Migraine Headache

Definition

Migraine is a type of headache marked by severe head pain lasting several hours or more.

Description

Migraine is an intense and often debilitating type of headache. Migraines affect as many as 24 million people in the United States, and are responsible for billions of dollars in lost work, poor job performance, and direct medical costs. Approximately 18% of women and 6% of men experience at least one migraine attack per year. More than three million women and one million men have one or more severe headaches every month. Migraines often begin in adolescence, and are rare after age 60.Two types of migraine are recognized. Eighty percent of migraine sufferers experience "migraine without aura" (common migraine). In "migraine with aura," or classic migraine, the pain is preceded or accompanied by visual or other sensory disturbances, including hallucinations, partial obstruction of the visual field, numbness or tingling, or a feeling of heaviness. Symptoms are often most prominent on one side of the head or body, and may begin as early as 72 hours before the onset of pain.

Causes and symptoms

Causes

The physiological basis of migraine has proved difficult to uncover. Genetics appear to play a part for many, but not all, people with migraine. There are a multitude of potential triggers for a migraine attack, and recognizing one's own set of triggers is the key to prevention.PHYSIOLOGY. The most widely accepted hypothesis of migraine suggests that a migraine attack is precipitated when pain-sensing nerve cells in the brain (called nociceptors) release chemicals called neuropeptides. At least one of the neurotransmitters, substance P, increases the pain sensitivity of other nearby nociceptors.Other neuropeptides act on the smooth muscle surrounding cranial blood vessels. This smooth muscle regulates blood flow in the brain by relaxing or contracting, thus constricting the enclosed blood vessels and stimulating adjacent pain receptors. At the onset of a migraine headache, neuropeptides are thought to cause muscle relaxation, allowing vessel dilation and increased blood flow. Other neuropeptides increase the leakiness of cranial vessels, allowing fluid leak, and promote inflammation and tissue swelling. The pain of migraine is though to result from this combination of increased pain sensitivity, tissue and vessel swelling, and inflammation. The aura seen during a migraine may be related to constriction in the blood vessels that dilate in the headache phase.GENETICS. Susceptibility to some types of migraine is inherited. A child of a migraine sufferer has as much as a 50% chance of developing migraines. If both parents are affected, the chance rises to 70%. In 2002, a team of Australian researchers identified a region on human chromosome 1 that influences susceptibility to migraine. It is likely that more than one gene is involved in the inherited forms of the disorder. Many cases of migraine, however, have no obvious familial basis. It is likely that the genes that are involved set the stage for migraine, and that full development requires environmental influences, as well.Two groups of Italian researchers have recently identified two loci on human chromosomes 1 and 14 respectively that are linked to migraine headaches. The locus on chromosome 1q23 has been linked to familial hemiplegic migraine type 2, while the locus on chromosome 14q21 is associated with migraine without aura.TRIGGERS. A wide variety of foods, drugs, environmental cues, and personal events are known to trigger migraines. It is not known how most triggers set off the events of migraine, nor why individual migraine sufferers are affected by particular triggers but not others.Common food triggers include:

cheese
alcohol
caffeine products, and caffeine withdrawal
chocolate
intensely sweet foods

dairy products
fermented or pickled foods
citrus fruits
nuts
processed foods, especially those containing nitrites, sulfites, or monosodium glutamate (msg)

Environmental and event-related triggers include:

stress or time pressure
menstrual periods, menopause
sleep changes or disturbances, oversleeping
prolonged overexertion or uncomfortable posture
hunger or fasting
odors, smoke, or perfume
strong glare or flashing lights

Drugs which may trigger migraine include:

oral contraceptives
estrogen replacement therapy
nitrates
theophylline
reserpine
nifedipine
indomethicin
cimetidine
decongestant overuse
analgesic overuse
benzodiazepine withdrawal

