Some Questions about Migraine?
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  What Are Migraine Headaches?

   The most common type of vascular headache is migraine. Migraine
   headaches are usually characterized by severe pain on one or both
   sides of the head, an upset stomach, and at times disturbed vision.

   Headache Vs Migraine : The major difference between the two types is
   the appearance of neurological symptoms 10 to 30 minutes before a
   classic migraine attack. These symptoms are called an aura. The person
   may see flashing lights or zigzag lines, or may temporarily lose
   vision. Other classic symptoms include speech difficulty, weakness of an
   arm or leg, tingling of the face or hands, and confusion.

   The pain of a classic migraine headache is described as intense,
   throbbing, or pounding and is felt in the forehead, temple, ear, jaw,
   or around the eye. Classic migraine starts on one side of the head but
   may eventually spread to the other side. An attack lasts 1 to 2
   pain-wracked days.

   The common migraine--a term that reflects the disorder's greater
   occurrence in the general population--is not preceded by an aura. But
   some people experience a variety of vague symptoms beforehand,
   including mental fuzziness, mood changes, fatigue, and unusual
   retention of fluids. During the headache phase of a common migraine, a
   person may have diarrhea and increased urination, as well as nausea
   and vomiting. Common migraine pain can last 3 or 4 days.

   Both classic and common migraine can strike as often as several times
   a week, or as rarely as once every few years. Both types can occur at
   any time. Some people, however, experience migraines at predictable
   times -near the days of menstruation or every Saturday morning after a
   stressful week of work.

   The migraine process. Research scientists are unclear about the
   precise cause of migraine headaches. There seems to be general
   agreement, however, that a key element is blood flow changes in the
   brain. People who get migraine headaches appear to have blood vessels
   that overreact to various triggers.

   Scientists have devised one theory of migraine which explains these
   blood flow changes and also certain biochemical changes that may be
   involved in the headache process. According to this theory, the
   nervous system responds to a trigger such as stress by creating a
   spasm in the nerve-rich arteries at the base of the brain. The spasm
   closes down or constricts several arteries supplying blood to the
   brain, including the scalp artery and the carotid or neck arteries.

   Blood supply is reduced. At the same time, blood-clotting particles
   called platelets clump together--a process which is believed to release
   a chemical called serotonin. Serotonin acts as a powerful constrictor
   of arteries, further reducing the blood supply to the brain.

   Reduced blood flow decreases the brain's supply of oxygen. Symptoms
   signaling a headache, such as distorted vision or speech, may then
   result, similar to symptoms of stroke.

   Reacting to the reduced oxygen supply, certain arteries within the
   brain open wider to meet the brain's energy needs. This widening or
   dilation spreads, finally affecting the neck and scalp arteries. The
   dilation of these arteries triggers the release of pain-producing
   substances called prostaglandins from various tissues and blood cells.
   Chemicals which cause inflammation and swelling, and substances which
   increase sensitivity to pain are also released. The circulation of
   these chemicals and the dilation of the scalp arteries stimulate the
   pain-sensitive nociceptors. The result, according to this theory: a
   throbbing pain in the head.

   Women and migraine. Although both males and females seem to be
   affected by migraine, the condition is more common in adult women.
   Both sexes may develop migraine in infancy, but most often the
   disorder begins between the ages of 5 and 35.

   The relationship between female hormones and migraine is still
   unclear. Women may have "menstrual migraine"--headaches around the
   time of their menstrual period--which may disappear during pregnancy.
   Other women develop migraine for the first time when they are
   pregnant. Some are first affected after menopause.

   The effect of oral contraceptives on headaches is perplexing.
   Scientists report that some women with migraine who take birth control
   pills experience more frequent and severe attacks. However, a small
   percentage of women have fewer and less severe migraine headaches when
   they take birth control pills. And normal women who do not suffer from
   headaches may develop migraines as a side effect when they use oral
   contraceptives. Investigators around the world are studying hormonal
   changes in women with migraine in the hope of identifying the specific
   ways these naturally occurring chemicals cause headaches.

