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House Calls / Treating migraine headaches / By Dr. Michael Schwartz

Published 5:53 pm, Friday, November 9, 2012
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A migraine is a chronic disorder defined primarily by recurrent unilateral headaches that are often severe and debilitating. Patients who suffer from migraine headaches often describe an "aura" before they occur. It may include flashing lights, visual disturbances, unusual smells, numbness or difficulty with speech. Although only about a third of migraine sufferers will describe an aura, it is important to identify these early subtle symptoms to rapidly diagnose and treat the syndrome.

Migraine headaches are thought to be caused by abnormal chemical levels in the brain resulting in a dilatation (or widening) of the vessels that supply blood to the brain. This change in blood flow often results in inflammation, which leads to the throbbing and severe pain associated with the condition. Patients may initially exhibit non-specific (i.e. unusual) symptoms referred to as the "prodrome" hours or even days before the migraine occurs. These might include fatigue, depression, aversion to or cravings for certain foods, changes in bowel habits or even unusual neurologic sensations. However, not all patients will suffer these symptoms.

Furthermore, not all sufferers will actually have the headache. Many individuals will have only the prodrome and aura, which may in its own way affect how they feel. Nonetheless, all the associated symptoms can be quite debilitating.

Once a migraine headache occurs, it can last several hours to a day or two. It may be accompanied by nausea, vomiting, light sensitivity, severe weakness and dizziness. Patients with these symptoms report such severe pain that they often need to visit the local emergency room for treatment. Migraines are a common cause of absence from work.

Migraines tend to be genetically inherited. They are more common between the ages of 30 and 50, and 75 percent of those affected are women. Although it's rare, even children can suffer from migraine headaches.

Triggers

Hormones -- Birth control medications and hormone replacement therapy can cause the disorder.

Foods -- Certain foods can increase the risk of migraines. However, these triggers differ from person to person. There is some evidence that low-fat diets may reduce the risk. Foods containing Tyramine (e.g. cheese, alcohol, chocolate, nuts) and certain additives, such as nitrates, may increase the risk as well.

Smells -- Perfumes, colognes and strong odors may bring on migraines.

Dehydration -- Inadequate fluid intake may increase risk.

Miscellaneous -- Bright lights, loud noises, smoking and stress increase the risk as well.

Treatment

A class of medications known as "Triptans" is the most common treatment for migraine headaches. If taken within 20 to 30 minutes of the onset of the symptoms (when the aura might occur), these medications are quite effective in preventing or minimizing the migraine.

Antidepressants have been shown to help alter the chemical imbalance in the brain and may decrease the frequency or severity of the disorder.

Anti-seizure medications are commonly used "off-label" (not the intended use) to reduce the likelihood of the headache occurring.

Blood pressure medications have been shown to reduce the risk of migraines by both reducing blood pressure to the brain and minimizing the effect of stress on the body.

Pain medicines with acetaminophen, aspirin and caffeine are often used. If the pain becomes severe, codeine derivatives may be prescribed. These medications are effective but can lead to dependence when overused.

Botox injections can be administered into the muscles of the scalp and neck to treat migraines.

Acupuncture has been shown to be an effective alternative in some patients

Exercise in moderation may decrease attacks. However, vigorous exertion may actually trigger an attack in some patients.

It is reported that more than 30 million Americans suffer from migraine headaches. However, not all severe headaches are caused by migraines. Headaches in general can indicate other entities including stress and tension, high blood pressure, sinus infections, temporal mandibular joint dysfunction, vision issues, spinal infections, muscle spasm and/or serious brain disorders.

If you develop a severe headache, visit your physician or hospital immediately. On rare occasions, it could be an indicator of a more severe problem.

Headaches can be a real pain; but simple treatments can help alleviate your suffering.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, visit his website at www.drmichaelbschwartz.com.