Symptoms

Migraine without aura may be preceded by elevations in mood or energy level for up to 24 hours before the attack. Other pre-migraine symptoms may include fatigue, depression, and excessive yawning.Aura most often begins with shimmering, jagged arcs of white or colored light progressing over the visual field in the course of 10-20 minutes. This may be preceded or replaced by dark areas or other visual disturbances. Numbness and tingling is common, especially of the face and hands. These sensations may spread, and may be accompanied by a sensation of weakness or heaviness in the affected limb.The pain of migraine is often present only on one side of the head, although it may involve both, or switch sides during attacks. The pain is usually throbbing, and may range from mild to incapacitating. It is often accompanied by nausea or vomiting, painful sensitivity to light and sound, and intolerance of food or odors. Blurred vision is common.Migraine pain tends to intensify over the first 30 minutes to several hours, and may last from several hours to a day or longer. Afterward, the affected person is usually weary, and sensitive to sudden head movements.

Diagnosis

Ideally, migraine is diagnosed by a careful medical history. Unfortunately, migraine is underdiagnosed because many doctors tend to minimize its symptoms as "just a headache." According to a 2003 study, 64% of migraine patients in the United Kingdom and 77% of those in the United States never receive a correct medical diagnosis for their headaches.So far, laboratory tests and such imaging studies as computed tomography (CT scan) or magnetic resonance imaging (MRI) scans have not been useful for identifying migraine. However, these tests may be necessary to rule out a brain tumor or other structural causes of migraine headache in some patients.

Treatment

Once a migraine begins, the person will usually seek out a dark, quiet room to lessen painful stimuli. Several drugs may be used to reduce the pain and severity of the attack.Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful for early and mild headache. NSAIDs include acetaminophen, ibuprofen, naproxen, and others. A recent study concluded that a combination of acetaminophen, aspirin, and caffeine could effectively relieve symptoms for many migraine patients. One such over-the-counter preparation is available as Exedrin Migraine.More severe or unresponsive attacks may be treated with drugs that act on serotonin receptors in the smooth muscle surrounding cranial blood vessels. Serotonin, also known as 5-hydroxytryptamine, constricts these vessels, relieving migraine pain. Drugs that mimic serotonin and bind to these receptors have the same effect. The oldest of them is ergotamine, a derivative of a common grain fungus. Ergotamine and dihydroergotamine are used for both acute and preventive treatment. Derivatives with fewer side effects have come onto the market in the past decade, including sumatriptan (Imitrex). Some of these drugs are available as nasal sprays, intramuscular injections, or rectal suppositories for patients in whom vomiting precludes oral administration. Other drugs used for acute attacks include meperidine and metoclopramide.Studies are showing that rizatriptan is a promising drug for the treatment of migraines. One study showed that 10mg of rizatriptan provided relief to 90% of the patients in the study group and kept 50% of them pain-free 2 hours after taking the medication. Sumatriptan has been on the market since 1993, while rizatriptan became available in 1998.Sumatriptan and other triptan drugs (zolmitriptan, rizatriptan, naratriptan, almotriptan, and frovatriptan) should not be taken by people with any kind of vascular disease because they cause coronary artery narrowing. Otherwise these drugs have been shown to be very safe.Continued use of some antimigraine drugs can lead to "rebound headache," marked by frequent or chronic headaches, especially in the early morning hours. Rebound headache can be avoided by using antimigraine drugs under a doctor's supervision, with the minimum dose necessary to treat symptoms. Tizanidine (Zanaflex) has been reported to be effective in treating rebound headaches when taken together with an NSAID.

Alternative treatments

Alternative treatments are aimed at prevention of migraine. Migraine headaches are often linked with food allergies or intolerances. Identification and elimination of the offending food or foods can decrease the frequency of migraines and/or alleviate these headaches altogether. Herbal therapy with feverfew (Chrysanthemum parthenium) may lessen the frequency of attacks. Learning to increase the flow of blood to the extremities through biofeedback training may allow a patient to prevent some of the vascular changes once a migraine begins. During a migraine, keep the lights low; put the feet in a tub of hot water and place a cold cloth on the occipital region (the back of the head). This treatment draws the blood to the feet and decreases the pressure in the head.

