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July 23, 1997, Vol 278, No. 4 >
ARTICLE | July 23, 1997

A 27-Year-Old Woman With Migraine Headaches FREE

K. M. A. Welch, MD
[+] Author Affiliations

This conference took place at the Medicine Grand Rounds of the Beth Israel Deaconess Medical Center, West Campus, Boston, Mass, on April 15, 1997.

Reprints: Erin E. Hartman, MS, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, East Campus, 330 Brookline Ave, LY318, Boston, MA 02215.

Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, and Jennifer Daley, MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA.


JAMA. 1997;278(4):322-328. doi:10.1001/jama.1997.03550040078041
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References

Dr Daley:  Mrs D is a 27-year-old married elementary school teacher with migraine headaches. She recently moved to Boston from the Midwest and works as a substitute teacher. Her health care insurance is through a commercial managed care plan. Her doctor, Dr N, practices in the primary care unit at Beth Israel Deaconess Medical Center.Mrs D has been in good health aside from migraine headaches since the age of 10 years. Her mother, brother, and a maternal aunt also have migraines. She has had "normal" computed tomographic scans and electroencephalograms. Her headaches begin with a prodrome she describes as a "weird feeling," then a headache follows over her right eye with nausea and vomiting. She has these headaches as frequently as 4 to 5 times a month, but recently she only gets them once a month prior to her menstrual period. In the summer of 1996, she began taking

