Symptoms: Warning signs develop, which may include visual disturbances or numbness in the arm or leg. Warning symptoms subside within 30 minutes followed by severe pain.
Precipitating Factors: There is a hereditary component. Other factors include certain foods; the Pill or menopausal hormones; excessive hunger; changes in altitude; weather; lights; excessive smoking; and emotional stress.
Treatment: At the earliest onset of symptoms, treat using biofeedback, ergotamine, dihydroergotamine, or a 5-HT agonist. Once the pain has begun, treat with: ice packs; isometheptene; mucate; combination products containing caffeine; ergotamine; DHE injectable and nasal spray; 5-HT agonists; analgesics or medications, which constrict the blood vessels. Steroids may be helpful for prolonged attacks.
Prevention: Biofeedback; beta-blockers (propranolol, timolol); anti-convulsant (divalproex sodium); calcium blockers; and NSAIDs. CGRP monoclonal antibodies were recently approved for prevention.