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Since the previous major survey in 2001, U.S. migraine prevalence was unchanged: 1-year female prevalence was 17.1% and male prevalence, 5.6%. Prevalence was higher in whites than blacks. There was a striking inverse relation between family income and migraine prevalence. Most respondents with migraine had 1 to 4 attacks per month, and >50% had severe impairment during headaches.

So, what does all this mean? Well, really nothing I just figured all the statistics would impress you! Did it? Well, good!! 😉

Migraine headaches can be a very debilitating illness, which seems to be prevalent in the United States. As a health care provider, it can be a very frustrating illness to treat. As a sufferer, it too can be very frustrating. Unless you have experienced a migraine, you truly don’t understand the pain. I can honestly say I have only had a few, but it is very frightening. I have experienced the vision changes, as well as the auditory aura (sounds) prior to the onset of the headache.

What is a Migraine?

A migraine headache can cause intense throbbing or pulsing in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down.

Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots or tingling in your arm or leg.

Migraine Triggers:

Migraine headache triggers
Whatever the exact mechanism of the headaches, a number of things may trigger them. Common migraine triggers include:

  • Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications — such as oral contraceptives and hormone replacement therapy — also may worsen migraines, though some women find it’s beneficial to take them.
  • Foods. Some migraines appear to be triggered by certain foods. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; aspartame; overuse of caffeine; monosodium glutamate — a key ingredient in some Asian foods; salty foods; and processed foods. Skipping meals or fasting also can trigger migraine attacks.
  • Stress. Stress at work or home can instigate migraines.
  • Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Unusual smells — including pleasant scents, such as perfume, and unpleasant odors, such as paint thinner and secondhand smoke — can also trigger migraines.
  • Changes in wake-sleep pattern. Either missing sleep or getting too much sleep may serve as a trigger for migraines in some individuals, as can jet lag.
  • Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
  • Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
  • Medications. Certain medications can aggravate migraines, especially oral contraceptives and vasodilators, such as nitroglycerin.

Symptoms of a Migraine:

Migraine headaches often begin in childhood, adolescence or early adulthood. Migraines may progress through four stages — prodrome, aura, attack and postdrome — though you may not experience all the stages.

Prodrome
One or two days before a migraine, you may notice subtle changes that may signify an oncoming migraine, including:

  • Constipation
  • Depression
  • Diarrhea
  • Food cravings
  • Hyperactivity
  • Irritability
  • Neck stiffness

Aura
Most people experience migraine headaches without aura. Auras are usually visual but can also be sensory, motor or verbal disturbances. Each of these symptoms typically begins gradually, builds up over several minutes, and then commonly lasts for 10 to 30 minutes. Examples of aura include:

  • Visual phenomena, such as seeing various shapes, bright spots or flashes of light
  • Vision loss
  • Pins and needles sensations in an arm or leg
  • Speech or language problems

Less commonly, an aura may be associated with aphasia or limb weakness (hemiplegic migraine).

Attack
When untreated, a migraine typically lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or much less frequently. During a migraine, you may experience some of the following symptoms:

  • Pain on one side of your head
  • Pain that has a pulsating, throbbing quality
  • Sensitivity to light, sounds and sometimes smells
  • Nausea and vomiting
  • Blurred vision
  • Diarrhea
  • Lightheadedness, sometimes followed by fainting

Postdrome
The final phase — known as postdrome — occurs after a migraine attack, when you may feel drained and washed out, though some people report feeling mildly euphoric.

When Should I See A Health Care Provider?

This is a very important question, as headaches are not to be taken lightly!

Migraine headaches are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your health care provider to discuss your headaches and decide on a treatment plan.

Even if you have a history of headaches, see your health care provider if the pattern changes or your headaches suddenly feel different.

See your health care provider immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems:

  • An abrupt, severe headache like a thunderclap
  • Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
  • Headache after a head injury, especially if the headache gets worse
  • A chronic headache that is worse after coughing, exertion, straining or a sudden movement
  • New headache pain if you’re older than 50

Diagnosing Migraines:

If you have typical migraines or a family history of migraine headaches, your health care provider will likely diagnose the condition on the basis of your medical history and a physical exam. But if your headaches are unusual, severe or sudden, your health care provider may recommend a variety of tests to rule out other possible causes for your pain.

  • Computerized tomography (CT). This imaging procedure uses a series of computer-directed X-rays that provides a cross-sectional view of your brain. This helps health care providers diagnose tumors, infections and other possible medical problems that may be causing your headaches.
  • Magnetic resonance imaging (MRI). MRIs use radio waves and a powerful magnet to produce very detailed cross-sectional views of your brain. MRI scans help health care providers diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.
  • Spinal tap (lumbar puncture). If your health care provider suspects an underlying condition, such as meningitis — an inflammation of the membranes (meninges) and cerebrospinal fluid surrounding your brain and spinal cord — he or she may recommend a spinal tap (lumbar puncture). In this procedure, a thin needle is inserted between two vertebrae in your lower back to extract a sample of cerebrospinal fluid (CSF) for laboratory analysis.