REFERENCES

1 +
International Headache Society.  Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain . Cephalalgia . 1988;;8:1-96.
2 +
Welch KMA, Darnley D, Simkins RT.  The role of estrogen in migraine: a review and hypothesis . Cephalalgia . 1984;;4:227-236.
3 +
Somerville BW.  Estrogen-withdrawal migraine, I . Neurology . 1975;;25:239-244.
4 +
Breslau N, Davis GC.  Migraine, physical health and psychiatric disorders: a prospective epidemiologic study of young adults . J Psychiatr Res . 1993;;27:211-221.
5 +
Mathew NT.  Transformed migraine, analgesic rebound, and other chronic daily headaches . Neurol Clin . 1997;;15:167-186.
6 +
Tzourio C, Iglesias S. Hubert J-B, et al.  Migraine and risk of ischemic stroke: a case-controlled study . BMJ . 1993;;307:289-292.
7 +
Ottman R, Hong S, Lipton RB.  Validity of family history data on severe headache and migraine . Neurology . 1993;;43:1954-1960.
8 +
Stewart WF, Lipton RB, Celentano DD, Reed ML.  Prevalence of migraine headache in the United States . JAMA . 1992;;267:64-69.
9 +
Rasmussen BK,Olesen J.  Migraine with aura and migraine without aura:an epidemiological study . Cephalalgia . 1992;;12:221-228.
10 +
Linet MS, Stewart WF, Celentano DD, et al.  An epidemiologic study of headache among adolescents and young adults . JAMA . 1989;;261:2211-2216.
11 +
Lipton RB, Stewart WF.  Migraine in the United States: epidemiology and health care use . Neurology . 1993;;44( (suppl 3) ):6-10.
12 +
Stewart WF, Lipton RB.  Work related disability . Cephalalgia . 1966;;16:231-238.
13 +
Welch KMA.  Migraine: a biobehavioral disorder . Arch Neurol . 1987;;44:323 327.
14 +
Olesen J, Larsen B, Lauritzen M.  Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine . Ann Neurol . 1981;;9:344-352.
15 +
Woods RP, Iacoboni M, Mazziotta JC.  Bilateral spreading cerebral hypoperfusion during spontaneous migraine headache . N Engl J Med . 1994;;331:1689-1692.
16 +
Welch KMA, Gao Y, Aurora S, Vinkingstad E.  Functional MRI (fMRI) of visually triggered headache . Neurology . 1997;;48:A85.
17 +
Barkley GL, Tepley N, Nagel-Leiby S, Moran JE, Simkins RT, Welch KMA.  Neuromagnetic fields in migraine . Cephalalgia . 1990;;10:171-176.
18 +
Welch KMA, D'Andrea G, Tepley N, Barkley G, Ramadan NM.  The concept of migraine as a state of central neuronal hyperexcitability . Neurol Clin . 1990;;8:817-828.
19 +
Ophoff RA, Terwindt GM, Vergouwe MN, et al.  Familial hemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca+2channel gene CACNLIA4 . Cell . 1996;;87:543-552.
20 +
Moskowitz MA.  The neurobiology of vascular head pain . Ann Neurol . 1984;;16:157-168.
21 +
Goadsby PJ, Edvinsson L, Ekman R.  Release of vasoactive peptides in the extracerebral circulation of men and the cat during activation of the trigeminovascular system . Ann Neurol . 1988;;23:193-196.
22 +
Goadsby PJ, Edvinsson L.  Sumatriptan reverses the changes in calcitonin generelated peptide seen in the headache phase of migraine . Cephalalgia . 1991;;11( (suppl 11) ):3-4.
23 +
Moskowitz MA, Buzzi MG.  Neuroeffector functions of sensory fibers: implications for headache mechanisms and drug actions . J Neurol . 1992;;238( (suppl 1) ):518-522.
24 +
Saxena PR, Ferrari MD.  From serotonin receptor classification to the antimigraine drug sumatriptan . Cephalalgia . 1992;;2:187-196.
25 +
Weiller C, May A, Limmroth V, et al.  Brainstem activation in human migraine attacks . Nat Med . 1995;;1:658-660.
26 +
Welch KMA.  Drug therapy in migraine . N Engl J Med . 1993;;329:1476-1483.
27 +
Sorbi MJ, Tellegen B, Du Long A.  Long term effects of training in relaxation and stress coping in patients with migraine . Headache . 1989;;29:111-121.
28 +
Subcutaneous Sumatriptan International Study Group.  Treatment of migraine attacks with sumatriptan . N Engl J Med . 1991;;325:316-321.
29 +
The Oral Sumatriptan International Multiple-Dose Study Group.  Evaluation of a multiple-dose regimen of oral sumatriptan for the acute treatment of migraine . Eur Neurol . 1991;;31:306-313.
