send to cells that direct their activities) cause the
abnormal vessel activity. Migraines tend to run in
families, which supports the premise of genetic
involvement.
There are two types of migraine:
- Classic migraine begins with an aura—a sen-
sory experience, such as seeing flashing lights
or smelling a particular odor that is not actually
present, that portends the arrival of the
headache. Disturbances of vision, confused
thinking, and tingling in parts of the body such
as the hands or feet may accompany the aura.
Nausea and often vomiting may come next.
Within about 30 minutes the pain erupts, often
beginning on one side of the head or around
the EYE. The pain may stay on one side of the
head or spread to the entire head. A classic
migraine lasts 24 to 48 hours. - Common migraine lacks an aura though often
there are vision disturbances, confusion, nau-
sea, and vomiting before the headache starts.
The pain may start on one side of the head and
spread to both sides, or start with full involve-
ment of the entire head. A common migraine
may last three or four days.
Medications are the usual approach for recur-
ring migraines. The most effective are those that
prevent the migraine from unfolding. A class of
drugs called triptans offering a new approach to
migraine treatment became available in the early
1990s. Triptans (such as sumatriptan and
zolmitriptan) work by binding with receptors on
the cells in arterial walls that selectively constrict
arteries, preventing the fluctuations in dilation
and constriction that result in pain. The effective-
ness of the different triptan products is highly
individual, so often a period of trial and error is
necessary to find the right match between person
and drug. Triptans also have potentially severe
side effects, includingHEART ATTACKresulting from
constricted CORONARY ARTERIES. People who have
CARDIOVASCULAR DISEASE (CVD) such as CORONARY
ARTERY DISEASE (CAD) or ISCHEMIC HEART DISEASE
(IHD), or who have significant risk for CVD, should
not take triptans.
Migraine headaches are most common in men-
struating women, raising the probability of a hor-
monal connection. Some women have persistent
migraines until pregnancy and then never have a
migraine headache again. Other women develop
migraines during pregnancy or after menopause.
Oral contraceptives (birth control pills), which are
hormones, also influence migraine headaches,
improving them in some women and worsening
them in others. The hormonal connection seems
obvious but its precise nature remains elusive.Cluster Headache
Cluster headache is a less common type of vascu-
lar headache in which a migraine-style headache
recurs at about the same time of day for two to
four months. The pain of cluster headache affects
one side of the head and is typically severe. What
will become a series of headaches begins suddenly,
often around one eye. The involved eye becomes
red and swollen, and the same side of the NOSE
often becomes congested. Each headache lasts 30
to 90 minutes and then goes completely away. A
person may go several months to several years
between clusters. However, severe chronic cluster
headache can occur in such a regular pattern that
there is very little break between the end of one
cluster and the start of the next. Cluster headache
is more common in men and does not appear to
have a hereditary component.Sinus Headache
Sinus headaches result from the pressure of sinus
congestion. The pain typically emanates from the
front of the face, is more severe upon first waking
and when tipping the head downward, and
includes POSTNASAL DRIP among its symptoms.
Sinus congestion may result from a cold, ALLERGIC
RHINITIS(seasonal allergies), or sinus infection. The
doctor should evaluate sinus headache that lasts
longer than three weeks or when there a thick,
green or yellow discharge accompanies the
headache as these symptoms may indicate a bacte-
rial infection that requires treatment with ANTIBI-
OTIC MEDICATIONS.Rebound Headache
Rebound headache is an unpleasant circumstance
that develops as a consequence of long-term use of
analgesic medications (more than twice a week on
a fairly regular basis) to treat chronic headache. The374 Pain and Pain Management