Migraine: Diagnosis and Treatment

Diagnosis

Usually, the description of the headache is enough to make the diagnosis (i.e., where it hurts, how often it occurs, what triggers it), without any specialized tests.
In rare cases, a headache may be a sign of a more serious disorder. If one of the following “danger signs” occurs, a physician should be notified immediately:

• A sudden onset of a severe headache that feels like “the worst headache of your life.”
• A severe headache that accompanies a fever or a stiff neck.
• A headache associated with confusion or loss of consciousness.
• A headache that occurs following head trauma.
• A headache that is associated with other neurologic symptoms, such as numbness of the arms or face, weakness, dizziness, difficulty walking, or disturbance of vision.

In such cases, further testing will be necessary, and may include blood tests, CT scan or MRI of the head, or lumbar puncture (“spinal tap”).

Treatment

• Prevention is, by far, the best approach. It helps to avoid situations that trigger or exacerbate migraines (see below). It is also useful to maintain a regular sleep schedule and avoid spicy foods, alcohol, and caffeine in the four–hour period before bedtime.  Stress management can cut down on migraine frequency.
  
• Even minor exposures to triggers can cause a migraine attack. These include:
  
• Dietary triggers (see Nutritional Considerations)
  
• Sensory triggers: Bright or flickering lights, strong odors, and loud noises.
  
• Environmental triggers: Changes in the weather, seasonal changes, long–distance travel, and altitudes (e.g., plane flights).
  
• Lifestyle triggers: Stress, significant life changes (e.g., death of a loved one, divorce, job change, moving, and schedule changes), intense or irregular physical activity, dieting or fasting, abnormal sleeping patterns.
  
• Hormonal triggers: Menstrual period, ovulation, and hormone replacement therapy.
  
• Tylenol, aspirin, ibuprofen, and other over–the–counter pain medications are often effective, especially if used as soon as the migraine attack or aura begins. However, they should not be used too often. If these medications are being used regularly they can lead to a syndrome of daily headaches, and other side effects. Your doctor may prescribe a stronger medication to treat or prevent the headaches.
  
• If over–the–counter pain medications do not effectively treat the headache, your doctor may prescribe stronger medications. The most common are the triptan medicines (e.g., sumatriptan, rizatriptan, almotriptan, zolmatriptan). These drugs should be avoided during pregnancy.
  
• In people who have very frequent (more than four per month) or very severe migraines, a daily medication may be necessary to prevent future attacks.