30 +
Ottervanger JP, Paalman HJA, Boxma GL, Stricker BHCh.  Transmural myocardial infarction after sumatriptan . Lancet . 1993;;341:861-862.
31 +
Visser WH,Jaspers NMWH, de Vriend RHM, Ferrari MD.  Risk factors for headache recurrence after sumatriptan . Cephalalgia . 1996;:16:264-269.
32 +
Tfelt-Hansen P, Johnson ES.  Ergotamine . In: Olesen J, Tfelt-Hansen P, Welch KMA, eds. The Headaches . New York, NY: Raven Press; 1993;:313-322.
33 +
Rapaport A, Weeks R, Sheftell F.  Analgesic rebound headache: theoretical and practical implications . Cephalalgia . 1985;;5( (suppl 3) ):448-449.
34 +
Tfelt-Hansen P, Lipton RB.  Miscellaneous drugs . In: Olesen J, Tfelt-Hansen P, Welch KMA, eds. The Headaches . New York, NY: Raven Press; 1993;:353-358.
35 +
Raskin NH.  Repetitive in intravenous dihydroergotamine as therapy for intractable migraine . Neurology . 1986;;36:995-997.
36 +
MacGregor EA.  Menstruation, sex hormones and migraine . Neurol Clin . 1997;;15:125-141.
37 +
DeLignieres B, Vincent M, Mauvais-Jarvis P, Mas JL, Touboul PJ, Bousser MG.  Prevention of menstrual migraine by percutaneous oestradiol . BMJ . 1986;;293:1540.
38 +
Herzog AG.  Continuous bromocriptine therapy in menstrual migraine . Neurology . 1997;;48:101-102.
39 +
Couch JR, Ziegler DK, Hassanein RS.  Amitriptyline in the migraine prophylaxis , Arch Neurol . 1979;;36:695-699.
40 +
Hering R, Kuritsky A.  Sodium valproate in the prophylactic treatment of migraine: double-blind study versus placebo . Cephalalgia . 1992;;12:81-84.
41 +
Silberstein SD.  Migraine and pregnancy . Neurol Clin . 1997;;15:209-231.
42 +
Welch KMA, Ramadan NM.  Mitochondria, magnesium and migraine . J Neurol Sci . 1995;;134:9-14.
43 +
Peikert A, Wilimzig C, Kohne-Volland R.  Prophylaxis of migraine with oral magnesium . Cephalalgia . 1996;;16:257-263.
44 +
Schoenen J, Jacquy J, Lenaerts M.  High-dose riboflavin is effective in migraine prophylaxis . Neurology . 1997;;48:A86-A87.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
International Headache Society.  Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain . Cephalalgia . 1988;;8:1-96.
2 +
Welch KMA, Darnley D, Simkins RT.  The role of estrogen in migraine: a review and hypothesis . Cephalalgia . 1984;;4:227-236.
3 +
Somerville BW.  Estrogen-withdrawal migraine, I . Neurology . 1975;;25:239-244.
4 +
Breslau N, Davis GC.  Migraine, physical health and psychiatric disorders: a prospective epidemiologic study of young adults . J Psychiatr Res . 1993;;27:211-221.
5 +
Mathew NT.  Transformed migraine, analgesic rebound, and other chronic daily headaches . Neurol Clin . 1997;;15:167-186.
6 +
Tzourio C, Iglesias S. Hubert J-B, et al.  Migraine and risk of ischemic stroke: a case-controlled study . BMJ . 1993;;307:289-292.
7 +
Ottman R, Hong S, Lipton RB.  Validity of family history data on severe headache and migraine . Neurology . 1993;;43:1954-1960.
8 +
Stewart WF, Lipton RB, Celentano DD, Reed ML.  Prevalence of migraine headache in the United States . JAMA . 1992;;267:64-69.
9 +
Rasmussen BK,Olesen J.  Migraine with aura and migraine without aura:an epidemiological study . Cephalalgia . 1992;;12:221-228.
10 +
Linet MS, Stewart WF, Celentano DD, et al.  An epidemiologic study of headache among adolescents and young adults . JAMA . 1989;;261:2211-2216.
11 +
Lipton RB, Stewart WF.  Migraine in the United States: epidemiology and health care use . Neurology . 1993;;44( (suppl 3) ):6-10.
12 +
Stewart WF, Lipton RB.  Work related disability . Cephalalgia . 1966;;16:231-238.
13 +
Welch KMA.  Migraine: a biobehavioral disorder . Arch Neurol . 1987;;44:323 327.
14 +
Olesen J, Larsen B, Lauritzen M.  Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine . Ann Neurol . 1981;;9:344-352.
15 +
Woods RP, Iacoboni M, Mazziotta JC.  Bilateral spreading cerebral hypoperfusion during spontaneous migraine headache . N Engl J Med . 1994;;331:1689-1692.
16 +
Welch KMA, Gao Y, Aurora S, Vinkingstad E.  Functional MRI (fMRI) of visually triggered headache . Neurology . 1997;;48:A85.
