Migraines: Can you make my head stop pounding!?

by Rebecca A. Shatsky, MD 2011 | shatsky@myhousecallmd.com

What do Julius Caesar, Elvis Presley, Ben Affleck and Whoopi Goldberg have in common? And no, we’re not referring to their magnificent stage presence or iconic hairstyles (although that may be true).  According to historical documentation and popular media, all of these people, in addition to millions of others, are reported to have suffered from migraine headaches.  Although only receiving attention in the past few decades, the debilitating condition is thought to have affected humans since the beginning of time.  In addition to those listed above, famous migraine suffers of the past include Thomas Jefferson, Charles Darwin, Lewis Carroll and even Sigmund Freud.  In 1999, the prestigious medical journal, The Lancet, proposed that Lewis Carroll’s wonderfully bizarre characters from the novel In the Looking Glass may have come from migraine-induced hallucinations that he had been known to experience from time to time.  This is what we call turning lemons into lemonade.

What is a migraine?

First of all, a migraine is a really bad headache (yes, we realize you probably know this).  On the other hand, a headache is not necessarily a migraine.  Confused yet?  Do we sound like Lewis Carroll?  If you are, you’re not alone.  The term “migraine” itself is one of the most commonly misused terms in modern medicine by both doctors and patients alike.  Many sufferers of the disease claim the symptoms  (including severe, throbbing pain, usually located on one side of the head, which may be accompanied by nausea, vomiting and “tunnel vision”) are hard to mistake. However, these days, the term is often thrown around to describe severe headaches of all types.  Migraines themselves come in different shapes and sizes. They can last from several hours to days, can begin as early as childhood or as late as menopause (in women, of course) and vary from person to person.  That being said, here is a breakdown of the most common types:

1. Migraine with Aura:

This variety, otherwise known as the “classic migraine,” involves the previously described pulsatile, unilateral headache.  This variety also comes with a constellation of neurological symptoms that begin 10-30 minutes before the onset of the headache, known as the “migraine aura.”  The aura is most often visual and may include seeing bright lights in your peripheral vision, seeing wavy images or a complete vision loss (scary but not necessarily dangerous).  There are also non-visual auras that can include weakness, speech abnormalities, vertigo and numbness.

2. Migraine without Aura:

This type of migraine is not preceded by any of the neurologic symptoms described above.  Migraines, both with and without aura, may be accompanied by nausea, vomiting and sensitivity to light and noise.  Migraine without aura is actually more common than migraine with aura.

3. Menstrual Migraine:

Gents, you get to sit this round out.  Some women experience migraines just prior to the start of their period.  These migraines occur with or without aura and are related to changes in hormone levels.  On a more positive note, they often get better or disappear completely during pregnancy…probably not the most efficient treatment plan but always an option.

What causes migraines?

The jury is still out regarding the exact cause of migraine headaches.  Nevertheless, current research asserts that migraines are caused by dilation of the blood vessels in the head (causing the throbbing sensation) and an activation of various “nuclei” in the brain (which causes the intense pain) (Note: “nuclei” are clusters of cells in the brain…different nuclei than you studied in 6th grade science class).  Imaging studies have also discovered significant changes in blood flow to the affected area of the brain preceding and at the onset of the migraine.  Essentially, the blood flow regulation in your brain temporarily goes haywire causing that classic throbbing sensation.  In addition, there is data to support a genetic predisposition that makes certain people and families more likely to suffer from migraines than others. There are also many well-known stimuli that can trigger migraines in those predisposed to the disease. Some common triggers include:

  • Lack of, or too much sleep (if there is such a thing as “too much” sleep)

  • Specific foods (chocolate or coffee)

  • Bright lights

  • Changes in weather or humidity

  • Hormones/ oral contraceptive pills

What can we do to avoid migraines and treat them when they occur?

The best course of action is to identify your personal migraine triggers and avoid them.  Much like allergies, migraine headaches are easier to prevent than they are to treat once they’ve begun.  Yes, we realize that this is easier said than done.  If you do experience a migraine, the best thing to do is treat it as soon as possible before the pain progresses.  While migraine headaches are not generally thought to be dangerous to the vascular or neurologic systems (there is some debate about possible increased stroke risk) treating the pain early could mean avoiding a full-blown attack.  For some people, treatment may be as simple as lying down in a quiet, dark room or taking an over-the-counter pain medication such as Tylenol, Advil or Aleve. Excedrin is also a popular choice because it contains a combination of caffeine (which works to constrict pulsating blood vessels) and the active ingredient in Tylenol (acetaminophen). Definitely check out the names of the active ingredients in over-the-counter medication for treating pain and those labeled specifically for the treatment of migraine headaches.  Often there is a noteworthy difference in price and no difference in active ingredients!


For those who do not respond to over-the-counter medications, prescription medication may be necessary. There are several preparations of prescription migraine treatment.  Those most commonly prescribed are: Imitrex (sumatriptan), Maxalt (rizatriptan), Cafergot (ergotamine + caffeine) and Topamax (topiramate). However there are literally dozens are medications approved (and used off label) for treatment of migraines (even Botox injections!!) and it may be necessary to try several different treatment options before finding one that works for you.

It is currently estimated that over 45 million Americans suffer from migraines.  While the idea of a headache so severe that it causes vomiting and vision loss may seem like a terrifying medical emergency to some people, for millions of Americans this type of devastating headache is a very painful and frequent reality.  If you do suffer from migraines, don’t lose hope!  Physicians and scientists are making great strides in the prevention and treatment of the disease, with new treatment options and support for migraine suffers being discovered daily.

Questions? E-mail the author: shatsky@myhousecallmd.com

References

1. Aminoff Michael J, Kerchner Geoffrey A, “Chapter 24. Nervous System Disorders” (Chapter). McPhee SJ, Papadakis MA, Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010: http://www.accessmedicine.com/content.aspx?aID=12507.

2. Bajwa ZH, et al. Pathophysiology, clinical manifestations, and diagnosis of migraine in adults. http://www.uptodate.com/home/index.html. Accessed May 19, 2010.

3. Migraine. National Headache Foundation. http://www.headaches.org/education/Headache_Topic_Sheets/Migraine. Accessed May 19th, 2010.

4.  National Migraine Association. http://www.migraines.org/myth/mythgood.htm. Accessed May 21st, 2010

5. Podoll, Klaus, and Derek Robinson. “Lewis Carroll’s Migraine Experiences.” The Lancet 353.9161 (1999): 1366.

6. Shuhendler AJ et al. “Efficacy of botulinum toxin type A for the prophylaxis of episodic migraine headaches: a meta-analysis of randomized, double-blind, placebo-controlled trial

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