   Triggers of headache. Although many sufferers have a family history of
   migraine, the exact hereditary nature of this condition is still
   unknown. People who get migraines are thought to have an inherited
   abnormality in the regulation of blood vessels.

   These triggers include stress and other normal emotions, as well as
   biological and environmental conditions. Fatigue, glaring or
   flickering lights, the weather, and certain foods can set off
   migraine. It may seem hard to believe that eating such seemingly
   harmless foods as yogurt, nuts, and lima beans can result in a painful
   migraine headache. However, some scientists believe that these foods
   and several others contain chemical substances, such as tyramine,
   which constrict arteries--the first step of the migraine process.
   Other scientists believe that foods cause headaches by setting off an
   allergic reaction in susceptible people.

   While a food-triggered migraine usually occurs soon after eating,
   other triggers may not cause immediate pain. Scientists report that
   people can develop migraine not only during a period of stress but
   also afterwards when their vascular systems are still reacting. For
   example, migraines that wake people up in the middle of the night are
   believed to result from a delayed reaction to stress.

   Other forms of migraine. In addition to classic and common, migraine
   headache can take several other forms:

   Patients with hemiplegic migraine have temporary paralysis on one side
   of the body, a condition known as hemiplegia. Some people may
   experience vision problems and vertigo--a feeling that the world is
   spinning. These symptoms begin 10 to 90 minutes before the onset of
   headache pain.

   In ophthalmoplegic migraine, the pain is around the eye and is
   associated with a droopy eyelid, double vision, and other sight
   problems.

   Basilar artery migraine involves a disturbance of a major brain
   artery. Preheadache symptoms include vertigo, double vision, and poor
   muscular coordination. This type of migraine occurs primarily in
   adolescent and young adult women and is often associated with the
   menstrual cycle.

   Benign exertional headache is brought on by running, lifting,
   coughing, sneezing, or bending. The headache begins at the onset of
   activity, and pain rarely lasts more than several minutes.

   Status migrainosus is a rare and severe type of migraine that can last
   72 hours or longer. The pain and nausea are so intense that people who
   have this type of headache must be hospitalized. The use of certain
   drugs can trigger status migrainosus. Neurologists report that many of
   their status migrainosus patients were depressed and anxious before
   they experienced headache attacks.

   Headache-free migraine is characterized by such migraine symptoms as
   visual problems, nausea, vomiting, constipation, or diarrhea.
   Patients, however, do not experience head pain. Headache specialists
   have suggested that unexplained pain in a particular part of the body,
   fever, and dizziness could also be possible types of headache-free
   migraine.

  How is Migraine Headache Treated?

   During the Stone Age, pieces of a headache sufferer's skull were cut
   away with flint instruments to relieve pain. Another unpleasant remedy
   used in the British Isles around the ninth Century involved drinking
   "the juice of elderseed, cow's brain, and goat's dung dissolved in
   vinegar." Fortunately, today's headache patients are spared such
   drastic measures.

   Drug therapy, biofeedback training, stress reduction, and elimination
   of certain foods from the diet are the most common methods of
   preventing and controlling migraine and other vascular headaches.
   Joan, the migraine sufferer, was helped by treatment with a
   combination of an antimigraine drug and diet control.

   Regular exercise, such as swimming or vigorous walking, can also
   reduce the frequency and severity of migraine headaches. Joan found
   that yoga and whirlpool baths helped her relax.

   During a migraine headache, temporary relief can sometimes be obtained
   by using cold packs or by pressing on the bulging artery found in
   front of the ear on the painful side of the head.

   Drug therapy. There are two ways to approach the treatment of migraine
   headache with drugs: prevent the attacks, or relieve symptoms after
   the headache occurs.

   For infrequent migraine, drugs can be taken at the first sign of a
   headache in order to stop it or to at least ease the pain. People who
   get occasional mild migraine may benefit by taking aspirin or
   acetaminophen at the start of an attack. Aspirin raises a person's
   tolerance to pain and also discourages clumping of blood platelets.
   Small amounts of caffeine may be useful if taken in the early stages
   of migraine. But for most migraine sufferers who get moderate to
   severe headaches, and for all cluster patients, stronger drugs may be
   necessary to control the pain.

