Migraines! (what more needs to be said?)

To continue our series on headaches we’re going to talk about migraines. Though I’m very prone to headaches, I don’t suffer from migraines. And from the stories I’ve heard, I’m one lucky guy.

Those who experience migraines will tell you the pain can last for hours, even days. Migraines may present a couple of times per year or multiple times in a month. As with many physical, emotional, and mental maladies; migraines often tip their hand in the form of auras, commonly described as flashes of light. Blind spots, tinging in the arms and legs, sugar cravings, drowsiness, irritability, depression, elevated mood, and thirst are also reported signs that trouble is just around the corner.

Here are the classic migraine symptoms…

  • Moderate to severe pulsating or throbbing pain, which may present on both sides of the head or just one
  • Pain worsens upon physical activity
  • Pain is sufficient to cause an interruption in one’s routine
  • Nausea and vomiting
  • Sensitivity to light and sound

Though no one knows exactly why migraines occur, it’s interesting that levels of the neurotransmitter, serotonin, drop during a migraine episode. And when this drop occurs it’s been suggested the trigeminal system (sensory innervation to the face and mucous membranes of the oral cavity, as well as motor innervation to the muscles of chewing) then begins to release neuropeptides; which travel to the meninges (the outer covering of the brain), causing severe head pain.

Here are some facts I believe you’ll find relevant and interesting…

The most common migraine triggers

  • Hormonal changes in women
  • The ingestion of beer, wine, aged cheeses, chocolate, aspartame, excessive caffeine, and monosodium glutatmate (MSG)
  • Skipping meals, fasting
  • Stress
  • Bright lights, sun glare, loud sounds, odd smells
  • Changes in wake/sleep pattern
  • Intense physical exertion
  • Meteorological changes
  • Medications

Things that make one more vulnerable to migraines

  • Family history, especially if both parents suffer from migraines
  • Being younger than 40 (50% of migraine sufferers report an onset prior to age 20. they most commonly present in folks ages 30-39)
  • Being female (sorry, but 3x more likely than men)
  • During times of hormonal change

In terms of treatment, the nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin may be helpful for minor migraine pain. The acetaminophen/aspirin/caffeine formulas may help with moderate pain. Of course, resting or sleeping in a dark and quiet place always helps.

But for severe migraine pain, and associated symptoms, the following have been used effectively

  • Triptans: sumatriptan (Imitrex), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova), eletriptan (Relpax), and a new single-tab formula of sumatriptan and naproxen sodium (Treximet)
  • Ergot: ergotamine (Migergot, Cafergot) – it’s much less expensive than the triptans, but also less effective. dihydroergotamine (Migranal) is an ergot derivative that’s more effective and has fewer side effects than ergotamine
  • Anti-nausea medications: metoclopramide (oral), prochlorperazine (oral or suppository)
  • Butalbital combinations: Butapap, Phrenlin Forte, Esgic-Plus, Fioricet
  • Opioids: codeine (only if the triptans or ergot don’t work)

It’s my understanding that after a few bouts with migraines one comes to know prevention makes a whole lot of sense. In addition to healthy lifestyle habits your physician may recommend various beta blockers, calcium channel blockers, antidepressants, anticonvulsants, antihistamines, and Botox. Also recommended are acupuncture, biofeedback, massage, herbs, vitamins, and minerals.

By the way, contact your physician or head to the E.R. if you experience…

  • Sudden onset “thunderclap” headache
  • Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness, or difficulty speaking
  • Headache after a head injury, especially if it gets worse
  • Chronic headache that worsens after exertion, coughing, straining, or sudden movement
  • New head pain if you’re 50+

Wow! That’s a ton of information. And more to come tomorrow on cluster headaches. As always, what I’ve provided is information, not recommendations. If you’re suffering from migraines, or are considering any of these remedies, please contact your physician for his/her input and direction.

We’d love to read about your experiences with migraines. You’re invited and encouraged to comment!