Prognosis

Most people with migraines can bring their attacks under control through recognizing and avoiding triggers, and by use of appropriate drugs when migraine occurs. Some people with severe migraines do not respond to preventive or drug therapy. Migraines usually wane in intensity by age 60 and beyond.

Prevention

The frequency of migraine may be lessened by avoiding triggers. It is useful to keep a headache journal, recording the particulars and noting possible triggers for each attack. Specific measures which may help include:

Eating at regular times, and not skipping meals.
Reducing the use of caffeine and pain-relievers.
Restricting physical exertion, especially on hot days.
Keeping regular sleep hours, but not oversleeping.
Managing one's time efficiently in order to avoid stress at work and home.

Some drugs can be used for migraine prevention, including specific members of these drug classes:

beta blockers
tricyclic antidepressants
calcium channel blockers
selective serotinin reuptake inhibitors (SSRIs)
monoamine oxidase inhibitors (MAOIs)
serotonin antagonists

One substance that is being studied as a possible migraine preventive is coenzyme Q₁₀, a compound used by cells to produce energy needed for cell growth and maintenance. Coenzyme Q₁₀ has been studied as a possible complementary treatment for cancer. Its use in preventing migraines is encouraging and merits further study.

Key terms

Aura — A group of visual or other sensations that precedes the onset of a migraine attack.Coenzyme Q 10 — A substance used by cells in the human body to produce energy for cell maintenance and growth. It is being studied as a possible preventive for migraine headaches.Nociceptor — A specialized type of nerve cell that senses pain.A study published in early 2003 reported that three drugs currently used to treat disorders of muscle tone are being explored as possible preventive treatments for migraine. They are botulinum toxin type A (Botox), baclofen (Lioresal), and tizanidine (Zanaflex). Early results of open trials of these medications are positive.Anti-epileptic drugs, which are also known as anticonvulsants, are also being studied as possible migraine preventives. As of 2003, sodium valproate (Epilim) is the only drug approved by the Food and Drug Administration (FDA) for prevention of migraine. Such newer anticonvulsants as gabapentin (Neurontin) and topiramate (Topamax) are presently being evaluated as migraine preventives.A natural preparation made from butterbur root (Petasites hybridus) has been sold in Germany since the 1970s as a migraine preventive under the trade name Petadolex. Petadolex has been available in the United States since December 1998 and has passed several clinical safety and postmarketing surveillance trials.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Migraine." Section 14, Chapter 168. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part II, "CAM Therapies for Specific Conditions: Headaches." New York: Simon & Schuster, 2002.Rakel, Robert. Conn's Current Therapy: Latest Approved Methods of Treatment for the Practicing Physician. Philadelphia: W.B. Saunders Company, 2001.Tierney, Lawrence, et al. Current Medical Diagnosis and Treatment. Los Altos, CA: Lange Medical Publications, 2001.