   One of the most commonly used drugs for the relief of classic and
   common migraine symptoms is ergotamine tartrate, a vasoconstrictor
   which helps counteract the painful dilation stage of the headache. For
   optimal benefit, the drug is taken during the early stages of an
   attack. If a migraine has been in progress for about an hour and has
   passed into the final throbbing stage, ergotamine tartrate will
   probably not help.

   Because ergotamine tartrate can cause nausea and vomiting, it may be
   combined with antinausea drugs. Research scientists caution that
   ergotamine tartrate should not be taken in excess or by people who
   have angina pectoris, severe hypertension, or vascular, liver, or
   kidney disease.

   Patients who are unable to take ergotamine tartrate may benefit from
   other drugs that constrict dilated blood vessels or help reduce blood
   vessel inflammation.

   For headaches that occur three or more times a month, preventive
   treatment is usually recommended. Drugs used to prevent classic and
   common migraine include methysergide maleate, which counteracts blood
   vessel constriction; propranolol hydrochloride, which stops blood
   vessel dilation; and amitriptyline, an antidepressant.

   Antidepressants called MAO inhibitors also prevent migraine. These
   drugs block an enzyme called monoamine oxidase which normally helps
   nerve cells absorb the artery-constricting brain chemical, serotonin.

   MAO inhibitors can have potentially serious side effects--particularly
   if taken while ingesting foods or beverages that contain tyramine, a
   substance that constricts arteries.

   Several drugs for the prevention of migraine have been developed in
   recent years, including drugs which mimic the action of serotonin,
   including serotonin agonists which mimic the action of this key brain
   chemical. Prompt administration of these drugs is important.

   Many antimigraine drugs can have adverse side effects. But like most
   medicines they are relatively safe when used carefully and under a
   physician's supervision. To avoid long-term side effects of preventive
   medications, headache specialists advise patients to reduce the dosage
   of these drugs and then to stop taking them as soon as possible.

   Biofeedback and relaxation training. Drug therapy for migraine is
   often combined with biofeedback and relaxation training. Biofeedback
   refers to a technique that can give people better control over such
   body function indicators as blood pressure, heart rate, temperature,
   muscle tension, and brain waves. Thermal biofeedback allows a patient
   to consciously raise hand temperature. Some patients who are able to
   increase hand temperature can reduce the number and intensity of
   migraines. The mechanisms underlying these self-regulation treatments
   are being studied by research scientists.

   A patient learning thermal biofeedback wears a device which transmits
   the temperature of an index finger or hand to a monitor. While the
   patient tries to warm his hands, the monitor provides feedback either
   on a gauge that shows the temperature reading or by emitting a sound
   or beep that increases in intensity as the temperature increases. The
   patient is not told how to raise hand temperature, but is given
   suggestions such as "Imagine that your hands feel very warm and
   heavy."

   In another type of biofeedback called electromyographic or EMG
   training, the patient learns to control muscle tension in the face,
   neck, and shoulders.

   Either kind of biofeedback may be combined with relaxation training,
   during which patients learn to relax the mind and body.

   Biofeedback can be practiced at home with a portable monitor. But the
   ultimate goal of treatment is to wean the patient from the machine.
   The patient can then use biofeedback anywhere at the first sign of a
   headache.

   The antimigraine diet. Scientists estimate that a small percentage of
   migraine sufferers will benefit from a treatment program focused
   solely on eliminating headache-provoking foods and beverages.

   Other migraine patients may be helped by a diet to prevent low blood
   sugar. Low blood sugar, or hypoglycemia, can cause dilation of the
   blood vessels in the head. This condition can occur after a period
   without food: overnight, for example, or when a meal is skipped.
   People who wake up in the morning with a headache may be reacting to
   the low blood sugar caused by the lack of food overnight.

   Treatment for headaches caused by low blood sugar consists of
   scheduling smaller, more frequent meals for the patient. A special
   diet designed to stabilize the body's sugar-regulating system is
   sometimes recommended.

