Migraine and Cluster Headche

Migraines are headaches that most likely stem from problems with blood vessels in the head. Migraine headaches typically last from 4-72 hours. They may happen as often as several times a week to only once a year. Migraine headaches cause moderate-to-severe pain. The pain may be located on one or both sides of the head, in the back of the neck, or around the face or eyes. Symptoms like nausea, vomiting, dizziness, stuffy nose, and/or watery eyes may occur. Some people have tunnel vision or see spots or halos. People who have migraines are called migraineurs.
Cluster headaches are vascular headaches that occur almost daily in episodes, or “clusters,” over weeks to months. The pain is severe and comes on very suddenly. Pain usually affects one side of the face and is accompanied by nasal congestion, runny nose, and watery eyes. In contrast to migraine headaches, cluster headaches occur more frequently in males.

What Causes Migraine and Cluster Headaches?

Many experts believe that migraine and cluster headaches share a common cause that begins in the nerve that carries sensation from the head to the brain (trigeminal nerve). Blood vessels on the brain’s surface expand (dilate), causing swelling in an area and pressure on nerve endings. The nerve endings submit signals to the brain to perceive pain. This may also explain some other symptoms associated with migraines, such as nausea, vomiting, and visual disturbances.

What Are the Risks of Migraine and Cluster Headaches?

Migraine and cluster headaches are debilitating and may affect quality of life, cause depression, worsen job performance, and increase absenteeism from school or work.

How Are Migraine and Cluster Headaches Treated?

Migraineurs often identify certain triggers that seem to “set off” a migraine episode. These triggers vary among individuals. Trigger avoidance and preventive treatment with medications or other therapies are important control measures. Migraineurs often report the following triggers:

• Foods (alcohol, nitrates [found in sausage, bacon, hot dogs, luncheon meats, nuts])
  
  
• Light
  
  
• Odors (smoke, perfume)
  
  
• Stress
  
  
• Heat or cold exposure
  
  
• Weather changes (sudden barometric changes)
  
  
• Caffeine
  
  
• Hormonal changes
  
  
• Motion
  
  
• Hunger
  
  
• Sleep pattern changes
  
  
• Smoking

When migraines occur, individuals often need to lie down in a dark, quiet environment away from any sensitizing triggers.
A headache may be stopped in its tracks with certain medicines. This is called abortive therapy. If headaches occur frequently, regularly scheduled medication may be prescribed to prevent headaches or to lessen their severity.

Migraine Headache Abortive Therapy

Abortive therapy for migraine headaches has improved over the last decade, and newer medications (for example, triptans) are very effective and act rapidly to treat the cause of migraines. Antinausea medications (for example, prochlorperazine [Compazine] or promethazine [Phenergan]) may be used for individuals who experience nausea or vomiting. Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil or Motrin are available without a prescription. Other nonprescription choices include combinations of aspirin, acetaminophen (Tylenol), and caffeine (for example, Excedrin Migraine). Potent analgesic agents that combine acetaminophen or aspirin with barbiturates (butalbital), caffeine, and narcotic analgesics like codeine (for example, Fioricet, Fiorinal, Tylenol #3) may also be needed.

Cluster Headache Abortive Therapy

One of the most common treatments for cluster headaches is to breathe 100% oxygen for 10-15 minutes. Other abortive therapy options are similar to those used for migraine headaches.

Migraine Headache Preventive Therapy

This type of treatment is considered for persons whose migraine headaches are frequent and/or severe enough to significantly alter their lifestyle. Physicians decide whether to start a migraine preventive medication on a case-by-case basis in consultation with their patients. Preventive medications are given on a regular schedule in order to decrease the severity and/or frequency of attacks. Preventive medications must be taken on a daily basis, even if the migraineur is not experiencing headaches every day. These drugs may take up to 3 months to significantly alter the frequency and severity of migraine headaches. In other words, a specific preventive medication cannot be considered a "failure" until it has been taken as prescribed for at least 3 months to little or no effect. The following medications are some of those used in migraine headache preventive therapies:

• Beta-blockers (also used to treat high blood pressure) such as propranolol (Inderal)
  
  
• Calcium channel blockers (also used to treat high blood pressure) such as verapamil (Calan, Isoptin)
  
  
• Serotonin modifiers such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and citalopram (Celexa) - these are relatively ineffective compared with those in the older tricyclic class of antidepressants (for example, amitriptyline [Elavil] and nortriptyline [Aventyl])
  
  
• Antiseizure medications like gabapentin (Neurontin), valproic acid (Depakote), and carbamazepine (Tegretol)

Cluster Headache Preventive Therapy

Prednisone (Deltasone), lithium (Eskalith), and verapamil (Covera-HS) are typically used to prevent cluster headaches.

(www.emedicinehealth.com)