both eyes but may appear more prominent in one eye. In younger patients, nausea and a throbbing headache often follow the light flashes. The headache may be described as a deep, boring pain or a painful stretching sensation. The headache often begins on one side of the head, but may spread over the entire head. There are a number of other unusual visual symptoms that are often difficult to identify as being part of the migraine syndrome.

What treatment is available?
Making the correct diagnosis is the most important step. Light flashes may be caused by other problems such as retinal detachment. Therefore the eye doctor is often called on to make this important distinction. If migraine symptoms occur infrequently, no treatment is needed.  Establishing regular sleep, meal, and exercise programs may help. Riboflavin and magnesium supplements may be of benefit as well. Prescription medication is available if headaches are severe or frequent. 

            If there is any significant change in symptoms or if permanent loss of function occurs, please contact your doctor without delay. In rare instances an aneurysm or tumor may cause unusual light flashes and headache. Your doctor will decide whether or not further examination or testing is required.

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