migraine /mī″grān/ [Gk, hemi, half, kranion, skull] , a recurring headache characterized by unilateral onset, severe throbbing pain, photophobia, phonophobia, and autonomic disturbances during the acute phase, which may last for hours or days. The disorder occurs more frequently in women than in men, and a predisposition to migraine may be inherited. The exact mechanism responsible for the disorder is not known, but the head pain may be related to dilation of extracranial blood vessels, which may be the result of chemical changes that cause spasms of intracranial vessels. Allergic reactions, excess carbohydrates, iodine-rich foods, alcohol, bright lights, or loud noises may trigger attacks, which often occur during a period of relaxation after physical or psychic stress. See also headache. ▪ OBSERVATIONS: An impending attack may be heralded by visual disturbances, such as aura, flashing lights or wavy lines, or by a strange taste or odor, numbness, tingling, vertigo, tinnitus, or a feeling that part of the body is distorted in size or shape. The acute phase may be accompanied by nausea, vomiting, chills, polyuria, sweating, facial edema, irritability, and extreme fatigue. After an attack the individual often has dull head and neck pains and a great need for sleep. ▪ INTERVENTIONS: Ergotamine tartrate preparations that constrict cranial arteries can usually prevent the headache from developing if administered early in the onset via injection, suppository, tablet, or nasal spray. Ergotamine tartrate is also available in combination with other drugs, such as caffeine, phenobarbital, and belladonna. Migraine patients unable to tolerate ergot preparations may use other analgesics, including acetaminophen, NSAIDs, triptan, and propoxyphene. If headaches happen frequently, a prophylactic medication may be taken daily.
