Migraine Headaches

Learn About Migraines and How to Cope

It’s an understatement to say that migraine headaches are a common affliction. Consider the following:

• The American Migraine Foundation reports that around 36 million Americans suffer from migraine headaches—that’s about 12% of the total population.
• The Migraine Research Foundation estimates American employers lose $13 billion annually as a result of migraine-induced workplace absences.
• The World Health Organization estimates that 3,000 migraines occur each day per 1 million of the world’s population, which ranks migraines 19th globally among causes of years lived with disability.

By Michael E. Haskew

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What are migraines, exactly?

Medical professionals consider migraines to be a “syndrome,” or a collection of symptoms that arise from a common cause. Migraine headaches are characterized by intense pulsating or throbbing pain in a localized area of the head. They typically last four to 72 hours if left untreated. Some migraines are accompanied by sensitivity to light or sound, a visual aura such as a bright light or zigzag line, tingling in the extremities, nausea, vomiting, aversion to food, or light-headedness. Pain may increase steadily for a period of one to two hours and spread beyond the initial center of discomfort.

Sufferers of chronic migraines report 15 or more headaches per month, each with a duration of at least four hours. Depression, anxiety, and sleep disorders are sometimes associated with chronic migraines, as well as overuse of medication. Those with episodic migraines will have 14 or fewer in a given month.

A migraine sometimes occurs in four distinct stages.

Prodrome: The prodrome stage emerges one to two days prior to the onset of the headache. It may include subtle symptoms such as stiffness of the neck, irritability, hyperactivity, food cravings, diarrhea, depression, and constipation.

Aura: About one in five patients with migraines experiences a visual or sensory aura.  The aura stage usually lasts 10 to 30 minutes and includes  the gradual building of visual or sensory/motor disturbances, such as vision loss, flashes of light or bright shapes in the field of vision, a sensation of pins and needles in the arms and legs, or speech and language issues.

Attack: The attack stage may last up to three days. Symptoms include: pulsating or throbbing pain on one side of the head, nausea and vomiting, blurred vision, diarrhea, light-headedness, and sensitivity to light, sound, and odors.

Postdrome: During the postdrome stage, the headache subsides. Some patients experience a mild euphoric feeling. However, more often than not, patients experience a deep fatigue.

Theories and Triggers

Because migraines occur about three times more frequently in women than men, some theorize they may sometimes be linked to hormones like estrogen and to menstruation. Others think that migraines are related to interactions between the brainstem and the trigeminal nerve, which carries pain signals to the brain. The idea is that drops in levels of serotonin—a neurotransmitter that regulates pain in the nervous system—causes the trigeminal system to release neuropeptides, which can generate pain when they reach the tissue surrounding the brain.

According to the National Institutes of Health, migraines can be triggered by additional factors like caffeine withdrawal,
changes in sleep patterns, physical stress, missed or skipped meals, and smoking or exposure to smoke. Potential external triggers include bright lights, sunlight, perfumes or other strong aromas, certain medications, and pressure changes caused by the weather. Certain foods are also suspected to trigger migraines. The most common among these are processed, pickled, or marinated foods that contain the flavor enhancer monosodium glutamate (MSG).

Migraine sufferers who frequently take over-the-counter or prescription medications are believed to be susceptible to “rebound headaches.” A recent study reported in the New York Times suggests that as many as one-half of chronic migraines have been triggered by the overuse of pain medications, which can trigger another migraine event.

Relief and Prevention

If you experience regular migraines, consult a physician to determine the most effective course of treatment and prevention. While researchers are still unsure about what causes migraines, certain pain relieving drugs, preventive drugs, and lifestyle alterations can bring relief.

Pain relievers can be taken as soon as migraine symptoms emerge. For mild migraines, ibuprofen, acetaminophen, or aspirin may be effective. More severe migraines may require triptans, ergot, anti-nausea drugs, opiates, or dexamethasone. These can be administered orally, by injection, or through nasal spray or suppositories.

If you experience two or more migraines per month, or if pain relievers aren’t working, you may be a candidate for preventive drugs. Preventative drugs can reduce the severity of migraines and increase the effectiveness of symptom-relieving medicines. Preventative migraine medications include cardiovascular drugs used to control blood pressure, antidepressants, anti-seizure medications, antihistamines, and the introduction of the typically cosmetic treatment Botox, injected into the forehead and neck at 12-week intervals.

Lastly, lifestyle and alternative treatments such as acupuncture, biofeedback, manual therapy, and taking vitamins, minerals, or herbs may also be effective. Activities frequently suggested to help relieve pain include: relaxation in a dark, quiet space, listening to music, light gardening, muscle relaxation exercises, meditation, and yoga.


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