 MIGRAINE HEADACHES
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                      All most everybody has had a headache at one time
                      or another. There are many types of headaches
                      including tension headaches, cluster headaches, and
                      sinus headaches.
                      But a migraine is different. "All migraine
                      headaches are characterized by sever pain, and in
                      many cases, nausea, vomiting, tremor, cold hands,
                      sensitivity to light (photosensitivity) and sound
                      (phonosensitivity)." All migraines are one sided
                      and the pain is throbbing or pulsating in nature.
                      The pain can be moderate to severe and can last an
                      hour or days, weeks and in extreme cases over a
                      month.

                      There are different kinds of migraines. These
                      include classic, common, and transformed. The
                      difference between a classic migraine and a common
                      one is that with a classic migraine the migraine
                      you get a warning of some kind prior to the
                      migraine. It may be a visual disturbance, a ringing
                      in the ears or even just a feeling. This is called
                      an aura. Other times the migraine can come on like
                      a freight train, that kind is the common migraine.
                      A transformed migraine is a tension headache that
                      turns into a migraine.
_____________________________________________________________________________

   What Is Migraine?

   Every year, more of us seek treatments for headache than for any other
   medical problem. In rare cases, the headache is found to be a symptom
   warning us of serious disease. In many more, it is a result of muscle
   tension, minor illness or ocular disorders.

   A syndrome is a group of symptoms that occur together in a similar
   pattern, time after time. There are several sets of symptoms of this
   type that are closely enough related that all of them are classed
   together as migraine. In most of these syndromes there is a special,
   particularly painful, kind of headache. This is so often the case, in
   fact, that many people seem to think "migraine" is simply another name
   for any very severe headache. Surprisingly, however, the name
   "migraine" has nothing to do with the severity of headache pain. There
   are such things as mild migraine headaches and in fact, some doctors
   believe unusual forms of migraine can occur with no headache at all!
   For instance, in some migraine variants there can be no pain at all
   and in others the pain may be in the eyes, stomach, or cardiothoracic
   region.

   Warning and Attack
   Whether or not all migraines include headaches, the chances are a
   thousand to one that your migraine does, and headache is the one
   symptom with which you are most concerned. If your migraine is at all
   typical, then it often sends you a warning before the headache
   strikes. This warning - the prodrome or aura as it is usually called -
   is the distinctive characteristic that sets the migraine family of
   headaches apart from all other headaches. But some migraine patients
   get no warning or aura, or get them only occasionally.

   The premonitory signs patients report most frequently are of the
   visual type: flashing lights, zigzag lines, scintillating patterns, or
   areas of darkness. Some migraine sufferers tell of prodromes that
   affect other senses, or even the emotions - a feeling of weakness in
   one or more limbs; or a sense of foreboding. Appearing one or two
   hours before the headache itself, the prodrome gradually lifts as the
   headache develops, until eventually the one replaces the other. The
   headache usually begins in one small area of the forehead or temple.
   It throbs and pulsates. It grows larger and uglier, and along with it
   comes nausea, a loss of appetite, or an aversion to light. There is
   redness and swelling of the eyes. Tears may begin to flow. Nasal
   passages sometimes feel swollen and rarely there may be a nose bleed.
   In one or two hours the headache reaches its overwhelming worst, then
   gradually subsides. One frequent pattern is for the headache to
   disappear entirely after about six hours. In other patterns, time
   between the prodromal phase and attack, as well as the overall
   duration of the attack itself, may vary widely. Some attacks may last
   for days, or even a week.

   The Most Noticeable Feature
   Probably the most striking thing about migraine headaches is the
   "shape" of the pain. In almost all cases, the migraine headache
   attacks just one side of the head - at least at the onset of the
   attack. Later on, in some patients, it may generalize and involve both
   sides. The unique one-sidedness of migraine pain was noted by the
   physicians of ancient Greece and was probably even known to physicians
   in early civilizations of the Tigris-Euphrates river valleys. The name
   "migraine" comes from this characteristic. It is a shortening of the
   old Greek name for the syndrome: "hemikrania" meaning "half the
   skull." In fact, "hemicrania" used to be the English name for
   migraine.

