Migraine headaches often involve severe pain in one side of the head, and are commonly accompanied by nausea, and sensitivity to light and sound. These headaches are thought to be vascular with constriction and then expansion of the vessels. Migraines occur in 28 million Americans, about 12% of the population with a ratio of 3:1 for females to males.
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4 Phases of a Migraine
A migraine attack usually has four phases:
- Premonitory symptoms. Symptoms of this phase include fatigue, lack of concentration, yawning, visual changes, neck pain. This phase may last from hours to days.
- Aura. The auras are usually a visual or sensory phenomenon, lasting minutes to an hour. These only occur in a small portion of people with migraines.
- Headache. The actual headaches have a gradual onset. First thing in the morning you will start to feel pain on one side of the head. The pain can start dull, then evolve into pulsating pain with jabs and jolts. 90% of sufferers also experience nausea and sensitivity to light, sound, and smells. Mood and mental awareness changes and neck pain are common.
- Postdrome. After the migraine, the postdromal period, involves fatigue, impaired concentration, irritability, and general pain and weakness.
The triggers for migraine headaches are numerous, and are partly dependent on the individual. All of the following can be triggers:
- Weather changes
- Caffeine withdrawal
- Sleep problems
- Certain foods including wine, MSG, nitrates, and aspartame
The correlation to a heart defect called a patent foramina ovale (PFO) is clear, but it is an association, not a cause, and fixing the heart defect sometimes does affect the migraines. In females, there is a correlation to hormonal changes, but regulating female hormones does not necessarily improve migraines.
Migraine Treatment Options
Migraine treatment includes a variety of medications depending on the severity and frequency of the headaches. First line medications include anti-inflammatories, combination analgesics like acetaminophen with caffeine, and sometimes nausea and seizure drugs. If the migraines are more severe but not more than once to twice a week, triptan type medications are often highly effective. The most common has been Imitrex and there are multiple similar drugs available.
Addictive medications like narcotics or benzodiazepines should be avoided since they are likely to cause increasing difficulties in management over time. When migraines become frequent, twice a week or more, seizure type medications and beta-blocker heart drugs may be effective. If the headaches become uncontrollable, sometimes intense interventions by Neurologists who just specialize in headache management is necessary.
Migraines & other Headaches
Migraines can also be mixed with other types of headaches, such as pain from the neck like whiplash or TMJ jaw problems. Treating headaches of mixed origins is often complex and needs a team of specialists and support staff including Neurologists, Pain specialists, physical therapists and psychologists to address the variety of problems these headaches cause.
If one has migraines, and simple treatment is not working, then a Neurologist and sometimes Pain specialists can be of great benefit. A team approach can often address the variety of factors impacting and contributing to the headaches.
Thomas Cohn, MD
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