Periodicals

Bendtsen, L. "Sensitization: Its Role in Primary Headache." Current Opinion in Investigational Drugs 3 (March 2002): 449-453.Corbo, J. "The Role of Anticonvulsants in Preventive Migraine Therapy." Current Pain and Headache Reports 7 (February 2003): 63-66.Danesch, U., and R. Rittinghausen. "Safety of a Patented Special Butterbur Root Extract for Migraine Prevention." Headache 43 (January 2003): 76-78.Diamond, S., and R. Wenzel. "Practical Approaches to Migraine Management." CNS Drugs 16 (2002): 385-403.Freitag, F. G. "Preventative Treatment for Migraine and Tension-Type Headaches: Do Drugs Having Effects on Muscle Spasm and Tone Have a Role?" CNS Drugs 17 (2003): 373-381.Lea, R. A., A. G. Shepherd, R. P. Curtain, et al. "A Typical Migraine Susceptibility Region Localizes to Chromosome 1q31." Neurogenetics 4 (March 2002): 17-22.Lipton, R. B., A. I. Scher, T. J. Steiner, et al. "Patterns of Health Care Utilization for Migraine in England and in the United States." Neurology 60 (February 11, 2003): 441-448.Marconi, R., M. De Fusco, P. Aridon, et al. "Familial Hemiplegic Migraine Type 2 is Linked to 0.9Mb Region on Chromosome 1q23." Annals of Neurology 53 (March 2003): 376-381.Rozen, T. D., M. L. Oshinsky, C. A. Gebeline, et al. "Open Label Trial of Coenzyme Q₁₀ as a Migraine Preventive." Cephalalgia 22 (March 2002): 137-141.Sheftell, F. D., and S. J. Tepper. "New Paradigms in the Recognition and Acute Treatment of Migraine." Headache 42 (January 2002): 58-69.Sinclair, Steven. "Migraine Headaches: Nutritional, Botanical and Other Alternative Approaches." Alternative Medicine Review 4 (1999): 86-95.Soragna, D., A. Vettori, G. Carraro, et al. "A Locus for Migraine Without Aura Maps on Chromosome 14q21.2-q22.3." American Journal of Human Genetics 72 (January 2003): 161-167.Tepper, S. J., and D. Millson. "Safety Profile of the Triptans." Expert Opinion on Drug Safety 2 (March 2003): 123-132.

Organizations

American Council for Headache Education. 19 Mantua Road, Mt. Royal, NJ 08061. (609) 423-0043 or (800) 255-2243. http://www.achenet.org.National Headache Foundation. 428 West St. James Place, Chicago, IL 60614. (773) 388-6399 or (800) 843-2256. http://www.headaches.org.U. S. Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857. (888) 463-6332. http://www.fda.gov.

Other

American Medical Association. "Migraine." 〈http://www.ama-assn.org/special/migraine/〉.

headache

[hed´āk] pain in the head; see also migraine. One of the most common ailments of humans, it is a symptom rather than a disorder in itself; it accompanies many diseases and conditions, including emotional distress. Although recurring headache may be an early sign of serious organic disease, relatively few headaches are caused by disease-induced structural changes. Most result from vasodilation of blood vessels in tissues surrounding the brain, or from tension in the neck and scalp muscles.
Immediate attention by a health care provider is indicated when (1) a severe headache comes on suddenly without apparent cause; (2) there are accompanying symptoms of neurological abnormality, for example, blurring of vision, mental confusion, loss of mental acuity or consciousness, motor dysfunction, or sensory loss; or (3) the headache is highly localized, as behind the eye or near the ear, or in one location in the head. Fever and stiffness of the neck accompanying the headache may indicate meningitis.cluster headache a migraine-like disorder marked by attacks of unilateral intense pain over the eye and forehead, with flushing and watering of the eyes and nose; attacks last about an hour and occur in clusters.exertional headache one occurring after exercise.histamine headache cluster headache.lumbar puncture headache headache in the erect position, and relieved by recumbency, following lumbar puncture, due to lowering of intracranial pressure by leakage of cerebrospinal fluid through the needle tract.migraine headache migraine.organic headache headache due to intracranial disease or other organic disease.tension headache a type due to prolonged overwork or emotional strain, or both, affecting especially the occipital region.toxic headache headache due to systemic poisoning or associated with illness.vascular headache a classification for certain types of headaches, based on a proposed etiology involving abnormal functioning of the blood vessels or vascular system of the brain; included are migraine, cluster headache, toxic headache, and headache caused by elevated blood pressure.

