Migraine headaches are usually diagnosed when the typical symptoms are present. Migraine generally begins in childhood to early adulthood. While migraines can first occur in an individual beyond the age of fifty, advancing age makes other types of headaches more likely. A family history usually is present, suggesting a genetic predisposition in migraine sufferers. The examination of individuals with migraine attacks usually is normal. Patients with the first headache ever, worst headache ever, a significant change in the characteristics of headache, or an association of the headache with nervous system symptoms, like visual or hearing or sensory loss, may require additional tests to exclude diseases other than migraine. The tests may include blood testing, brain scanning, and a spinal tap.
Specific Diagnostic Critera
Formal diagnostic criteria for migraines include: five or more episodic headaches lasting from 4 to 72 hours with two of the following characteristics: unilateral (one-sided), throbbing, moderate or severe, and worsened by movement; plus any ONE of the following: nausea or vomiting, decreased tolerance to sounds, or decreased tolerance to light.
How are migraine headaches treated?
Treatment includes therapies that may or may not involve medications. Therapy that does not involve medications can provide symptomatic and preventative therapy.
• Using ice, biofeedback, and relaxation techniques may be helpful in stopping an attack once it has started.
• Sleep may be the best medicine, if it is possible.
Prevention of migraine requires motivation by the patient to make some life changes. Patients are educated as to triggering factors that can be avoided. These triggers include:
• smoking
• avoiding certain foods, such as sharp cheeses, wines, nuts, or pressed meats.
Generally, leading a healthy lifestyle with good nutrition, an adequate intake of fluids, sufficient sleep, and exercise may be useful. Acupuncture has also been suggested to be a useful therapy. Individuals with occasional, mild migraine headaches that do not interfere with daily activities usually medicate themselves with over-the-counter pain relievers. Many OTC analgesics are available. OTC analgesics have been shown to be safe and effective for short-term relief of headache when used according to the instructions on their labels. There are two major classes of OTC analgesics:
• acetaminophen (Tylenol)
• nonsteroidal anti-inflammatory drugs (NSAIDs).
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