When migraines attack
Local physician assistant discusses headache treatment
MARQUETTE — There are headaches, and then there are headaches.
Count migraines in that second category.
Migraine is a genetic neurological disease, characterized by episodes often called migraine attacks, according to migraine.com. Some migraines cause pain on just the right or left side of the head, while others result in pain all over.
If attack is a strong word, consider what people afflicted with them suffer.
Migraines can be debilitating, with sufferers having moderate or severe pain and usually not being able to participate in normal activities because of the pain.
Physician assistant Bonnie Kilpela talked about these insidious headaches Wednesday at the monthly “Meet the Physicians” presentation held by UP Health System-Marquette at the Peter White Public Library.
Kilpela works for neurologist Dr. Thomas Schmidt at UPHS.
“I really love treating headaches,” Kilpela said. “I love treating everything, but headaches are very much something I like to treat because I feel like there’s definitely treatment and there’s definitely rewards to helping people.”
In the United States, more than 30 million people suffer from migraines, which is huge, she said. Of those people, more than 75 percent are women.
“Basically, that is really having a big impact on our workforce and it’s costing about $13 billion every year,” Kilpela said.
Many sufferers start getting migraines between ages 12 and 17 and have them throughout their entire lives, she said, and often their health care providers tell them they simply just have headaches.
Then nothing gets done, and they continue to suffer.
And unfortunately, unlike other disorders, migraine attacks occur over and over.
Kilpela also said there’s no specific reason why one person gets migraines while another isn’t affected.
“We know it’s chemical,” Kilpela said. “We know it’s mechanical, and we know it’s electrical, and that’s why when we treat it, we treat it from many different modalities.”
Pre-headache conditions vary, she said, and they include sensitivity to light, sound and odors; sleepiness; fatigue; food cravings; dizziness; tingling on one side of the face; depression; excessive thirst; constipation; and diarrhea.
Another is an aura, which she noted can be a flashing light or even a change in vision.
“This tells a lot of people: ‘Uh-oh, I’m going to get the headache,'” Kilpela said.
Migraines do come with a certain set of diagnostic criteria, Schmidt said.
“It’s an interesting constellation of symptoms that people get,” said Schmidt, whose approach begins with identifying triggers. “It varies from person to person.”
Triggers can be as individualistic as the person getting the migraine — and there are many triggers, Kilpela said. They can be medications, menstrual periods, a stressful situation, too much or too little sleep, medications, smoking, bright lights, weather changes and strong odors.
“You want to avoid whatever your triggers are,” Kilpela said.
That’s understandable, considering most of not all sufferers would rather avoid the pain to begin with.
She said prevention is at the top of the list for dealing with migraines.
Over-the-counter items with acetaminophen are used, although too much of that substance can affect the kidney and liver, she said. Aspirin too can result in stomach ulcers if overused, with ibuprofen connected with heart disease and stroke.
Kilpela cautioned that these items can result in rebound headaches.
“When you take something everyday, that headache is just going to keep coming back until you stop using whatever you’re taking,” Kilpela said.
Magnesium is an OTC item that could help, she said, while drinking plenty of water is another way to combat migraines, with a guideline of half an ounce of water for each pound of weight.
Lifestyle changes too can be good proactive measures, and they include eating healthy with protein, practicing good sleep hygiene and getting a lot of exercise to produce endorphins, which she noted is the only way the body copes with stress in a natural way.
Stopping the headache involves different methods, one of which is the use of a class of drugs called Triptans. However, Kilpela acknowledged they carry risks and aren’t for people who have had a heart attack or stroke.
Oral medications are other options, she said.
She and Schmidt plan to use sphenopalatine ganglion blocks, which involve inserting small catheters into patients’ noses and injecting Lidocaine Viscous. The minimally invasive procedure is needle-less and is not used near the brain, she said.
Migraine frequency is another issue.
“If you have greater than two a month, we usually like to try and prevent them, especially if their duration is greater than 24 hours because that means you’re losing four days a month or whatever it is, and that’s significant for people, especially if it’s causing problems with their job or their social life or even life in general,” Kilpela said.
Botox shots are for patients who typically have at least 15 headache days per month and for whom at least three preventive medications have failed, she said. The Botox treatment cycle is every 12 weeks, and side effects go away within three months.
Tinted sunglasses also are available for people with migraines, so Kilpela suggested patients ask their ophthalmologists or optometrists about these special items.
One of her patients, in fact, was having severe head pain following a motor vehicle accident.
“We got it to go away completely after we did the glasses,” Kilpela said.
When meeting a patient, Kilpela said she asks a lot of questions to get an idea of red flags and triggers, with imaging not always needed. However, a full neurological workup is performed.
“What is the best thing for this person in terms of — is it related to this or is it related to that, or what would be the best thing?” Kilpela said.
Whatever the treatment, Kilpela wants to understand the individual patient.
“A lot of times people feel like, ‘I’ve had headaches, and everybody’s just been ignoring me all these years,'” Kilpela said.
For more information, call the Brain & Spine Center at UPHS-Marquette at 906-225-3993.
Christie Bleck can be reached at 906-228-2500, ext. 250. Her email address is firstname.lastname@example.org.