mi·graine

(mī'grān, mi-grān'), A familial, recurrent syndrome characterized usually by unilateral head pain, accompanied by various focal disturbances of the nervous system, particularly in regard to visual phenomenon, such as scintillating scotomas. Classified as classic migraine, common migraine, cluster headache, hemiplegic migraine, ophthalmoplegic migraine, and ophthalmic migraine. Synonym(s): bilious headache, blind headache, hemicrania (1) , sick headache, vascular headache [through O. Fr., fr. G. hēmi- krania, pain on one side of the head, fr. hēmi-, half, + kranion, skull]

mi·graine

(mī'grān) A symptom complex occurring periodically and characterized by pain in the head (usually unilateral), vertigo, nausea and vomiting, and photophobia. Onset of pain may be preceded by a warning (i.e., aura), often consisting of bilateral scintillating scotomas. Subtypes include classic migraine, common migraine, cluster headache, hemiplegic migraine, ophthalmoplegic migraine, and ophthalmic migraine.
Synonym(s): hemicrania (1) , sick headache. [through O. Fr., fr. G. hēmi-krania, pain on one side of the head, fr. hēmi-, half, + kranion, skull]

Migraine Headache

DRG Category:	101
Mean LOS:	3.3 days
Description:	MEDICAL: Seizures Without Major CC

Migraine headache is a primary headache syndrome that is an episodic vascular disorder with or without a common aura. Approximately 30 million people have migraine headaches in the United States. A migraine headache is a prototype of a vascular headache, which involves vasodilation and localized inflammation. Ultimately, arteries are sensitized to pain. Cerebral blood flow is diminished before the onset of the headache and is increased during the actual episode. Most migraine sufferers have a trigger, or precipitating factor, that is associated with the onset of symptoms.

There are two types of migraine headaches: classic migraine and common migraine. Classic migraine has a prodromal (preheadache) phase that lasts approximately 15 minutes and is accompanied by disturbances of neurological functioning such as visual disturbances, speech disturbances, and paresthesias. Neurological symptoms cease with the beginning of the headache, which is often accompanied by nausea and vomiting. Common migraine does not have a preheadache phase but is characterized by an immediate onset of a throbbing headache.

Causes

Although the causes of migraine headache are uncertain, a commonly held theory is that early vasoconstriction and subsequent vasodilation occur because of the release of biologically active amines such as serotonin, dopamine, norepinephrine, and epinephrine. Serotonin seems to be the most important of these substances. These amines, which stimulate an inflammatory cascade with the release of endothelial cells, mast cells, and platelets, are powerful vasoconstrictors, and after their release, degradation and depletion may lead to vasodilation and the headache syndrome. Another theory suggests that neurokinin, a biological substance similar to bradykinin, may be responsible for the inflammatory response.

Genetic considerations

The inheritance of migraine headaches has been written about since the late 1920s. Twin studies have reported a recurrence risk of migraine with aura at 50% in identical twins and 21% in nonidentical twins. Several loci have been linked or associated with typical migraines. Two genes implicated in the rare disease familial hemiplegic migraine (FHM) have been described. FHM is usually transmitted in an autosomal dominant pattern, primarily from the mother.

Gender, ethnic/racial, and life span considerations

Migraine headaches generally begin in childhood or near puberty, affect females more than males, and decrease in frequency and severity as people age. It is uncommon for migraine headaches to occur during old age. Migraine headaches often increase in frequency during pregnancy in the first trimester for those who have experienced them before pregnancy. Oral contraceptives and hormone replacement therapy also increase the frequency of headaches. Migraine headaches have a higher prevalence among people with European ancestry than those with African or Asian ancestry. In the United States, households with lower educational levels and lower economic resources have higher migraine prevalence.

Global health considerations

The World Health organization reports that the prevalence of migraines are highest in North America, followed by other regions of the globe.

Assessment

History

Elicit a history of contributing, or triggering, factors such as consumption of red wine, chocolate cake, cheese, alcohol, caffeine, and foods high in refined sugar. Other triggers are the smell of perfume, presence of flickering lights, intake of nicotine, hunger, fatigue, sleep deprivation, physical exertion, and emotional stress. Ask the patient to describe the symptoms associated with the headache. Generally, migraine headaches are unilateral with pulsating or throbbing pain and are associated with nausea, vomiting, and phonophotophobia (intolerance to light and noise). Duration is from 4 to 72 hours, although the pain builds over minutes to hours.