   What Happens During A Migraine Attack?
   Another name for migraine headache, used by doctors, is "vascular
   headache." It is a useful name because it describes the cause of the
   pain. "Vascular" is a term pertinent to the blood vessels. The vessels
   involved include, among others, the carotid arteries - large arteries
   that carry blood from the heart, up each side of the neck to the head.
   The lower part of each carotid artery is called the common carotid. At
   a point just below the ear, it splits into two branches.

   One of the branches, the external carotid, disappears under the bones
   of the skull. Some time before the migraine attack begins, the carotid
   arteries on the affected side undergo a period of random narrowing.
   This odd behavior of the arteries may cause flushing or pallor of the
   skin, and is probably responsible for the strange sensations of the
   prodrome. After this constriction, the arteries dilate, or swell. The
   walls of the arteries stretch, and like any other body tissues that
   are put under strain, release certain chemicals that stimulate nearby
   nerve endings to create pain.

   Early in the headache-phase of the attack, some patients find that
   pressure on the carotid artery can partially alleviate the pain.
   Medical science still doesn't know for sure what causes the peculiar
   arterial behavior that starts the migraine process, but a good deal of
   evidence suggests the answer may lie in the way our bodies use
   serotonin, an important body chemical that affects size of blood
   vessels.

   Migraine "Triggers"
   Migraine may be viewed as a final common pathway which can be reached
   from multiple side paths, trails, waterways or what you will. Even if
   one is able to identify certain precipitating factors, these may not
   be operative on all occasions. Patients will experience varying
   degrees of susceptibility to such factors depending on their status,
   perhaps in part related to altering of their internal milieu. In a
   sense, the patient needs to be primed, like a pump, for the
   precipitating factor(s) to become operative.
   The most common provoking factors to be assessed in migraine include
   stress, hormonal changes, dietary factors, sleep patterns, atmospheric
   conditions and personal habits. These will be discussed in brief
   detail subsequently.

   Stress and Emotions
   Emotional dynamics play an important role in the precipitation of many
   migraine attacks. Prolonged stress, internalized hostilities and a
   wide variety of other emotional and personality factors appear
   important in many but not all migraine patients. In particular, rage
   and resentment for which full expression is lacking and which may
   accumulate, can trigger an attack. Individuals with compulsive
   personality traits adapt poorly to change and stress and, in the
   appropriate biological setting, give way to migraine.

   While stress is important, many patients may experience migraine in a
   period of "let down" after the stress has subsided. Many will state
   that headaches occur after the stress has terminated, for example, on
   the first day of a vacation (holiday headache) or on the weekend after
   an intense week of sustained emotional duress. This may in part be due
   to sustained vasoconstriction during intense emotion, followed by a
   relaxation of vascular tone and the development thereafter of
   headache.

   To summarize, stress, depression, exhilaration, anxiety and anger as
   well as "let down" after intense emotional events can all provoke
   headache attacks. Although the biological aspects of these adverse
   psychological states are not well understood, there is little doubt
   that intense emotions, of the type described above, may provoke
   migraine.

   Hormonal Changes
   Approximately 70% of the women seen with migraine say that some of
   their attacks occur prior to, during, or at the end of their
   menstruation. By the third month of pregnancy, most women are free of
   their migraine - except for a very small number who get their first
   attack with pregnancy.
   The physician should be cognizant that the estrogens contained in oral
   contraceptives or postmenopausal hormones can be precipitating factors
   of migraine attacks. It is believed that the fluctuations in the
   estrogen levels may be the triggering mechanism, rather than the
   estrogen itself. In postmenopausal migraineurs, the use of hormonal
   supplements should be avoided unless the patient is insistent on using
   these agents. If that is the case, the estrogen dose should be as low
   as possible.

