February 8, 2017

Migraine

Migraines are a type of recurring severe headache that can cause you to have time off work and need to rest in bed. They are often accompanied by feeling sick, vomiting or an increased sensitivity to light.

It’s estimated that about 36 million Americans suffer from migraine, but only 1 of every 3 people talk with a doctor about their headaches. Of those, only half get the right diagnosis.

Women are roughly three times more likely to get migraines than men. About four in every 20 women get migraines, while only about one in every 20 men do. You can get migraines for the first time at any age, but they commonly start during the teenage years.

In general, a migraine is a very bad headache that tends to come back. It may occur as often as several times a week or only once every few years. It can last anywhere from a few hours to 3 days. The pain usually begins in the morning, on one side of the head. (In fact, the word migraine is derived from a Greek word that means “half-head.”) Less frequently, the entire head is swallowed up by pain.

The amount of pain can vary. Some migraines can be fairly mild, while others seem almost unbearable. Obviously, the worse the pain, the more trouble you have carrying out daily activities, whether it’s going to work or simply getting out of bed. Of course, different people have different abilities to put up with pain. For some people, even a mild migraine can force them to lie down; others are able to work through a more severe migraine.

Two types of migraines

While there are many variations, there are two main types of migraines –

Migraine without aura (previously called common migraine) – Almost 80 percent of migraine sufferers have this type of migraine.

Migraine with aura (previously called classic migraine) – This type of migraine announces itself about a half-hour before the onset of head pain with an aura.

Aura is a term used to describe the visual or sensory symptoms that some people get when their migraine is starting. The following are less common types of migraine –

  • Retinal migraines are headaches associated with visual changes in one eye only.
  • Abdominal migraines are associated with stomach pains, and happen more often in children.
  • Menstrual migraines can happen in women two days before their period starts or finishes.
  • Status migrainosus are migraines that can last for a few weeks.

Migraine is a medical condition that can have a big effect on your life and others caring for you. It can affect your daily life and can mean taking time off work or school.

Causes

There are many theories that discuss the causes of migraine. The cortical spreading depression (CSD) theory suggests that migraine is a disease of the brain such as angina is a disease of the heart. Disruption of normal brain functioning is believed to be the underlying cause of the migraine pain and aura. Another theory is the vascular theory which suggests that migraines result from the widening of blood vessels surrounding the brain. The chemical serotonin is also thought to play an important role in migraine development. While the precise cause of migraines remains unknown, a number of potential migraine triggers (habits or conditions associated with the onset of a migraine) have been identified.

Some people who suffer from migraines can clearly identify triggers or factors that cause the headaches, but many cannot. Potential migraine triggers include –

  • Allergies and allergic reactions
  • Bright lights, loud noises, flickering lights, smoky rooms, temperature changes, strong smells and certain odors or perfumes
  • Physical or emotional stress, tension, anxiety, depression, excitement
  • Physical triggers such as tiredness, jet lag, exercise
  • Changes in sleep patterns or irregular sleep
  • Smoking or exposure to smoke
  • Skipping meals or fasting causing low blood sugar
  • Dehydration
  • Alcohol
  • Hormonal triggers such as menstrual cycle fluctuations, birth control pills, menopause
  • Tension headaches
  • Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs and salami)
  • Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products and fermented or pickled foods
  • Medication such as sleeping tablets, the contraceptive pill, hormone replacement therapy.
  • A higher percentage of obese people have episodic (occasional) migraines compared to individuals with a healthy body weight.
  • Sudden weather changes, including a drop in barometric pressure or changes in temperature, humidity, or wind
  • Loud noises
  • Perfumes or fumes
  • Secondhand smoke
  • Exposure to glare or flickering lights

Symptoms

Migraine symptoms may begin one to two days before the headache itself. This is known as the migraine’s prodrome stage. Symptoms include –

  • Food cravings
  • Depression
  • Fatigue or low energy
  • Frequent yawning
  • Hyperactivity
  • Irritability
  • Neck stiffness

Some people may also experience an aura after the prodrome stage. An aura causes visual, motor, and/or speech disturbances, such as –

  • Difficulty speaking clearly
  • Feeling a prickling or tingling sensation in the arms and legs
  • Flashes of light
  • Seeing shapes, light flashes or bright spots
  • Transient vision loss

The next phase is known as the attack phase. This is the most acute or severe of the phases when the actual migraine occurs. Attack phase symptoms can last anywhere from four hours to three days. Symptoms of a migraine can vary from person to person. Some symptoms may include –

  • Feeling dizzy or faint
  • Increased sensitivity to light and sound
  • Nausea
  • Pain on one side of the head
  • Pulsing and/or throbbing pain
  • Vomiting

Risk Factors

Family history – You are much more likely to have migraines if one or both of your parents had migraines.