Elicit a description from the patient of all symptoms. Classic migraines are associated with a transient visual, motor, sensory, cognitive, or psychic disturbance that lasts up to 15 minutes and precedes the headache. A second phase occurs with numbness or tingling of the lips, changes in mental status (confusion, drowsiness), aphasia, and dizziness. Common migraines have an immediate onset of throbbing pain. Early warning is often a mood change, and pain is often accompanied by nausea and vomiting. Elicit the timing and pattern of episodes. Two to four attacks a month, often beginning in the mornings and usually lasting a day or two, are a common pattern. If the patient is a female, determine the timing of the menstrual cycle, any birth control pills or hormone replacement therapy, and if the patient is pregnant.

Physical examination

The most common symptom is a throbbing, pulsatile headache. Perform a neurological assessment to determine focal neurological dysfunction (e.g., drowsiness, vertigo, aphasia, unilateral weakness, confusion) and visual disturbances (e.g., spots, lines, or shimmering light). Test the cranial nerves, particularly cranial nerves V, IX, and X. The patient has no signs and symptoms when the headache is not present, but other disorders need to be ruled out before the initial diagnosis of migraine headache is made.

Psychosocial

Psychosocial assessment should include assessment of the degree of stress the person experiences and the strategies she or he uses to cope with stress. Determine the patient’s lifestyle patterns, such as exercise patterns, family relationships, rest and work patterns, and substance abuse patterns.

Diagnostic highlights

No test is diagnostic for migraine headaches. The following tests may be necessary for differential diagnosis: computed tomography scan, skull x-ray, cranial nerve testing, arteriogram, lumbar puncture, cerebrospinal fluid testing, electroencephalogram, and magnetic resonance imaging.

Primary nursing diagnosis

Diagnosis

Pain related to vasoconstriction or vasodilation

Outcomes

Comfort level; Pain control behavior; Pain level; Symptom control behavior; Symptom severity; Pain: Disruptive effects; Well-being

Interventions

Medication administration; Medication management; Pain management; Comfort; Nutritional monitoring; Environmental management: Comfort; Biofeedback; Sleep enhancement; Guided imagery

Planning and implementation

Collaborative

Most patients can have their migraine headaches managed pharmacologically. Dietary modification may decrease symptoms; this includes reducing the intake of caffeinated beverages, monosodium glutamate, cheese, sausage, sauerkraut, citrus fruit, chocolate, and red wine.

Pharmacologic highlights

Medication or Drug Class	Dosage	Description	Rationale
Nonnarcotic analgesics	Varies with drug	Either aspirin, acetaminophen, or NSAIDs may abort a migraine headache if taken early; ketorolac tromethamine, ketoprofen, naproxen sodium, flurbiprofen, indomethacin, isometheptene, butalbital with aspirin, and acetaminophen reduce headache pain	Abort or relieve a migraine headache
Serotonin 5-ht-receptor agonists (sumatriptan, naratriptan, zolmitriptan, rizatriptan, almotriptan, frovatriptan, eletriptan)	Varies with drug	Serotonic receptor stimulant; antimigraine that acts by binding with vascular receptors producing a vasoconstrictive effect on cranial blood vessels	Acts on receptors on intracranial blood vessels and sensory nerve endings to relieve migraine headache
Prochlorperazine	5–10 mg IV	Antiemetic, antipsychotic that terminates migraines and helps alleviate nausea	Relieves a migraine headache
Ergotamine	2–3 mg PO; may add additional doses to reach 6 mg in a 24-hr period or 10 mg/wk	Antimigraine that may have an agonist/antagonist action with alpha-adrenergic, serotonergic, and dopaminergic receptors; directly stimulates vascular smooth muscle, constricting arteries and veins	To prevent or abort migraine headache
Dihydroergotamine (DHE)	1–2 mg IM or SC; during the peak of a headache 5–10 mg or prochlorperazine may be given IV followed by 0.75 mg of DHE IV over 3 min	Venoconstrictor with minimal peripheral arterial constriction; use with caution with patients with cardiac disease	Relieves the pain of migraine headache
Beta blockers, tricyclic antidepressants, calcium channel blockers	Varies with drug	Used to prevent headaches, particularly those that do not respond to acute therapy	To prevent migraine headaches