17 +
Barkley GL, Tepley N, Nagel-Leiby S, Moran JE, Simkins RT, Welch KMA.  Neuromagnetic fields in migraine . Cephalalgia . 1990;;10:171-176.
18 +
Welch KMA, D'Andrea G, Tepley N, Barkley G, Ramadan NM.  The concept of migraine as a state of central neuronal hyperexcitability . Neurol Clin . 1990;;8:817-828.
19 +
Ophoff RA, Terwindt GM, Vergouwe MN, et al.  Familial hemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca+2channel gene CACNLIA4 . Cell . 1996;;87:543-552.
20 +
Moskowitz MA.  The neurobiology of vascular head pain . Ann Neurol . 1984;;16:157-168.
21 +
Goadsby PJ, Edvinsson L, Ekman R.  Release of vasoactive peptides in the extracerebral circulation of men and the cat during activation of the trigeminovascular system . Ann Neurol . 1988;;23:193-196.
22 +
Goadsby PJ, Edvinsson L.  Sumatriptan reverses the changes in calcitonin generelated peptide seen in the headache phase of migraine . Cephalalgia . 1991;;11( (suppl 11) ):3-4.
23 +
Moskowitz MA, Buzzi MG.  Neuroeffector functions of sensory fibers: implications for headache mechanisms and drug actions . J Neurol . 1992;;238( (suppl 1) ):518-522.
24 +
Saxena PR, Ferrari MD.  From serotonin receptor classification to the antimigraine drug sumatriptan . Cephalalgia . 1992;;2:187-196.
25 +
Weiller C, May A, Limmroth V, et al.  Brainstem activation in human migraine attacks . Nat Med . 1995;;1:658-660.
26 +
Welch KMA.  Drug therapy in migraine . N Engl J Med . 1993;;329:1476-1483.
27 +
Sorbi MJ, Tellegen B, Du Long A.  Long term effects of training in relaxation and stress coping in patients with migraine . Headache . 1989;;29:111-121.
28 +
Subcutaneous Sumatriptan International Study Group.  Treatment of migraine attacks with sumatriptan . N Engl J Med . 1991;;325:316-321.
29 +
The Oral Sumatriptan International Multiple-Dose Study Group.  Evaluation of a multiple-dose regimen of oral sumatriptan for the acute treatment of migraine . Eur Neurol . 1991;;31:306-313.
30 +
Ottervanger JP, Paalman HJA, Boxma GL, Stricker BHCh.  Transmural myocardial infarction after sumatriptan . Lancet . 1993;;341:861-862.
31 +
Visser WH,Jaspers NMWH, de Vriend RHM, Ferrari MD.  Risk factors for headache recurrence after sumatriptan . Cephalalgia . 1996;:16:264-269.
32 +
Tfelt-Hansen P, Johnson ES.  Ergotamine . In: Olesen J, Tfelt-Hansen P, Welch KMA, eds. The Headaches . New York, NY: Raven Press; 1993;:313-322.
33 +
Rapaport A, Weeks R, Sheftell F.  Analgesic rebound headache: theoretical and practical implications . Cephalalgia . 1985;;5( (suppl 3) ):448-449.
34 +
Tfelt-Hansen P, Lipton RB.  Miscellaneous drugs . In: Olesen J, Tfelt-Hansen P, Welch KMA, eds. The Headaches . New York, NY: Raven Press; 1993;:353-358.
35 +
Raskin NH.  Repetitive in intravenous dihydroergotamine as therapy for intractable migraine . Neurology . 1986;;36:995-997.
36 +
MacGregor EA.  Menstruation, sex hormones and migraine . Neurol Clin . 1997;;15:125-141.
37 +
DeLignieres B, Vincent M, Mauvais-Jarvis P, Mas JL, Touboul PJ, Bousser MG.  Prevention of menstrual migraine by percutaneous oestradiol . BMJ . 1986;;293:1540.
38 +
Herzog AG.  Continuous bromocriptine therapy in menstrual migraine . Neurology . 1997;;48:101-102.
39 +
Couch JR, Ziegler DK, Hassanein RS.  Amitriptyline in the migraine prophylaxis , Arch Neurol . 1979;;36:695-699.
40 +
Hering R, Kuritsky A.  Sodium valproate in the prophylactic treatment of migraine: double-blind study versus placebo . Cephalalgia . 1992;;12:81-84.
41 +
Silberstein SD.  Migraine and pregnancy . Neurol Clin . 1997;;15:209-231.
42 +
Welch KMA, Ramadan NM.  Mitochondria, magnesium and migraine . J Neurol Sci . 1995;;134:9-14.
43 +
Peikert A, Wilimzig C, Kohne-Volland R.  Prophylaxis of migraine with oral magnesium . Cephalalgia . 1996;;16:257-263.
44 +
Schoenen J, Jacquy J, Lenaerts M.  High-dose riboflavin is effective in migraine prophylaxis . Neurology . 1997;;48:A86-A87.

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