Sex – Women are more likely than men to have migraines.

Age – Most people have their first migraine during adolescence, but migraines can start at any age, usually before age 40.

Treatment 

Medications

Analgesia – Over-the-counter medications such as naproxen, ibuprofen, acetaminophen (paracetamol), and other analgesics like Excedrin (aspirin with caffeine) are often the first abortive therapies to eliminate the headache or substantially reduce pain.

Anti-emetics – Metoclopramide may also be used to control symptoms such as nausea and vomiting.

Serotonin agonists – Sumatriptan may also be prescribed for severe migraines or for migraines that are not responding to the over-the-counter medications. Antidepressants such as tricyclics – are prescribed to reduce migraine symptoms although they are not approved in all countries for this purpose.

Ergots – Another class of abortive treatments is called ergots, which are usually effective if administered at the first sign of a migraine.

Alternative Treatment

5-hydroxytryptophan – Body makes the amino acid 5-HTP and converts it into serotonin, an important brain chemical. Researchers think abnormal serotonin function in blood vessels may be related to migraines, and some of the drugs used to treat migraines work by affecting serotonin.

Magnesium – People with migraines often have lower levels of magnesium than people who do not have migraines, and several studies suggest that magnesium may reduce the frequency of migraine attacks in people with low levels of magnesium.

Vitamin B2 – A few studies indicate that riboflavin may reduce the frequency and duration of migraines. In one study, people who took riboflavin had more than a 50% decrease in the number of attacks.

Coenzyme Q10 – CoQ10 can interact with several medications including blood thinners such as warfarin (Coumadin), some cancer medications, and medications for high blood pressure.

Melatonin – Melatonin can interact with a number of medications, so ask your doctor before taking it.

Butterbur – A few studies suggest that butterbur may help reduce both the frequency and duration of migraine attacks when taken on a regular basis for up to 4 months. More research is needed to see whether butterbur is really effective at preventing migraines.

Feverfew – Feverfew has been used traditionally to treat headaches, and several well-designed studies have found that it may help prevent and treat migraines.

Acupuncture has been studied as a treatment for migraine headache for more than 20 years. While not all studies have shown it helps, researchers agree that acupuncture appears safe, and may work for some people.

Chiropractic – In another study, people with migraine headaches were randomly assigned to receive spinal manipulation, a daily medication (Elavil), or a combination of both. Spinal manipulation worked as well as Elavil in reducing migraines and had fewer side effects. Combining the 2 therapies didn’t work any better.

Reflexology is a technique that places pressure on specific “reflex points” on the hands and feet that are believed to correspond to areas throughout the body. Some early studies suggest it may relieve pain and allow people with migraines to take less pain medication.

 

Reference –

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/headache-migraine

http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/treatment/con-20026358

http://www.medicinenet.com/migraine/article.htm

http://www.migraine.org.uk/get-involved/events

https://www.acponline.org/patients_families/pdfs/health/migraine.pdf

http://familydoctor.org/familydoctor/en/diseases-conditions/migraines.html

http://www.migraines.org/myth/mythreal.htm

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/headache-migraine

 

 

 

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August 4, 2010

Migraine

Headaches are extremely common, affecting nearly 100% of Americans at some time in their lives. Anyone who has recurrent headaches should suspect possible migraines; an estimated 28 million Americans suffer from migraines, but many are never diagnosed. Migraine headaches are characterized by recurrence, and some of the following symptoms, at least some of the time: involvement of one side of the head, throbbing, moderate to severe intensity, worsening of the throbbing and severity with activity and with bending forward or valsalva maneuver (compression of the abdominal muscles as in lifting or expelling a bowel movement), sensitivity to light and/or loud noise, nausea/vomiting, association with hormonal changes in women (especially around the time of menses), triggering by certain foods, and there is often a family history of migraine.

