Keys to Successful Headache Management
You anticipate a productive day. Your task list pulses with urgency. You jump into your schedule, but pain taps your temples and flashes across your forehead, your vision blurs, you feel weak and your thought-processes become sluggish. Your resolve to cross tasks off your to-do list quickly weakens.
You have a headache.
By Tawnee Stimson
According to the National Headache Foundation, 45 million Americans suffer with chronic headaches. There are over 150 diagnostic headache categories, the most common being a tension headache caused by muscle contractions experienced as a result of stress, poor posture or eye strain. Another common headache is caused by pressure within the sinus cavities: the frontal, maxillary, ethmoid or sphenoid. Sinus cavities can become affected by pollen – especially in the Tennessee Valley, which is home to more than 300 varieties of trees and 900 types of wildflowers.
Of all the types of headaches, one of the most debilitating is the migraine. The New England Journal of Medicine characterizes a migraine attack as a neurovascular disorder that involves serious head pain as well as involvement of the autonomic nervous system. There are two types of migraine headaches: those experienced with flashing lights, known as auras, and those without. Researchers who have studied brain images of people experiencing an aura suggest that an aura is an electrical phenomenon involving nerves in the brain.
Although the exact cause of migraines is unknown, more than 28 million Americans suffer from migraines each year. Women are three times more likely than men to have a migraine, the exacerbation of which is tied to estrogen levels. To further this theory, migraines often begin at puberty and decrease, or stop entirely, with menopause.
The Mayo Clinic hypothesizes that the migraine event is brought about by changes within the trigeminal nerve, which is a major pain pathway of the nervous system, and may be stimulated by imbalances in brain chemistry. Studies suggest that serotonin, which acts as a pain moderator, may be a link. When a migraine strikes, serotonin levels drop and the trigeminal nerve releases substances called neuropeptides. The neuropeptides travel to the brain’s outer covering (meninges) and the blood vessels dilate and become inflamed.
In addition to being disabling, migraines can be associated with serious health issues. Twenty-seven percent of all strokes in individuals less than 45 years of age coincide with migraine attacks. Twenty-five percent of cerebral infarctions are associated with migraine pain. Additionally, ischemic strokes can be aggravated by or associated with migraine onset.
Diagnosing Migraines Key to Treatment
Dr. Yuchan “Charles” Han, a neurologist and pain management specialist at the Chattanooga Neurology & Headache Center, stresses that individuals with severe, recurring headaches should undergo diagnostic evaluations and not assume that headaches are migraines. Dr. Han says an accurate diagnosis is critical for effective pain management.
Typical migraine diagnostics include a family history – as genetics play a role – and a physical exam. However, if a headache has an unusual onset – such as sounding like a clap of thunder – or is not responding to migraine treatment, other tests may be recommended.
Computerized tomography (CT) is a procedure that may be used for diagnosing migraines. CT produces a series of computer-directed X-rays that provide a cross-sectional view of the brain. Magnetic resonance imaging (MRI) is another procedure that uses radio waves and a powerful magnet to produce an even more detailed cross-sectional view of the brain, as well as the blood vessels that supply the brain. A spinal tap, or lumbar puncture, may also be administered to determine any possible underlying conditions, such as meningitis or subarachnoid hemorrhage.
Four Phases of a Migraine
Following a migraine diagnosis, familiarity with the four distinct phases of the migraine event can help minimize an attack.
• The prodrome phase can occur hours or days before the migraine itself. The body may begin to feel tight and symptoms may include gastrointestinal disorders or other primary disruptions.
• The aura phase typically begins 15 to 30 minutes before the pain. Symptoms may include the appearance of blinking lights, blind spots or visual zigzags.
• The migraine attack follows. Pain explodes, accompanied by vomiting and extreme sensitivity to light and sound. This is best endured in a darkened, quiet room.
• The postdrome phase follows immediately after the migraine. This phase can include dizziness, confusion and weakness that linger up to 24 hours following the attack. A migraine can last anywhere from four to 72 hours, without a pattern of recurrence.
Migraine Diary an Important Tool
A diary is an important tool for establishing the what, when and how of migraine episodes. Once you have sufficiently recovered from your postdrome phase, reconstruct the 12 to 24 hours prior to your episode. Write down anything you consumed. Note any physical symptoms. Record substances you may have inhaled, including fragrances. Recall how much you slept. Since a nine-degree change in temperature or a drop in barometric pressure can increase the chances of a migraine attack, research the weather patterns (weather.org) and write them down. Note any unusually stressful or exciting events in your life. For women, chart the number of days from the start of your last period to pain onset.
To establish migraine patterns, information should be added to the diary after each episode. Once you have the comparative data, you can determine precursors to the migraine onset in order to lessen or, hopefully, prevent the next attack.
Food and Supplements
Certain foods are known migraine-inducers and should be consumed with caution: nitrates, found in many hot dogs and luncheon meats; tyramines, found in aged cheese, soy products, fava beans, hard sausage and smoked fish; aspartame, marketed under names such as NutraSweet® and Equal®; as well as MSG, red wine, chocolate and beer.
As for pharmaceutical intervention, the primary prescriptions used today are classified as preventative and abortive. Preventatives are often taken daily, while abortives interrupt the pain cycle and lessen the severity once the migraine has started.
In addition to medications, Neurology® reports that riboflavin (vitamin B-2) has been shown to help prevent migraines, as has magnesium, Coenzyme Q10 and the herbs feverfew and butterbur. Biofeedback and relaxation techniques, such as meditation or yoga, have additionally proven effective.
For optimum results, partner with your physician to create a preventative regime and discuss all options, triggers and cyclic issues that affect your migraine attacks.
A migraine can seem like an ambush out of nowhere. “Education and empowerment are the keys to successful migraine management,” says Dr. Richard Lipton of the Albert Einstein College of Medicine at Yeshiva University in New York. “Patients who understand their disease, identify triggers, and learn to use both behavioral strategies and medication effectively, can dramatically reduce their burden of illness.”
Tawnee Stimson has lived in the Chattanooga area for 28 years. She studied psychology and screenwriting at the University of Arizona and UCLA respectively. She is the President of Tawnee Stimson Designs and Essence in a Bucket Greeting Cards.