Treating Migraines:

It is important to make a plan with your health care provider for treating migraines. Often, migraines can be treated with medications when you have an onset of the headache. If your headaches are more frequent, it may be important to take medications to prevent them.

Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine. It may help if you rest or sleep in a dark room after taking them:

  • Pain relievers. These medications, such as ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may help relieve mild migraines. Drugs marketed specifically for migraines, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraine pain but aren’t effective alone for severe migraines. If taken too often or for long periods of time, these medications can lead to ulcers, gastrointestinal bleeding and rebound headaches. The prescription pain reliever indomethacin may help thwart a migraine headache and is available in suppository form, which may be helpful if you’re nauseous.
  • Triptans. For many people with migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea, and sensitivity to light and sound that are associated with migraines. Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), zolmitriptan (Zomig), frovatriptan (Frova) and eletriptan (Relpax). Side effects of triptans include nausea, dizziness and muscle weakness. They aren’t recommended for people at risk for strokes and heart attacks. A single-tablet combination of sumatriptan and naproxen sodium (Treximet) has proved more effective in relieving migraine symptoms than either medication on its own.
  • Ergot. Ergotamine and caffeine combination drugs (Migergot, Cafergot) are much less expensive, but also less effective, than triptans. They seem most effective in those whose pain lasts for more than 48 hours. Dihydroergotamine (D.H.E. 45, Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine. It’s also available as a nasal spray and in injection form.
  • Anti-nausea medications. Because migraines are often accompanied by nausea, with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications are metoclopramide (Reglan) or prochlorperazine (Compro).
  • Opiates. Medications containing narcotics, particularly codeine, are sometimes used to treat migraine headache pain when people can’t take triptans or ergot. Narcotics are habit-forming and are usually used only as a last resort.
  • Dexamethasone. This corticosteroid may be used in conjunction with other medication to improve pain relief. Because of the risk of steroid toxicity, dexamethasone should not be used frequently.

Preventive medications
You may be a candidate for preventive therapy if you have two or more debilitating attacks a month, if pain-relieving medications aren’t helping, or if your migraine signs and symptoms include a prolonged aura or numbness and weakness.

Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks. Your health care provider may recommend that you take preventive medications daily, or only when a predictable trigger, such as menstruation, is approaching.

In most cases, preventive medications don’t eliminate headaches completely, and some cause serious side effects. If you have had good results from preventive medicine and have been migraine-free for six months to a year, your health care provider may recommend tapering off the medication to see if your migraines return without it.

For best results, take these medications as your health care provider recommends:

  • Cardiovascular drugs. Beta blockers — commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. The beta blocker propranolol (Inderal La, Innopran XL, others) has proved effective for preventing migraines. Calcium channel blockers, another class of cardiovascular drugs, especially verapamil (Calan, Verelan, others), also may be helpful in preventing migraines and relieving symptoms from aura. In addition, the antihypertensive medication lisinopril (Zestril) has been found useful in reducing the length and severity of migraines. Researchers don’t understand exactly why these cardiovascular drugs prevent migraine attacks. Side effects can include dizziness, drowsiness or lightheadedness.
  • Antidepressants. Certain antidepressants are good at helping to prevent some types of headaches, including migraines. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil) are often prescribed for migraine prevention. Tricyclic antidepressants may reduce migraine headaches by affecting the level of serotonin and other brain chemicals, though amitriptyline is the only one proved to be effective for migraine headaches. You don’t have to have depression to benefit from these drugs. Other classes of antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) haven’t been proved as effective for migraine headache prevention. However, preliminary research suggests that one SNRI, venlafaxine (Effexor, Venlafaxine HCL), may be helpful in preventing migraines.
  • Anti-seizure drugs. Some anti-seizure drugs, such as valproate (Depacon), topiramate (Topamax) and gabapentin (Neurontin), or the long-acting form of Neurontin – Gralise seem to reduce the frequency of migraines. Lamotrigine (Lamictal) may be helpful if you have migraines with aura. In high doses, however, these anti-seizure drugs may cause side effects, such as nausea and vomiting, diarrhea, cramps, hair loss, and dizziness.
  • Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
  • Botulinum toxin type A (Botox). The FDA has approved botulinum toxin type A for treatment of chronic migraine headaches in adults. During this procedure, injections are made in muscles of the forehead and neck. When this is effective, the treatment typically needs to be repeated every 12 weeks.

Don’t take a sudden migraine for granted, but learning to deal with them is vital!

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