Independent

Teach the patient to avoid triggers that may lead to headaches. Patients may be sensitive to odors from cigarette or cigar smoke, paint, gasoline, perfume, or aftershave lotion. Explain to the patient that at the beginning of an attack, he or she may be able to limit pain by resting in a darkened room. If patients sleep uninterrupted with their eyes covered, symptoms may be alleviated.

A combination of complementary therapies may be successful in managing symptoms. Introduce to the patient the possibility of behavior therapy such as biofeedback, exercise therapy, and relaxation techniques. Explore with the patient some techniques for stress reduction and adequate rest. Discuss family- or work-related stress to determine a regimen that may reduce stress and provide for adequate rest and relaxation. Lifestyle management may be essential to control headaches. Ask a dietician to evaluate the patient’s food intake and to work with the patient to develop a diet that will minimize exposure to triggers.

Evidence-Based Practice and Health Policy

Spector, J.T., Kahn, S.R., Jones, M.R., Jayakumar, M., Dalal, D., & Nazarian, S. (2010). Migraine headache and ischemic stroke risk: An updated meta-analysis. The American Journal of Medicine, 123(7), 612–624.

Investigators speculate that history of a migraine headache is associated with increased cardiovascular risk. However, evidence to support this hypothesis is limited.
For example, findings from a meta-analysis of 21 studies, which included 622,381 participants, revealed a relative risk of ischemic stroke 2.41 times higher among migraine sufferers (95% CI, 1.81 to 3.20) compared to those without migraines even when controlling for confounders such as hypertension, smoking, cholesterol, and oral contraceptive use. However, the heterogeneity of the samples among these studies was low.
The pooled adjusted hazard ratio of ischemic stroke from three studies was 1.52 times higher among migraine sufferers (95% CI, 0.99 to 2.35) compared to those without migraines. The heterogeneity among these three studies was high.

Documentation guidelines

Discomfort: Timing, character, location, duration, precipitating factors
Nutrition: Food and fluid intake; understanding of dietary restriction
Medication management: Understanding of drug therapy, response to medications
Response to alternative treatments: Success of treatment, interest in developing other, nontraditional management strategies

Discharge and home healthcare guidelines

Teach the patient how to maintain lifestyle changes with regard to rest, nutrition, and medication management. Make sure the patient and family understand all aspects of the treatment regimen. Review dietary limitations and recommendations, and make sure the patient understands the dosage and side effects of all medications. Provide a referral to a headache clinic that teaches alternative therapies.

Patient discussion about Migraine Headache

Q. what is migraine??? A. this is a disease

Q. What the reasons to the migraine? A. A migraine headache has many triggers- among which are different foods (cheese, red wine), drinking coffee or caffeine containing beverages, lack of sleep, smoking, drinking alcohol, exposure to strong noise and more. There is also a genetic factor, and you see migraine more in people whose relatives suffer from it too.

Q. What Is a Migraine? I have these headaches and my doctor says it sounds like I’m suffering from migraines. What exactly are migraines?A.
A migraine is a situation that generally combines a headache with certain characteristics, such as increased sensitivity to light, pulsating pain, usually only one sided and that lasts no longer than 72 hours. It is usually a phenomenon that runs in the family, and sometimes can be very difficult to overcome. Here are some tips about dealing with a migraine- http://www.5min.com/Video/How-to-Treat-Headaches-21797151

More discussions about Migraine Headache