   Dietary Factors/Medications
   No clinical problem is more perplexing to the practicing physician
   than the relationship of foods and beverages to the production of
   migraine. A great deal of folklore surrounds the subject and little
   scientific work has been done to clarify the issue. Furthermore,
   various misconceptions about diet and migraine are given credence by
   articles in the popular press. Thus, the physician may encounter
   patients who have constructed elaborate diets in the hope of escaping
   recurrent migraine attacks. Occasionally these diets assume ridiculous
   extremes; for example, one may find that a patient is living primarily
   on scallions or bananas or onions.
   Some substances contained in food and drink act directly on blood
   vessels and cause them to dilate, and thus to produce migraine. These
   include:

     * Amines
       Tyramine (e.g. aged cheeses, meats)
       Phenylethylamine (chocolate)
     * Nitrites (e.g. hot-dogs)
     * Monosodium Glutamate (e.g. Chinese food)
     * Alcohol*

   Other substances or conditions act more indirectly, either through a
   rebound effect, or through nervous system reflexes. These include:

     * Caffeine+
     * Nicotine+
     * Ergot+
     * Monoamine Oxidase Inhibitors
     * Ice Cream
     * Hypoglycemia
     * Allergy ?

   Alcohol causes blood vessels to dilate through direct effects on the
   brain and on the blood vessels themselves.
   Rebound vasodilation may occur after excessive consumption.

   The following specific dietary recommendations may be useful to you in
   avoiding a migraine attack.

   Foods Allowed

   Foods to Avoid

   Beverages

   Decaffeinated coffee, fruit juice, club soda, non-cola soda (e.g.
   lemon-lime, ginger ale)
   Caffeine sources limited to 2 cups/day: coffee, tea, cola

   Chocolate, cocoa
   Alcoholic beverages

   Meat, Fish, Poultry

   Fresh or frozen; turkey, chicken, fish, beef, lamb, veal, pork
   Egg as meat substitute (limit 3 eggs/wk)
   Tuna, tuna salad

   Aged, canned, cured, or processed meat; canned or aged ham; pickled
   herring; salted and dried fish; chicken liver; aged game; hot-dogs;
   bologna; fermented sausage (e.g. salami, pepperoni, summer sausage);
   bacon; meat prepared with tenderizer; soy sauce, or yeast extract (any
   food containing nitrates, nitrites, or tyramine)

   Dairy Products

   Milk: homogenized, 2% or skim
   Cheese: American, cottage, farmer, ricotta, cream, processed
   Yogurt (limit 1/2 cup daily)

   Cultured dairy products (e.g. buttermilk, sour cream)
   Chocolate milk
   Cheese: bleu, Boursault, brick, Brie types, Camembert types, cheddar,
   Swiss (Emmentaler), Gouda, Roquefort, Stilton, mozzarella, Parmesan,
   provolone, Romano

   Bread, Cereal

   Commercial bread: white, whole wheat, rye, French, Italian, English
   muffin, melba toast, crackers, bagel
   All hot and dry cereals (e.g. hot wheat cereal, oatmeal, cornflakes,
   puffed wheat, puffed rice, bran)

   Hot, fresh homemade yeast bread; bread or crackers containing cheese
   Fresh yeast coffee cake, doughnuts, sourdough bread
   Any product containing chocolate or nuts

   Potato or Substitute

   White potato, sweet potato, rice, macaroni, spaghetti, noodles

   None

   Vegetables

   Any except those to avoid (e.g. asparagus, string beans, carrots,
   spinach, pumpkin, tomatoes, squash, corn, zucchini, broccoli, green
   lettuce)

   Pole or broad beans, lima or Italian beans, beets, lentils, snow peas,
   fava beans, navy beans, pinto beans, pea pods, sauerkraut, garbanzo
   beans, onions (except for flavoring), olives, pickles

   Fruit

   Any except those to avoid (e.g. prunes, apples, applesauce, cherries,
   apricots, peaches, pears, fruit cocktail)
   Oranges, grapefruit, tangerines, pineapple, lemons, limes (limit 1/2
   cup/day)

   Avocados, figs, raisins, papaya, passion fruit, red plums

   Soup

   Cream soups made from foods allowed in diet, homemade broths

   Canned soups, soup cubes, bouillon cubes, soup base with autolytic
   yeast or MSG (read labels)

