How Are Migraine Headaches Diagnosed?

In most cases, migraine headaches are diagnosed when the symptoms are already present. Migraine often begins during childhood all the way to early adulthood. Though migraines can occur in someone over the age of fifty, advancing age can also makes other kinds of headaches more likely. A family history is often present, which can further suggest a genetic pre-disposition in migraine sufferers. In addition to diagnosing migraine from the clinical presentation, there is usually an accompanying examination.

Patients with a first headache or if there are any significant alterations in the headaches, the presence of nervous system symptoms, e.g. visual or hearing or sensory loss, might need some additional tests. The tests can include blood testing, brain scanning - CT or MRI - as well as a spinal tap.

How To Treat Migraine Headaches?

Treatment usually includes non-medication and with-medication approaches.

Non-medication treatment for migraine:

Therapy that doesn't involve medication can sometimes promote other symptomatic and preventative therapies. Using ice for example, bio-feedback and relaxation techniques can also be quite helpful for preventing a headache attack once it has started. Sleep can also most often be the best kind of medicine. Preventing migraine usually takes some motivation for the patient to make some lifestyle modifications. Once diagnosed, patients can then be educated regarding triggering factors that can be avoided. These factors usually include quitting smoking, avoiding certain foods, especially foods which are high in tyramine, e.g. sharp cheeses, or foods containing sulphites, e.g. wine, or nitrates, e.g. nuts, and pressed meats. More generally, leading a healthy lifestyle with good nutrition, adequate water, sufficient sleep and exercise can be most useful. Acupuncture has also been suggested by some to be a very useful non-medication therapy.

Medication therapies for migraine

Individuals with certain occasional mild migraine headaches that do not interfere with daily activities will usually medicate themselves with over-the-counter (OTC, non-prescription) pain relievers (analgesics). Also, many OTC analgesics are available. OTC analgesics have been shown to be very safe and effective for short-term relief of headaches (as well as muscle aches, pains, menstrual cramps, and fever) when used according to the instructions on their labels.

There are also two major classes of OTC analgesics: acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs). The two types of NSAIDs are aspirin and non-aspirin. Examples of non-aspirin NSAIDs are ibuprofen (Advil, Nuprin, Motrin IB, and Medipren) and naproxen (Aleve). Some NSAIDs are also available by prescription only. Prescription NSAIDs are usually prescribed for treat arthritis and other inflammatory conditions such as bursitis, tendonitis, etc. The difference between OTC and prescription NSAIDs might only be the amount of the active ingredient contained in each pill. For instance, OTC naproxen (Aleve) contains 220 mg of naproxen per pill, whereas prescription naproxen (Naprosyn) contains a further 375 or 500 mg of naproxen per pill.

Acetaminophen reduces pain and fever by acting on pain centers located within the brain. Acetaminophen is well tolerated and is generally considered far easier on the stomach than NSAIDs. Nevertheless, acetaminophen can also cause some severe liver damage in high (toxic) doses or if used on a regular basis over certain extended periods of time. In individuals who tend to regularly consume moderate or large amounts of alcohol, acetaminophen can also cause some serious damage to the liver in lower doses that usually are not that toxic. Acetaminophen can also cause severe damage to the kidneys when taken in large doses. This is why, acetaminophen should not be taken any more frequently or in larger doses than ever recommended on the label. For further information, you should please read the Acetaminophen and Liver Damage article.

NSAIDs relieve pain by reducing the inflammation that can cause the pain (They are called non-steroidal anti-inflammatory drugs or NSAIDs because they are different from corticosteroids such as prednisone, prednisolone, and cortisone which also tend to reduce inflammation). Corticosteroids, though valuable in reducing inflammation, have a predictable and potentially serious amount of side effects, especially when used over long-term. NSAIDs don't always have the same side effects that corticosteroids might have.

Aspirin, Aleve, Motrin, and Advil are all NSAIDs and are similarly effective in relieving pain and fever. One of the major differences between aspirin and non-aspirin NSAIDs is their effect on the platelets. Platelets are small particles in the blood that can cause blood clots to form. Aspirin can prevents the platelets from forming blood clots. Hence, aspirin can increase bleeding by preventing blood from clotting; however it can also be used therapeutically for prevent clots from causing heart attacks and strokes. The non-aspirin NSAIDs also have anti-platelet effects, but their anti-platelet action doesn't last as long as aspirin.

Aspirin, acetaminophen, and caffeine are also available combined in OTC analgesics for the treatment of headaches. Instances of such combination analgesics are Pain-aid, Excedrin, Fioricet, as well as Fiorinal.

Finding an effective analgesic or analgesic combination can often be a process of trial and error because individuals might respond differently to various analgesics. More generally, a person should try to use the analgesic that would have worked best in the past. This will increase the likelihood that an analgesic would ever be effective and able to decrease the risk of any side effects.

There are several precautions that should be observed with OTC analgesics:
* Children and teenagers shouldn't ever use aspirin for the treatment of headaches, other pains, or fevers, because of the risk of developing Reye's Syndrome, which is a life-threatening neurological disease that can lead to coma and even death.
* Patients with certain balance disorders or hearing impairments should avoid using aspirin because aspirin can aggravate these conditions.
* Patients taking blood thinners such as warfarin (Coumadin) shouldn't take aspirin and non-aspirin NSAIDs without a doctor's supervision because they further add to the risk of bleeding that might be caused by the blood thinner.
* Patients with active ulcers of the stomach and duodenum shouldn't ever take aspirin and non-aspirin NSAIDs because they can strongly increase the risk of bleeding from the ulcer and prevent the ulcer for healing.
* Patients with advanced kinds of liver disease shouldn't ever take aspirin and non-aspirin NSAIDs because they are able to impair the function of the kidney. Deterioration of the kidney function in these patients can lead to rapid and life-threatening deterioration of their liver disease.
* Patients shouldn't ever overuse OTC or prescription analgesics. Overuse of analgesics can lead to the development of tolerance (increasing ineffectiveness of the analgesic) and rebound headaches (return of the headache as soon as the effect of the analgesic wears off, usually in the early morning hours). Therefore, overuse of analgesics can make it possible to lead to a vicious circle of increasing amounts of analgesics for headaches that will consequently respond less and less to treatment and occur more frequently.