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.
Former basketball star Kareem Abdul-Jabbar remembers experiencing
his first migraine at age 14. The pain was unlike the discomfort of
his previous mild headaches.
"When I got this one I thought, 'This is a headache'," he says. "The
pain was intense and I felt nausea and a great sensitivity to light.
All I could think about was when it would stop. I sat in a dark room
for an hour and it passed."
Symptoms of Migraine
Abdul-Jabbar's sensitivity to light is a standard symptom of the
two most prevalent types of migraine-caused headache: classic and
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 may be 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.
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 - for example, 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 causing a
spasm of 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.
As these arteries constrict, the flow of blood to the brain 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
equally 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
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.
"It's like a cocked gun with a hair trigger," explains one
specialist. "A person is born with a potential for migraine and the
headache is triggered by things that are really not so terrible."
These triggers include stress and other normal emotions, as well as
biological and environmental conditions. Fatigue, glaring or
flickering lights, changes in 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
In ophthalmoplegic migraine, the pain is around the eye and is
associated with a droopy eyelid, double vision, and other problems
Basilar artery migraine involves a disturbance of a major brain
artery at the base of the brain. 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
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