   Dessert

   Fruit allowed in diet, serbet, ice cream, cake and cookies made
   without chocolate or yeast, gelatin dessert

   Ice cream, pudding, cookies, or cake containing chocolate
   Mincemeat pie

   Sweets

   Sugar, jelly, jam, honey, hard candy

   Chocolate candy or syrup, carob

   Miscellaneous

   Salt in moderation, lemon juice, butter or margarine, cooking oil,
   whipped cream
   White vinegar and commercial salad dressing in small amounts

   Pizza, cheese sauce, soy sauce, MSG in excessive amounts, yeast, yeast
   abstract, brewer's yeast, meat tenderizer, flavor enhancer, seasoned
   salt
   Mixed dishes (e.g. macaroni and cheese, feef stroganoff, cheese
   blintze, lasagna, frozen or TV dinners)
   Nuts and seeds; peanut butter, peanuts, and pumpkin, sesame and
   sunflower seeds
   Some snack items (read labels)
   Any pickled, preserved, or marinated food

   General Hints

     * Eat three meals each day, or even more frequently, with smaller
       portions.
     * Avoid skipping meals.
     * Avoid prolonged fasting.
     * Avoid excessive ingestion of carbohydrates, fats, protein or sugar
       in any sitting.
     * In all things, moderation!

   Medications
   Certain medications are capable of producing headaches, particularly
   in those patients predisposed to migraine. Among these agents are
   reserpine, oral contraceptives, nonsteroidal anti-inflammatory agents,
   vasodilators, monoamine oxidase inhibitors, hydralazine, some
   diuretics and antiasthmatic medications such as theophylline and
   aminophylline. Ironically, the nonsteroidal anti-inflammatory agents
   are also used as treatment in some migraine patients. In addition to
   these agents, prolonged use and subsequent and sudden withdrawal from
   ergotamine, amphetamines, propranolol and phenothiazine drugs may
   provoke migraine.

   Sleep
   Patients with migraine, like those suffering from other vascular
   headaches, may be awakened from sleep by a headache. Nighttime sleep
   and daytime napping are well recognized precipitants to migraine. Many
   patients will cite either too much or too little sleep as provoking
   influence for their headaches.

   Among the various stages of sleep, rapid eye movement (REM) sleep has
   been most associated with headache arousal. Rapid eye movement sleep
   is that phase accompanied by rapid eye movements, in conjunction with
   lower voltage, high frequency electroencephalographic (EEG) patterns,
   and a variety of physiological events including elevated heart rate,
   increased cerebral blood flow, rapid respiration and dreaming.

   Patients with migraine frequently report that awakening one or two
   hours later than usual will often be associated with headache. In
   these patients, sleep rationing can be employed.

   Atmospheric Alterations
   Patients often identify weather changes as responsible for migraine.
   These "winds of ill repute," associated with positive ionization of
   the atmosphere are found throughout the world and are identified by
   multiple names including:

     * Chamsin or Sharav of the Middle East
     * Chinook of Canada
     * Desert Winds of Arizona
     * Foehn of the European Alps
     * Mistral or Autun of France
     * North Winds of Melbourne, Australia
     * Santa Ana of California
     * Sirocco of Italy
     * Thar of India
     * Xlokk of Malta
     * Zonda or Xonda of Argentina

   Some have suggested the use of air ionizers as a helpful therapeutic
   agent for migraine; negative ions are said to improve mood and
   performance, while positive ions have an opposite effect. This issue
   is, however, unresolved, especially given the lack of consistency in
   experimental studies performed on this question.

   Personal Habits/Inhalants and Fumes
   Smoking is generally not assumed to provoke migraine, but is
   strikingly correlated with the related condition of cluster headache.
   Many have suggested that intense odors or penetrating smells provoke
   migraine, but proof is lacking. Patients often blame migraine on
   pollution, especially smog or carbon monoxide in the atmosphere.

