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Migraine is a type of severe headache that can have a major impact on quality of life. It's often accompanied by feeling sick, vomiting or increased sensitivity to light. Migraine is one of the most common types of headache in adults and is about twice as common in women than in men.

About migraine: Migraine affects about 15 in every 100 people in the UK and is most common in adults aged between 20 and 50.

However, migraines may start in childhood and persist into old age. About eight in 10 people who have migraines have a family history of them.People who get migraines are completely symptom-free between attacks and have an average of around 13 migraines per year.
Types of migraine:  The most common types of migraine are classic migraine (migraine with aura) and common migraine (migraine without aura). Other types of migraine include aura without headache and abdominal migraine.
Symptoms of migraine: You may be able to sense when a migraine attack is about to start. Irritability, lack of concentration, food cravings and tiredness can all alert you that you're getting a migraine.
Classic migraine: Around one in 10 people have aura with their migraines. Aura symptoms usually last less than an hour and begin before the headache symptoms (which are the same as for common migraine). Common aura symptoms include visual disturbances (such as flashing/flickering lights, zigzag lines and even temporary blindness), numbness, tingling sensations and slurred speech. Other aura symptoms include a stiff neck, weakness on one side, partial paralysis, confusion or fainting.
Common migraine: A common migraine causes a persistent and severe throbbing or pounding pain, usually on one side of your head (although there may be pressure on both sides). You may also become sensitive to light, sound and movement and you may feel sick, vomit and/or have diarrhoea. An attack usually lasts between four and 72 hours but you may feel tired for several days afterwards. These symptoms may be caused by problems other than migraines. You should visit your GP for advice. It's particularly important that you see your GP if you have any of the following.

| A sudden change in the character of your migraine such as attacks coming more frequently, or treatment not working | Your first migraine occurs when you're over 50 | Aura symptoms between attacks or which occur on the same side of your body with every attack | A fever with the headache |

Complications of migraine:  Occasionally, migraines can last for much longer than 72 hours and don't respond to standard treatment. This type of migraine is known as status migrainosus, and you may need to go to hospital for pain relief and to treat dehydration caused by vomiting. If you have migraines on more than 15 days per month, this is known as chronic migraine. People with chronic migraine often have to take increasing amounts of medication to control their migraines. In turn, this can lead to further headaches, known as medication-overuse headaches (also called rebound or withdrawal headaches). Migraine has also been found to be associated with an increased risk of anxiety and panic disorder, depression and stroke (where the blood supply to part of the brain is blocked).
Causes of migraine: It's thought that migraine symptoms occur when there is a sudden change in the level of a chemical in the brain (a neurotransmitter) called serotonin. This then affects other neurotransmitters and causes changes in the blood vessels in the brain. It's not yet known exactly what causes the serotonin levels to change. You may find that your migraines are caused by specific foods or drinks, by exposure to particular noises, smells or lights, or by other identifiable triggers. Steering clear of these triggers can help to prevent migraines from occurring. Hormonal changes that occur during the menstrual cycle or as a result of taking oral contraceptives, hormone replacement therapy, pregnancy and menopause can all affect the frequency and severity of migraines in some women. Migraines are more common in people with depression, and depression is more common in people who have migraines. Researchers are investigating whether treating depression can help relieve migraines and vice versa.
Diagnosis of migraine: If you think you have or have had a migraine, talk to your GP who will be able to make a diagnosis and suggest or prescribe a suitable treatment for you. Your GP will ask you about your symptoms and examine you. He/she may also ask you about your medical history. A diagnosis will be made based on the type, number and duration of your symptoms, how often you have had them and how they responded to any treatments you have tried before.
Treatment of migraine: Self-help: It's best to rest in a quiet, darkened room - try to sleep if possible. Try applying a hot or cold compress, such as ice or a bag of frozen peas, wrapped in a towel, to your head. Don't apply ice directly to your skin because you could damage your skin. Applying pressure to the pulse points on the side of your forehead or neck may also help.
Medicines: Treatments for migraine are generally more effective if you use them as soon as you know a migraine attack is coming on. Medicines for migraine aren't suitable for everybody and can cause side-effects in some people. If you use any kind of painkiller for your migraine too frequently, it may become less effective and may cause medication-overuse headache. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice.
Over-the-counter medicines: Over-the-counter painkillers (such as aspirin, paracetamol and ibuprofen) may be effective in treating the headache symptoms of mild/moderate migraines. Soluble versions of these painkillers are absorbed more quickly and may work better than tablets. Medicines containing anti-emetics (antisickness medicines) such as buclizine (eg Migraleve) may stop you feeling sick and vomiting and help your body absorb the painkillers more quickly and efficiently.
Triptans: Triptans are specifically used for migraine because they stop the effects of serotonin. Triptans are available as tablets, injections, nasal sprays or dissolvable wafers. They aren't suitable if you have had a heart attack or stroke, have high blood pressure, or are taking certain medicines. Common side-effects of triptans include dizziness, a feeling of pressure in the neck or chest area, feeling sick and vomiting. There are many different triptans (including sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan and frovatriptan) and you may need to try several before you find one that works for you. Most triptans are only available on prescription. However, sumatriptan (Imigran) can be bought without a prescription following a consultation with a pharmacist.
Other prescription-only medicines: Your GP may also prescribe anti-emetics (eg metoclopramide and domperidone) and non-steroidal anti-inflammatory drugs (NSAIDs) (eg diclofenac, tolfenamic acid).
Talking/physical/complementary therapies: You may find other therapies help your migraines including:

| relaxation or cognitive behavioural therapy | acupuncture | herbal remedies (eg feverfew) |

Talk to your GP before trying them, as he/she may be able to refer you to a specialist practitioner.
If you're pregnant: Many treatments for migraine aren't suitable for use during pregnancy and/or breastfeeding. If you're pregnant or breastfeeding, talk to your GP before taking any medications for your migraine (even if they were prescribed for you previously) as they may be harmful for your baby.
Prevention of migraine: Keep a diary - it will help you to identify if there is a pattern to your migraines and to identify your migraine triggers so that you can steer clear of them in future. Maintaining regular sleeping and eating routines, reducing stress levels and taking regular exercise may also help prevent migraine attacks. You may find that wearing a dental splint at night to prevent you from grinding your teeth, or wearing tinted glasses, can help prevent migraines.
Preventive medicines: If you have frequent and/or severe migraines, your GP may prescribe medicines to help prevent them. These include:

| beta-blockers - such as propanolol | tricyclic antidepressants - such as amitriptyline | certain anticonvulsants - such as topiramate or valproate the antihistamine pizotifen |

These medicines aren't suitable for everybody and can cause side-effects in some people. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
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