About 15% of migraine sufferers will sometimes experience an aura, usually around the onset of the headache; auras typically involve transient loss of part of one’s vision due to flashing lights, an expanding blind spot, or loss of vision in the left or right visual field, experienced in both eyes. Less frequently, an aura can cause brief numbness or even weakness of one side of the face or body. The duration of a migraine headache is typically one to several hours to three days, and a refractory migraine can last much longer.

If your headaches are migraines, it is important that you know this, because migraine, particularly with aura, can cause stroke. Those who develop migraines with aura late in life are at six-fold risk of having a stroke, compared with the rest of the population. Additionally, migraineurs have a highter incidence of epilepsy, depression, anxiety, panic attacks, and elevated homocysteine (a protein associated with inadequate utilization of the B vitamins folic acide, B12, and B6; if elevated, you have increased risks of myocardial infarction, stroke, and other disease).

The brain processes underlying an acute migraine headache include local inflammation, reduced energy production, low levels of ionic magnesium, and high levels of the amino acid glutamate. MRI spectroscopy reveals that migraineurs have lower brain levels of magnesium than do nonmigraineurs. Glutamate is a problem because it is your brain’s primary excitatory neurotransmitter, and in excess, it is able to overexcite neurons to the point that they die. (This process has been well established as the reason that an acute stroke typically involves a larger territory than would be expected, based on the size of the vascular territory that is compromised.) You are able to modify all the causative factors in migraine. Dietary changes can reduce inflammation, increase energy productions and magnesium, and lower levels of glutamate. Many sufferers have eliminated migraines simply by changing from a typical American diet to a more wholesome diet, devoid of processed foods and rich in leafy greens and other vegetables, berries, nuts, seeds, and wholesome animal products (eg grass fed or wild meats and eggs, wild fish). Such foods supply ample magnesium and B vitamins (which are needed for energy production) and reduce inflammation and glutamate. It is very important for any migraine patient to avoid dietary sources of glutamate and aspartate; in the high doeses absorbed from foods, both these neurotoxic substances can kill your brain cells! Both glutamate and aspartate are heavily used in many processed foods and their presence is disguised by euphemisms.

In my extensive experience as a neurologist, providing a well-absorbed form of magnesium, over time, greatly reduces the number and severity of migraines. One can also abort an acute migraine attack by taking a high enough dose of well-absorbed magnesium, such as powdered or liquid magnesium malate/citrate or a chelated magnesium. Intravenous magnesium sulfate has been shown, in many studies, to be a very effective intervention for acute migraine, stopping the headache in up to 80% of patients. Magnesium Sulfate can be equally effective when taken sublingually.

For prevention of migraines, use magnesium as above. Riboflavin (vitamin B-2) in doses up to 400 mg per day, coupled with COQ10, at 200-300 mg up to three times a day, has reduced the number of headache days by 50% in one study. All antioxidants and natural antiinflammatories reduce migraine severity and may also reduce the number of attacks. These include vitamin C, natural vitamin E (mixed tocopherols), curcumin plus quercetin, omega-3 fatty acids, and silymarin. Getting sufficient sleep is also important in migraine prevention, and both sleep and migraine control may be aided by nightly melatonin (a powerful natural brain antioxidant) in doses from 0.5 up to 9 mg.

At the Center for Occupational and Environmental Medicine we classify migraines as a cranial neuronitis, which also includes Bells Palsy, Meniere’s Syndrome, (vertigo, tinnitus, nausea, vomiting) and Globus (lump in throat sensation). The importance is that all of these conditions may be caused by the Herepes Simplex Virus, which we have learned to turn off with one of our molecular signals.

When we combine the viral signal with Histamine and Serotonin the treatment becomes even more effective. By rushing a series of 4 separate drops under the tongue most migraines can be turned off. For patients with recurrent migraines taking one drop twice a day often prevents the headaches.

Also, remember that most migraines may be triggered by foods. If you or your loved ones suffe from migraine, schedule an appointment and let us help.

To your health,
Carol E. Benoit, D.O.
The Center for Occupational and Environmental Medicine

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