Migraine with aura has a particular set of symptoms that the patient regularly experiences before the onset of the headache. These include either visual or sensory symptoms. Migraine with aura has specific criteria, including the following:
■ Headache that has the same elements as migraine without aura
■ Presence of aura
■ No permanent effects of the headache once the postdrome occurs
Menstrual migraine headaches are a women's pain syndrome that affects 50% to 60% of female migraine patients (Brandes, 2006). Menstrual migraine may occur with or without aura, but for purposes of classification, the International Headache Society describes menstrual migraine as a migraine headache without aura. In addition, the menstrual migraine occurs exclusively on day 1+/-2 of menstruation in at least 2 of 3 menstrual cycles (Silberstein et al., 2005). The cause of menstrual migraine is the variation in estrogen levels that normally occur with the menstrual cycle.
Treatment options for migraine headache include the use of nonpharmacologic treatments thought to reduce pain by 35% to 50%, such as:
■ Biofeedback therapy
■ Cognitive behavioral therapy
Medication options include:
■ Abortive: triptan medication, nonsteroidal anti-inflammatory drugs, ergotamine, dihydroergotamine, butorphanol tartrate, Midrin, Fiorinal
■ Prophylaxis: amitriptyline, propranolol, timolol, divalproex sodium, methylsergide
■ Treatment: Moderate symptoms can be helped with triptan medications, such as sumatriptan, but use caution with patients who have uncontrolled hypertension or coronary artery disease. Opioids should be reserved for severe pain, coupled with medications such as metoclopramide for nausea and vomiting.
Thiere are mixed reviews on the use of oral contraceptives and botu-linum toxin injection. Oral contraceptives can worsen the migraine headaches in younger women (MyMigraineConnection.com, 2006). The recommendation for botulinum toxin injections is mixed. ASPMN (2009) makes the recommendation to use the injections, but the the U.S. Food and Drug Administration has issued a warning for botulinum toxin injections, because there is the potential for the injection to spread beyond the desired location.
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