   To conclude, I have presented some factors which may be of importance
   as "triggers" to migraine. Their impact is debatable but may be of use
   in helping direct both patient and physician to the concept of a
   well-directed therapeutic regimen. By this I mean careful attention to
   good health habits including proper diet, adequate aerobic exercise,
   adequate rest and the avoidance of habits known to alter health.
   Attention to these details almost invariably improves the lot of the
   migraine patients, despite the provoking factors implicated.

   Prognosis and Treatment
   All of us who suffer from migraine can take comfort, however slight,
   from the knowledge that migraine usually diminishes as we grow older.
   On the whole, migraine attacks usually begin between the ages of 16
   and 35 and begin to lessen in frequency at around 50. The type of
   migraine associated with the menstrual cycle in women usually
   disappears at the onset of menopause. Similarly, men may experience a
   lessening in severity and frequency of migraine attacks as they
   approach middle age. In general, although there are exceptions,
   migraine is not a problem in the later years.

   Until that happy age arrives, there is much that doctors and medicine
   can do to relieve the pain of migraine. Certainly highly potent
   medications are available, both in pill and suppository form, which
   can abort the attack {that is stop it before it has time to develop to
   its full frenzied fury) if given early enough in the initial first
   stage. Any decisions as to whether you should take this kind of
   medication, that containing a substance called ergotamine tartrate,
   can be made only by your physician, since these are prescription
   drugs. If your physician does prescribe this kind of medication, you
   must assist its effectiveness by taking it at the first possible sign
   of an attack. You can't wait to see if there are going to be more
   signs, or if the symptoms are going to get worse. YOU MUST TAKE IT
   RIGHT AWAY! In some cases, your physician may also prescribe other
   treatment for you - tranquilizers to reduce your nervous tension, or
   counseling sessions to help eliminate the cause of tension. If you are
   having very frequent attacks, your physician will probably suggest
   daily medication use, such as a beta blocker, to reduce the intensity
   and frequency of attacks. Whatever your doctor prescribes, follow
   his/her instructions.

   Helpful Hints for the Migraine Sufferer

    1. Follow your doctor's recommendations faithfully. While treatment
       will not cure migraine, treatment will help control attacks so
       that they don't become the focal point of your life.
    2. Take only the medication prescribed and in the dosage your doctor
       recommends. Remember - the sooner you take the medicine, the
       sooner you will get relief and the more likely are your chances of
       avoiding the migraine. Always carry your medication with you.
       Don't be taken in by false claims for remedies said to "cure your
       migraine." If there were any cures, your doctor would undoubtedly
       know about them.
    3. During a migraine attack, lie down in a quiet, darkened room, with
       your head slightly raised. If you have learned relaxation
       techniques, use them now. If not, listen to a restful musical
       tape. The following phrases may help you to relax and to reduce
       the pain of migraine:
       I feel quite quiet...I am beginning to feel quite relaxed...My
       feet feel heavy and relaxed...My ankles, my knees and my hips,
       feel heavy, relaxed and comfortable...My stomach and the whole
       central portion of my body, feel relaxed and quiet...My hands, my
       arms and my shoulders, feel heavy, relaxed and comfortable...My
       neck, my jaws and my forehead feel relaxed...They feel comfortable
       and smooth...My whole body feels quiet, heavy, comfortable and
       relaxed.
       I am quite relaxed...My arms and hands are heavy and warm...I feel
       quite quiet...My whole body is relaxed and my hands are warm,
       relaxed and warm...My hands are warm...Warmth is flowing into my
       hands, they are warm...Warm.
    4. Keep a record of your attacks: Of the foods you eat, the things
       you do and the way you feel before the attack begins. You may find
       that there is a pattern to your migraine and that by changing the
       pattern, attacks might be avoided.

   What Migraine Isn't

    1. Migraine isn't a disease (it's a syndrome or a group of symptoms
       characteristic of a condition).
    2. Migraine isn't "just a severe headache" (it may not be a headache
       at all).
    3. Migraine isn't "just nerves" or "all in your imagination" (but
       tension may make it worse).
    4. Migraine isn't contagious (but it does seem to be inherited).