The following is from www.headaches.org, Web site of the National Headache Foundation: 1-888-NHF-5552.

Who gets migraines?

More than 29.5 million Americans suffer from migraine, with women being affected three times more often than men. This vascular headache is most commonly experienced between the ages of 15 and 55, and 70 percent to 80 percent of sufferers have a family history of migraine. Less than half of all migraine sufferers have received a diagnosis of migraine from their healthcare provider. Migraine is often misdiagnosed as sinus headache or tension-type headache.

What triggers them?

Many factors can trigger migraine attacks, such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near daily use of medications designed for relieving headache attacks; bright lights, sunlight, fluorescent lights, TV and movie viewing; certain foods; and excessive noise. Stress and/or underlying depression are important trigger factors that can be diagnosed and treated adequately.

What happens in a migraine?

Pain typically on one side of the head

Pain has a pulsating or throbbing quality

Moderate to intense pain affecting daily activities

Nausea or vomiting

Sensitivity to light or sound

Attacks last four to 72 hours, sometimes longer

Visual disturbances or aura

Exertion such as climbing stairs makes headache worse

Approximately one-fifth of migraine sufferers experience aura, prior to the headache pain. Visual disturbances such as wavy lines, dots or flashing lights and blind spots begin from 20 minutes to one hour before the actual onset of migraine. Some people will have tingling in their arm or face or difficulty speaking.

What causes the pain?

The pain of migraine occurs when excited brain cells trigger the trigeminal nerve to release chemicals that irritate and cause swelling of blood vessels on the surface of the brain. These swollen blood vessels send pain signals to the brainstem, an area of the brain that processes pain information.

How is it diagnosed?

A doctor establishes the history of the migraine-related symptoms and other headache characteristics as well as a family history of similar headaches. Tests such as the CT scan and MRI are useful to confirm the lack of organic causes for the headaches. There is currently no test to confirm the diagnosis of migraine.

How is it treated?

Trigger factors include diet, sleep, activity and psychological issues. The use of a diary to record events that may play a role in causing the headaches and possible trigger factors can be useful for you and your healthcare provider. Avoiding trigger factors reduces the number of headaches. Healthful lifestyles including regular exercise and avoidance of nicotine may also enhance migraine management. Non-drug techniques for control of migraine can be helpful: biofeedback, physical medicine and counseling.

What drugs can be used to treat acute migraines?

The Food and Drug Administration has approved three over-the-counter products to treat migraine: Excedrin Migraine (a combination of aspirin, acetaminophen and caffeine) and Advil Migraine and Motrin Migraine Pain, both ibuprofen medications. Prescription anti-inflammatory agents may be effective. Migraine-specific therapies include:

Ergotamine preparations: no longer readily available.

Dihydroergotamine (DHE) may be used for self-injection.

DHE is also available as the nasal spray Migranal.

A combination product containing isometheptene (Midrin) is not usually effective for migraine.

Sumatriptan (Imitrex), a 5-HT agonist, is available in self-injectable, nasal spray and rapidly-dissolving tablet forms.

Other 5-HT agonists are almotriptan (Axert), naratriptan (Amerge), rizatriptan (Maxalt), zolmitriptan (Zomig), frovatriptan (Frova) and eletriptan (Relpax). All are available in tablet form. Both rizatriptan and zolmitriptan are available in an orally disintegrating tablet (Maxalt-MLT and Zomig-ZMT), which can be taken without water. Zomig also comes in a nasal spray.

Abortive medications are most effective when taken early in an attack, while the pain is still mild and before skin sensitivity increases. The goal is complete relief of pain and associated symptoms, allowing the sufferer to quickly return to normal functioning.

Some attacks may not be eliminated by abortive therapy, yet the patient requires pain-relieving measures. Due to the severity of the headaches, some patients may require a narcotic analgesic, but if the patient is experiencing frequent migraine attacks habit-forming analgesics should be avoided. Butorphanol (Stadol) is available for intranasal administration and is not typically associated with dependency problems, but may result in dependency if used regularly for pain relief. Alternative medical treatments with medications belonging to the group known as the Phenothiazines have proven useful as non-analgesic options for treating severe migraine headaches. Patients with prolonged migraine attacks lasting more than 24 hours are experiencing status migraine and corticosteroids may be used in these cases due to their anti-inflammatory effects.

When are preventive medications needed?

If needed, preventive medications can reduce the migraine frequency and improve the response to the acute migraine medicines. The FDA has approved four drugs for migraine prevention. These include propranolol (Inderal), timolol (Blocadren), topiramate (Topamax) and divalproex sodium (Depakote). These have had many years of use and make up the majority of the items considered first-line therapy for migraine prevention. Amitriptyline, which is an antidepressant, may also be very effective as a migraine preventive.

Does biofeedback work?

Once familiar with the technique, people can use it to stop an attack or reduce its effects. Self-hypnosis exercises are also taught to control both muscle contraction and the swelling of blood vessels. Children have an excellent response to biofeedback training.