Local Doctors Help Make Sense of the Pain of Migraines
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June is National Migraine Awareness Month, bringing attention to a condition the World Health Organization lists as one of the 20 most disabling illnesses on earth—one that affects 36 million Americans.
What is a migraine?
“[A] migraine is one of the most common types of headaches,” says Dr. Asad Chaudhary, MD, neurologist with Mercy Medical Group. “It occurs three times more commonly in females than men,” and lasts between 4-72 hours. It has at least two of the following symptoms: “Pain on one side of the head, throbbing sensation, moderate to severe intensity, nausea/vomiting, sensitivity to light or sound and pain [that] worsens with routine physical activity,” says Nancy J. Coombes, RN, BSN, neurology/neurosurgery manager at Kaiser Permanente, Sacramento and Roseville Medical Centers. While they typically don’t occur every day, migraines tend to be recurrent over time.
“Migraines often have certain triggers that set them off, such as eating or drinking a specific item, weather or altitude change, lack of sleep, stress or exhaustion,” says Dr. Amer Khan, MD, pediatric neurologist and sleep specialist with Sutter Medical Group. “Hormonal changes, puberty, pregnancy and menopause are often implicated in women.” Other triggers can include exercise and caffeine overuse. Coombes cites processed meats, ripened cheeses, avocado, breads made with yeast and chocolate as possible food triggers; eliminating these foods one by one may help determine which, if any, are triggers.
Explaining the Aura
Before migraines start, during the “prodrome” stage, many patients may experience moodiness, fatigue and changes in taste or smell. Some patients experience symptoms that are similar to strokes, such as difficulty speaking, weakness or numbness, an upset stomach or a feeling of a heavy head or confusion. Others see flashing lights and have tunnel vision. “These symptoms are often considered to be ‘an aura’ of the migraine and can occur just before or after head pain appears, and only last a short time,” Dr. Khan says.
Headache expert Dr. Marc Lenaerts, MD, FAHS, and associate professor of clinical neurology at UC Davis, says there are four pillars of migraine treatment: proper lifestyle, abortive therapy, rescue therapy, and prophylactic therapy. He says migraine sufferers need regular sleep, regular physical activity, avoidance of weight excess, stress management and avoidance of food triggers.
Abortive therapy refers to medications that can be taken up to two days per week to relieve symptoms. “Triptans are the mainstay of such treatment and specific for migraines and may reduce the pain, nausea and vomiting, and sensitivity to light and noise,” he says, explaining patients can also take “any medication that reduces inflammation or pain in a less specific way” such as Ibuprofen. “Combination medications like Excedrin, Fioricet and Fiorinal can also be used,” says Dr. Chaudhary, cautioning patients not to use abortive medications more that 8-10 days per month “to avoid development of medication-overuse headaches.”
If abortive treatment doesn’t work, rescue therapy, or the use of a stronger painkiller such as opioids or IV treatment, may be used once a month or so, according to Dr. Lenaerts.
Prophylactic therapy, which is typically done for a few months until the patient has one or fewer weekly migraines, includes taking medications daily to reduce the frequency of symptoms.
“Multiple Botox injections in the scalp have also been found to be effective,” says Dr. Khan, noting, “Anti-anxiety medicines are sometimes used to help with the severe distress caused by the pain, and may help the person ‘sleep the headache off.’”
Alternative Treatment Options
“Complementary or alternative approaches can also offer relief,” says Rosie McNeilly, a California licensed acupuncturist (LAc) of El Dorado Community Acupuncture (EDCA). “Studies show that acupuncture decreases the frequency and severity of migraine attacks, often outperforming educations.”
Naturopathic Doctor George Hudson, ND, MS, suggests patients first log and track the circumstances related to their migraines to identify triggers. “Once these are identified, primary prevention is the avoidance of triggers,” he says, noting for treatment, natural solutions include herbs like feverfew and butterbur; “promising data on butterbur shows that when taken daily for 8-10 weeks migraine frequency declines.”
Dr. Hudson also recommends stress-management techniques like relaxation breathing and meditation, as well as Chinese medicine of herbs, acupuncture and homeopathy. These “methods of treatment focus on modifying the patient’s ‘internal terrain’ so to speak,” he says. “The purpose is increase general well-being and reduce susceptibility; like most of the other treatments, some patients report improvements, while others do not.”
Alternative therapies can include “cranial therapy, neuromuscular therapy, myofacial therapy, spinal manipulation, acupuncture, biofeedback and relaxation therapies,” says Michael A. Clifford, neuromuscular/cranialsacral therapist at Hands on Healer, noting these therapies are often used with mainstream treatment and prescriptions. As Clifford explains, “the focus has been to reduce symptoms and reduce frequency of attacks.” With cranial therapy, for example, the therapist uses light touch to assist the natural movement of fluid in the membranes surrounding and protecting the brain and spinal cord.
Acupuncture is another treatment option, says McNeilly, noting with regular treatment, most patients have significant migraine improvements. “Acupuncture treatments are customized for each patient’s unique presentation, with some points used more for symptom relief and others to address the underlying pattern of imbalance in the body,” she says.
Headache vs. Migraine
Tension headaches can last from 30 minutes to seven days with symptoms like a feeling of “a tight band squeezing around the head, tension or pain in neck and shoulders moving into the back of the head, aching and tightness in the forehead or temples,” says Coombes, explaining tension headaches can also be chronic, occurring 15 or more days a month.
She says while people who don’t suffer from migraines can get chronic daily headaches, the chronic pain can result from overuse of medication, resulting in “rebound headaches.”
How can you tell if your headaches are actually migraines? You need to track your pain levels and symptoms, including how long each headache lasts, headache frequency and any headache patterns. “Keeping a journal of when the headaches occur, including food intake, activity, stressors, and a description of the headache will aid in both the diagnosis and treatment of headaches,” says Coombes, who suggests asking family members if they suffer from headaches, since migraines can be hereditary.