Migraine Misery?

My daughter has been having migraine symptoms, which are scary. Her doctor said the headaches were "classic migraines," but to be safe, he ordered a CT scan. Are there other tests he could have performed to determine whether her headaches are migraines?

– October 2, 2009

The term "classic migraine" usually refers to one-sided headaches preceded by an "aura" – seeing visual changes like flashing lights or zigzag lines about a half an hour before the headache sets in. These can be pretty intense with throbbing pain in the forehead, temple, around one eye, or even in the jaw or ear, often accompanied by nausea or vomiting. There are no specific medical tests – no X-rays or other scans that identify headaches as migraines. Instead, doctors usually can make a diagnosis on the basis of a patient’s symptoms and medical history. CT scans are sometimes done to exclude the possibility that something else is causing the headaches.

Not all migraines are "classic" – you can have a migraine without an aura or accompanying nausea or vomiting. Once you’ve got a diagnosis, you can focus on prevention. As a start, keeping a diary of what she eats may enable your daughter to identify any foods that might trigger the headaches.

In women, migraines often occur with the hormonal changes prior to menstruation. Changes in weather, lack of sleep, stress, and skipping meals can all bring on the headaches. Neurologists who treat migraines recommend trying to maintain a regular daily routine in order to hold the headaches in check. They also recommend regular, aerobic exercise for at least 30 minutes three times a week to reduce frequency and severity.

Conventional medicine treats migraines with drugs called triptans. These drugs can relieve many migraines but are not free of side effects, some of which are serious.

Many alternative treatments are available, both to relieve and prevent migraines. A study published in the December 28, 2004, issue of Neurology found that patients who took two 75 mg tablets of the herb butterbur (Petasites hybridus) cut headache occurrence by an average of 48 percent (compared to 26 percent among patients who received a placebo). When buying butterbur, choose extracts guaranteed to be free of pyrrolizidine alkaloids (PAs), compounds that are toxic to the liver. Take butterbur with meals.

Another possibility is high-dose vitamin B-2. A Belgian study published in the February 1998 issue of Neurology found that 400 mg of B-2 reduces the frequency and duration of migraines. You’ll need a doctor’s prescription to get that dosage.

Biofeedback training can also help.

Andrew Weil, M.D.

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